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Acne

A Guide to Understanding Acne and Sensitive Skin

Treating acne can be a difficult and frustrating process, especially if you have sensitive skin.

The good news is that some products are suitable and effective for acne and sensitive skin. 

At Nava MD, we know how challenging it can be to find acne treatments that don’t cause irritation or worsen existing breakouts on sensitive skin. 

In this article, we outline the causes of acne and how to determine if you have sensitive skin. We also discuss some of the best things to do to combat acne, and share a list of ingredients you should avoid if you have sensitive skin. 

Summary

  • Start with low concentrations of ingredients like salicylic acid, azelaic acid, niacinamide, retinoids, sulfur, and benzoyl peroxide.
  • Sensitive skin often requires some testing to find the right formulations that won't cause your skin to flare-up.
  • Avoid products containing alcohols and comedogenic ingredients, which can actively clog pores and cause irritation.

How to Determine If You Have Sensitive Skin

People with sensitive skin often have a lower tolerance for over-the-counter (OTC) acne treatments and cosmetic products. 

This is because the building blocks of the skin— these lipids, cells, and enzymes—are often weaker or simply more prone to inflammation in people who have sensitive skin. 

Not only does this result in the skin’s natural barrier being prone to external damage, but it also means that the skin may take longer to repair itself. Some of the most common symptoms of sensitive skin include: 

  • Redness
  • Itchiness or prickling sensations
  • Skin tightness

What Causes Acne?

Acne is a skin condition that occurs when your pores become clogged with excess oil and dead skin cells. It affects nearly 50 million Americans.

While acne is usually non-inflammatory and mild, many people can also experience severe acne if their pores become infected.

Before you start an acne treatment, it’s important to know which factors can cause a breakout. Although acne is commonly caused by lifestyle and hormonal factors, it can also be attributed to excess sebum production and bacterial infections. 

Excess Sebum Production

Sebum is a naturally occurring mixture of oil, fatty acids, and waxes produced by your body’s sebaceous glands. 

Although sebum protects and moisturizes the skin, it can clog pores and cause acne to develop when it’s produced in excessive amounts. 

When excess sebum combines with dead skin cells, blackheads and pimples begin to form. If these blemishes are not treated, they can become more severe and inflamed. 

Bacterial Infections

Bacteria on the skin can also get trapped inside your pores and cause existing acne to become infected.

This is most commonly caused by Propionibacterium acnes (P. acnes). This bacteria can also cause acne to become inflamed and painful to the touch. 

Types of Acne

Before you can choose products that will treat your acne, you first need to identify the type of breakout that you’re experiencing. This will help ensure that you choose the right treatment plan for your skin’s needs and sensitivities. 

There are two main types of acne that develop on sensitive skin, namely inflammatory and non-inflammatory acne. 

Non-inflammatory Acne

This type of acne is mainly the result of clogged pores and generally doesn’t cause discomfort or scarring. 

Comedonal acne is one of the most common forms of non-inflammatory breakouts. It typically presents in the form of whiteheads and blackheads.

Whiteheads

Blackheads

These are small blemishes that have a white or yellowish appearance.

Blackheads are small bumps on the skin that have a dark or black surface. 

Whiteheads develop when pores become clogged with excess oil and dead skin cells. 

These blemishes develop when hair follicles and pores become clogged. 

These blemishes cause pores to stay closed, which gives them a white or yellow appearance.

When the skin around the blemish opens, it turns black by interacting with oxygen in the air, forming a blackhead. if the skin doesn’t open, the spot remains a whitehead. 

Non-inflammatory acne can develop due to factors like:

  • Dietary sensitivities to dairy, fats, or sugars
  • Overly hydrated skin
  • Environmental factors, like high humidity
  • Chemical peels
  • Irritated skin from picking at blemishes
  • Smoking

Although comedonal acne can be treated with over-the-counter (OTC) treatments, it often requires stronger prescription treatments if the breakout doesn’t clear. 

Inflammatory Acne

These blemishes develop when the skin’s pores become infected with bacteria and may result in scarring. Inflammatory acne can either be mild to moderate or severe. 

Mild-To-Moderate Inflammatory Acne

This is similar to a comedonal breakout but can also result in inflamed blemishes called papules, pustules, and nodules.

The number of blemishes will vary depending on the severity of the acne infection.

Although papules look similar to whiteheads, they often have a pink or red appearance. These blemishes develop when clogged pores become infected with harmful bacteria.

Pustules, on the other hand, contain yellow or white pus that can be seen on the surface of the skin.

These blemishes are often mistaken for whiteheads. However, you can tell the difference if the skin around the blemish is red and painful to the touch. 

If this is the case, you’re dealing with pustules.

Nodules are typically found in more moderate inflammatory acne breakouts. These are large, red bumps that develop below the skin’s surface and are often painful.

Mild-to-moderate inflammatory acne is typically caused by:

  • Excess sebum production. 
  • Lifestyle factors like stress and a poor diet.
  • Comedogenic products that clog pores.
  • Hormonal changes.

