Whether you are a teenage girl or an adult woman, acne does not discriminate—nor is it any easier to clear up. For many women, just when we think we have finally left pimples in the past, peri-menopause begins…and with the hormonal flares, the pimples return. (It usually stops again after menopause, but breakouts can still occur from other factors that I talk about below.) Breakouts can affect your confidence, mood and overall outlook. There are many topical product choices available when it comes to treating acne, but I believe that the key is a whole-person approach in balancing the bacteria, hormones and oil secretions that cause the acne breakouts.

The obvious place to begin is with a skincare routine that incorporates cleansing, exfoliation, bacterial control and nutrients to support healthy skin turnover and oil control. The regimen will need to be tailored to suit the person, but my basic approach includes the following every morning and evening…

Step 1: Cleanser. The face must be cleansed in the morning and evening using a cleanser that contains mild alpha hydroxy acids (AHAs). Why? AHAs, such as glycolic acid, loosen cellular debris and clear the pores, helping to stop pimples from forming. When included in a cleanser, they are in low concentrations so they clean without irritating or stimulating excess oil production.

Step 2: Toner. For oily or acne-prone skin, I am a big fan of toner. I especially like those that include some mild AHAs and antioxidants. The idea here is to remove excess oil and deeply clean the pores to allow for better nutrient penetration. You might think that if you have AHA in your cleanser you don’t need it in your toner, but I believe you need both. I have very sensitive skin, and this regimen does not irritate or dry my skin. The antioxidants offer free radical protection. (There’s no connection between free radicals and acne, but protecting against free radicals will keep your skin looking younger). Choose a witch hazel-based toner with 1% glycolic and some moisture (we use hazelnut and aloe in our products). You want to feel clean and supple, not dry and tight after using a good toner.

Step 3: Vitamin A. Anyone who reads my blogs knows how passionate I am about getting your daily nutrients for your skin like healthy fats and probiotics. Vitamin A is crucial to acne management because it encourages cell turnover. Without cell turnover, debris and bacteria settle in and form pimples. If you can find a serum with some light moisturizing agent in it, such as aloe, that is a good choice—and you can skip the moisturizer step.

Step 4: Exfoliate. Weekly (not daily!), exfoliate with an enzymatic exfoliator like a fruit enzyme-based product with bromelain (from pineapple) and papain (from papaya). Like topical vitamin A, exfoliating keeps those skin cells turning over. Include this step in your weekly routine after cleansing for a more intense exfoliation.

Topical skincare is only part of the solution. What you put inside of your body and how you rest and deal with stress are equally important…

  • Keep inflammation in check. An anti-inflammatory diet with a good balance of omega 3 to omega 6 fats is critical. Be sure to include plenty of fatty fish like salmon and/or plant sources of omega 3 fatty acids like milled flax seeds and walnuts. Limit fried foods and baked cookies and crackers, which contain high amounts of omega 6 fatty acids.
  • Eat your veggies and fruits. Large amount of green vegetables not only provide much-needed B and C vitamins, but also are detoxifying and anti-inflammatory. Aim for five to seven servings per day, with a focus on eating a rainbow of colors to ensure that you get a variety of phytonutrients.
  • Feed your flora. Your GI tract and skin are both lined with healthy bacteria that help fight off unhealthy bacteria and maintain overall immunity. When your gut flora are imbalanced you will see it on your skin. Fermented foods like yogurt, kefir, kimchi, sauerkraut and miso are great natural sources of probiotics (healthy bacteria). People with acne, especially those who have taken antibiotics for years, have compromised gut flora and may need a probiotic supplement in addition to regular intake of fermented foods.
  • Skip the sugar. Sugar and refined carbs are not your partners in good health in general…and if you are prone towards acne, they can be especially detrimental to your skin. Strictly limit or completely avoid refined sugar and refined carbs (for example, anything made with white flour), which create AGEs—advanced glycation-end products. These AGEs damage collagen and elastin and lead to premature skin aging, including wrinkles.
  • Hydrate. Drink plenty of filtered tap or mineral water to flush out toxins and give your cells the hydration they require. Limit alcohol, caffeine and sugar-sweetened beverages.

The final piece of the whole-person approach involves your lifestyle choices. There are many choices you make in your daily living that can cause acne to flare. Consider the following changes to your daily routine:

  • Stomp out stress. Stress causes your body to produce more cortisol, a hormone that can wreak havoc on your skin and increase overall inflammation in your body. Take time for you every day. It could be yoga, meditation or just laughing with friends. Don’t let your worries control you, but rather take control of your thinking around your worries.
  • Get your zzzz’s. Inadequate sleep also raises cortisol and leads to cravings for unhealthy foods as the body craves the quick glucose spike of refined carbs to increase energy. Stick to a regular sleep schedule—even on the weekends. Equally as important, keep electronics out of the bedroom and make your bed a place for intimacy and rest, not work.
  • Keep germs off your face. You probably don’t even realize how many germs, dirt and oil you add to your face during the day from unexpected places. Clean phones and keyboards daily with an alcohol wipe. Change your pillow case daily (yes, I said daily!). Choose a fragrance free, eco-friendly laundry detergent for bedding and towels. Keep your hands off your face too. This one is hard. We unconsciously touch our faces many times during the day. At the very least, keep hands clean by washing several times per day to avoid transferring bacteria to your sensitive skin.

Acne is a skin condition that affects us both mentally and physically. Try taking a whole-person approach to managing your acne…and let me know how it works for you.

Click here to read Ginger Hodulik Downey’s book The Esthetician’s Guide to Outstanding Esthetics.