The Role of Skin Care in Optimizing Treatment of Acne and Rosacea

Catherine Zip, MD, FRCPC


Skin Therapy Letter. 2017;22(3) 

In This Article


Acne vulgaris is the most common skin disease seen in dermatology office practice. Optimal management includes, in addition to selection of an appropriate therapeutic regimen, patient education and integration of proper skin care. Providing instructions on skin care and cosmetics to female acne patients improves quality of life compared to patients to whom no instructions are given.[1]

Acne is associated with impaired epidermal barrier function.[2] Decreased stratum corneum hydration and reduced free sphingosine and total ceramide, indicative of an impaired stratum corneum intercellular lipid membrane, has been demonstrated in patients with acne. Although sebum excretion is increased in acne patients, alteration in the lipid composition of acne skin may further impair barrier function. Moreover, medications used to treat acne can alter stratum corneum integrity and function. An increase in transepidermal water loss has been shown with use of benzoyl peroxide, likely due to damage to the stratum corneum.[3] Treatment with topical retinoids results in enhanced desquamation, reducing stratum corneum thickness and function. Use of appropriate skin care products in patients being treated for acne has been shown to increase adherence to pharmacological treatment and improve treatment outcomes.[4]


Although the majority of acne patients believe that suboptimal skin care and dirt on the skin contribute to acne,[5] there are little scientific data to guide our recommendations regarding cleansing of acne prone skin.

The optimal frequency of cleansing is unclear, but most dermatologists recommend twice daily washing with a mild cleanser. One small study of males with mild to moderate acne compared the effect of face washing with a gentle cleanser once, twice or four times daily on acne severity.[6] Although no statistically significant differences were noted between the groups, significant improvement in both open comedones and total inflammatory lesions were seen in the group washing twice daily. Worsening of acne was observed in the study group who washed once a day, whereas washing four times daily did not adversely affect acne severity.

Although more frequent facial cleansing may not aggravate acne, aggressive scrubbing of the involved areas should be avoided to prevent irritation and trauma to underlying comedones, leading to increased inflammation.


As acne prone skin is associated with epidermal barrier dysfunction which can be aggravated by acne medications, regular use of an emollient is an importance part of acne therapy. Use of a noncomedogenic and nonacnegenic moisturizer is typically recommended. However, due to difficulties in testing for both comedogenicity and acnegenicity, including variability in individual patient susceptibility to acne formation, ensuring that a product will not trigger acne in a particular patient can be difficult.[7]

Sun Protection

Sun protection should also be recommended to acne patients.[8] A systemic review found no convincing evidence that natural sunlight improves acne, although such studies are inherently difficult to conduct.[9] Several oral acne treatments, including doxycycline and isotretinoin, are potentially photosensitizing.[10] The US Food and Drug Administration official labelling for medications containing benzoyl peroxide and topical retinoids advises sun avoidance,[11,12] although no effect on ultraviolet Binduced erythema was shown with use of either benzoyl peroxide or adapalene in one study.[13] In addition to providing sun protection, the emollient component of the sunscreen may improve epidermal barrier function. Finally, sun protective measures may prevent or minimize postinflammatory hyperpigmentation, particularly in patients with higher skin types.[14]