A dermatologist will often prescribe topical antibiotics and OTC products to treat mild-to-moderate inflammatory acne. 

Severe Inflammatory Acne

Not only does severe inflammatory acne include the blemishes we’ve mentioned above, but it can also result in the formation of cysts.

These are large, pus-filled bumps that develop beneath the skin and are also painful to touch. 

This type of acne can typically last for months and is difficult to get rid of completely. Severe acne can also cause swelling and scarring. It’s caused by a range of factors, including:

  • Hormonal changes
  • Genetics
  • Stress
  • Menopause

Severe inflammatory breakouts are usually diagnosed by a dermatologist and treated with prescription acne medication.

Topical creams and cleansers are also prescribed with acne medications to improve the appearance of the skin. 

How to Improve an Acne Breakout

While developing acne is often out of our control, there are a few things you can do to help minimize a breakout.

Lifestyle Changes

Mild and severe acne are sometimes caused by lifestyle factors such as stress, smoking, and poor diet.

Sensitive skin is often more prone to these kinds of damages, which is why it’s important to stay hydrated and choose healthy foods and lifestyle habits. 

The nicotine in cigarettes is also damaging to the skin. Nicotine causes blood vessels to narrow. This results in reduced oxygen, blood flow, and nutrients reaching the skin—three things the skin needs to keep it firm and healthy. 

To avoid this damage, dermatologists often advise people who smoke and suffer from acne to stop using nicotine products to improve their skin.

Although our stress levels are often beyond our control, incorporating regular exercise into your daily routine and ensuring you get enough sleep can improve your skin, too.

This is because the skin repairs itself most effectively at night when it's away from environmental pollutants and UV radiation. 

Introduce New Products Slowly

People with sensitive skin should be extra cautious when they introduce a new product into their daily routine. 

This is why we recommend gradually introducing new acne treatment products to your skincare routine by using them every second or third day at first. 

If no irritation occurs after a few weeks, you can gradually start using the product more regularly. 

This will also help you identify which products irritate your skin and give you time to find an alternative before a breakout becomes worse. 

Choose the Correct Ingredients

If you have sensitive skin, it can be challenging to know which ingredients will clear an acne breakout and not cause irritation or redness. 

This is why you’ll want to look for products with ingredients that are antibacterial and anti-inflammatory. 

Not only will this help reduce any pain or swelling around the breakout, but it will also prevent the blemishes from becoming infected. 

You should also try to avoid harsh exfoliating cleansers and products that contain alcohol.

Let’s take a closer look at some of the best (and worst) ingredients for treating sensitive acne-prone skin.

The Best Ingredients to Treat Sensitive Skin with Acne

Salicylic Acid

Salicylic acid is an anti-inflammatory exfoliant that:

  • Removes dead skin cells
  • Reduces excess oil production
  • Combats breakouts

It’s a great acne treatment option for people who experience non-inflammatory breakouts and are struggling with whiteheads and blackheads.

Salicylic acid dissolves oil and dead skin cells that clog pores to revitalize the skin and prevent pimples from forming. 

For people with sensitive skin, it’s recommended to use products with a 0.5% concentration of salicylic acid to avoid any irritation. 

Nava MD’s Top Tip:

There are many ways to use salicylic acid if you have acne-prone and sensitive skin. 

For example, serums or gels with salicylic acid can be used as a spot treatment to dry out pimples.

If the product is only applied to the blemish, it’s unlikely to cause a negative reaction.

Azelaic Acid

Azelaic acid is a good option for people with sensitive skin because it’s often prescribed as an alternative to Accutane, a popular acne-fighting medication.

This is because azelaic acid is less potent than Accutane and causes fewer adverse reactions while clearing a breakout. 

As a topical exfoliant, azelaic acid can treat acne by:

  • Fighting inflammation caused by bacterial infections.
  • Improving the appearance of post-acne scarring and hyperpigmentation.
  • Killing infectious bacteria.
  • Preventing new infections.

Nava MD’s Top Tip:

Although azelaic acid is a good option for people with sensitive skin, cleansers that contain this ingredient may cause over-exfoliation which could result in dryness or peeling.

That's why we recommend using an azelaic acid gel, cream, or lotion to minimize the risk of negative reactions.

Clindamycin

Clindamycin is a topical antibiotic treatment that helps prevent acne by:

  • Reducing bacterial infections
  • Decreasing inflammation
  • Preventing bacterial growth

If you experience a severe breakout, clindamycin also decreases inflammation and makes acne less painful to the touch.

Clindamycin is generally well-tolerated, making it one of the best treatments for acne-prone and sensitive skin. It can, however,  cause some irritation, so it’s helpful to use a low concentration and incorporate it into your routine gradually.

Research shows that a 1% concentration of clindamycin is the most beneficial for reducing acne and breakouts.

Nava MD’s Top Tip:

Unlike salicylic acid spot treatments, clindamycin is most effective when applied to the entire acne-affected area.

Clindamycin is formulated to target existing breakouts and prevent future infections by removing bacteria across the face. 

When used as a spot treatment, it can only treat the infected blemish and may be less effective.

Niacinamide 

Niacinamide is a vitamin B3 derivative and a great ingredient for:

  • Fighting inflammation
  • Reducing hyperpigmentation and acne scarring
  • Boosting the skin’s moisture levels

Keeping the skin hydrated helps repair damage from environmental pollutants and prevents acne breakouts. Niacinamide is also a great treatment option for people with acne and sensitive skin since it’s non-irritating and helps to soothe skin. 

Nava MD’s Top Tip:

When shopping for a product that contains niacinamide, it’s often recommended that you start with a maximum concentration of 5%.

People with sensitive and acne-prone skin should gradually build up to a higher concentration as their skin adjusts to the ingredient. 

This will ensure that you minimize the risk of potential adverse reactions.

Retinoids

As vitamin A derivatives, retinoids are popular ingredients in acne-fighting products. Here are a few reasons why: 

  • Retinoids increase the production of new and healthy cells
  • They have anti-inflammatory properties
  • Retinoids improve the appearance of acne scars

Although retinoids can be too potent for sensitive acne-prone skin, negative side effects can be avoided if used correctly.

Dermatologists often recommend starting with a lower dose of retinoid products—such as a 0.2–0.5% concentration depending on the type—and gradually incorporating it into your skincare routine. 

Once your skin has built up a tolerance to the retinoid product, you can start to use it more regularly. 

Nava MD’s Top Tip:

Vitamin A loses its effectiveness when it's exposed to UV radiation. In fact, sunlight breaks the ingredient down and causes it to become unstable.

This is why it’s recommended that you incorporate retinoids into your nighttime skincare routine to get the most out of the product. 

Sulfur

Sulfur-based products are also effective treatments for acne-prone skin. This is because they can: 

  • Absorb excess oil
  • Decrease inflamed acne lesions
  • Fight whiteheads and blackheads

It also helps to remove dead skin cells and unclog pores. 

Sulfur works to exfoliate the skin without drying or irritating it, making it a good treatment option for people with acne-prone and sensitive skin. 

This ensures that the skin’s natural moisture barrier is not overstripped, while also reducing bacterial infections and acne breakouts. 

Nava MD’s Top Product Tip:

A sulfur clay mask draws out impurities without causing irritation for most people. It also clears your skin by absorbing excess oil from clogged pores.

This can also be used as a spot treatment to dry active blemishes and remove dirt from the pore. 

Benzoyl Peroxide 

Benzoyl peroxide is a great treatment option for severe inflammatory acne, as well as cysts and nodules because it: 

  • Kills bacteria that cause infection, pain, and inflammation
  • Unclogs pores
  • Removes dead skin cells
  • Absorbs excess oil

Products containing a small amount of benzoyl peroxide—ranging from 0.05%–2%—are best to treat acne in people with sensitive skin.

This concentration is effective enough to fight acne but mild enough for people with sensitive skin to use without it irritating their skin too much.

We recommend only using a benzoyl peroxide cream or lotion as an acne treatment. A cleanser may be too harsh.

Nava MD’s Top Tip:

To further minimize the risk of causing skin irritation, look for a lotion that combines benzoyl peroxide with soothing ingredients like niacinamide or aloe vera.

Both of these ingredients work well with benzoyl peroxide because they can help calm any redness or irritation that may develop. 

Ingredients to Avoid If You Have Sensitive Skin 

Alcohol-Based Products

To absorb excess oil, many serums and toners use alcohol-based ingredients like ethanol in their formulations. While this may work for some skin types, alcohol can be damaging for sensitive and acne-prone skin because it can dry out the skin. 

This often results in the skin becoming red, flaky, itchy, or painful to the touch. 

Comedogenic Ingredients

Products that contain comedogenic ingredients are known to cause clogged pores because the skin is unable to fully absorb the formulation.

One common example of a comedogenic ingredient is isopropyl palmitate. It can deprive the skin of oxygen, leading to clogged pores and dry skin. 

Other examples of comedogenic ingredients include coconut oil and cocoa butter, both of which contain lauric acid.

Not only does lauric acid also clog pores, but it can also cause irritation on skin that’s already susceptible to inflammation.

The Bottom Line

Treating acne-prone skin is often a tricky and frustrating process made harder by having sensitive skin.

Luckily, Nava MD makes it easy to get the best skincare advice and products with the help of a board-certified dermatologist. 

After an online consultation, our clinicians can prescribe the right products for your skin’s needs and sensitivities—all from the comfort of your own home.

Our acne treatments are formulated with ingredients that are proven to combat acne breakouts and soothe sensitive skin, like clindamycin, azelaic acid, and niacinamide.

Take our free online skin consultation and start your journey to acne-free skin today.