Professional acne treatments and lifestyle changes will make the client’s efforts successful. There are many factors that support the clearing process and help maintain results. An anti-acne lifestyle plan will help reduce future breakouts but will not take the place of using the proper homecare products the right way. Homecare regimens work best when they are non-comedogenic and include a product like benzoyl peroxide, which kills bacteria and dislodges comedones, along with one or two products to fade dark spots, brighten skin tone, reduce scarring, unclog pores, and smooth out rough texture. These include mandelic, lactic, and glycolic acids, salicylic acid, alpha and beta hydroxy acid blends, skin brighteners, and active vitamin A. Clients should also use a non-drying cleansing routine, sheer, zinc-based sunscreen and a light moisturizer to combat daytime dryness.

HOMECARE PRACTICES
Homecare products should be used exactly as directed. Instruct clients not to overuse or underuse their homecare products. Overuse causes drying of the surface layers and rebound oiliness at the same time. A thickened, dead-cell layer from product overuse can also trap comedones under the skin and prolong the clearing process. Inconsistent use will interfere with the clearing process and make it difficult to stay clear. Periodic guidance and support from a knowledgeable skin care professional, one who specializes in acne, is key to monitoring the client’s product use.

Regular Use
Advise clients not to slack on homecare once their acne has cleared. Although the client might stay clear for a while, skipping active homecare will allow microcomedones to form deep in the pores, causing more breakouts and leading to more scarring, dark spots, and/or red blemishes.

Planning Ahead
Homecare products should be refilled before they are empty. Clients should also consider stocking up before they go out of town. Advise clients not to stop their acne homecare regimen if they run out of one or two products.

Exfoliation
Clients should also avoid scrubbing off dead skin cells. Washcloths, spa gloves, abrasive scrubs, brushes, buffing pads, alcohol-based astringents, and rubbing with a towel can cause over-exfoliation, irritation, darkening, dead skin buildup, more flaking, and can inflame existing acne.

Safe Sun Practices
Clients should also use a non-comedogenic sunscreen every day and reduce sun exposure. Sunscreen should be reapplied often when the client is exposed to direct sunlight, including overcast skies, and while driving. Sunscreen use reduces the risk of sun damage and skin cancer and helps to keep dark spots, red blemishes, and blotchy skin tone from worsening. As some active, acne products can increase sun sensitivity, clients should be made aware of the ingredients that can cause photosensitivity.

LIFESTYLE CHANGES
Stress
Reducing stress is a must. Clients should do whatever it takes to remain stress free. Stress is a major acne culprit that is caused by the wear and tear of daily living, a lack of sleep, and changes that take place in the client’s life, both good and bad.

Adequate Sleep
Clients should also try to sleep at least seven hours per night on a consistent basis. Broken sleep for any reason, such as crossing time zones, night shift work, sleeping with infants or small children, and mid-life hormonal changes, can lead to severe physical stress, making it harder to clear acne. Sleep deprivation acts on various hormonal mechanisms that can worsen acne and cause other health problems.

Laundry
Advise clients to use laundry products that are free of perfumes and dyes. Fabric softeners and dryer sheets should be skipped because they leave a waxy residue that can clog pores. Clients should look for white containers that say free and clear, free of perfume and dyes, or free and gentle. Clorox 2 for Colors Free & Clear is a safe option for bleach, while chemical-free dryer balls are acceptable fabric softeners.

Linens
Clients should change their pillowcase every night because it traps sweat, saliva, hair products, skin products, and hand lotions. Clients can purchase several pillowcases and choose white if they are using acne products containing
benzoyl peroxide.
When it comes to new linens, clients should wash new clothing, bedding, and towels a couple of times in fragrance-free detergent (no softener) to remove the pesticides, fungicides, and formaldehyde applied to fabrics before being shipped from overseas.

Swimming
Swimming pools and hot tubs contain disinfectants, like chlorine and iodide, that can aggravate an acne client's skin. As a result, clients should shower as soon as they get out of the pool. Daily swimmers may have to apply an anhydrous petrolatum-based ointment to protect their skin, as the molecule in petrolatum is too big to penetrate and clog pores. Clients should be advised not to use water softeners if they contain potassium chloride.

Skin Picking
Remind clients to stop picking and tampering with their skin. This slows the healing process, invites secondary infection, and pushes pimples deeper into the follicle, causes scarring and turning tiny bumps into huge colored blemishes that take long periods of time to heal and fade away.

DIETARY REVISIONS
Iodine
Dairy products, processed foods, take-out meals, frozen dinners, fast food, canned food, soft drinks, salty snacks, seaweed snacks, salted sunflower seeds, salted nuts, canned, packaged, and restaurant soups, ramen noodles, tomato juice, V-8, seasoned salt, iodized salt, salty condiments, processed and deli meats, and condiments containing kelp, MSG, and/or iodized salt should be avoided by clients.
Furthermore, clients should stop using iodized table salt and seasoned salt, which contain iodine. Sea salt or kosher salt is a better option. Clients can also choose to make their own seasoned salt with a blend of iodine-free sea salt, Mrs. Dash, garlic powder, onion powder, black pepper, paprika, cayenne pepper, and herbs.

Dairy
Cheese, milk, ice cream, sour cream, Greek yogurt, and dairy-rich coffee drinks cause breakouts. Dairy is linked to acne, allergies, eczema, psoriasis, weight gain, digestive problems, water retention, high blood pressure, bloating, puffy eyes, and many other health problems. Try different brands of vegan cheeses, Daiya Cheese products, almond milk, coconut milk, and rice milk.

Water
Clients should drink more water to keep the skin from getting dry and irritated from active products.

Androgenic Hormones
Food containing androgenic hormones, like peanuts, peanut oil, peanut butter, and wheat germ, should be avoided. Many Chinese, Thai, and other Asian restaurants, Chick Fil-A, and Five Guys Burgers cook with peanut oil. Clients can still enjoy other nuts, as long as they are unsalted. Clients can try low-sodium almond butter, cashew butter, and other nut butters.

Refined Carbohydrates
Fruit juice and refined carbohydrate intake should be reduced, especially white rice, sugar, high-fructose corn syrup, bread, and sweets. This reduction is especially imperative if the acne is inflamed and if the client is diabetic or has polycystic ovary syndrome, has been told he/she is pre-diabetic or has insulin resistance, is overweight, or has a family history of diabetes.

ORAL MEDICATION AND DRUGS
Supplements
Supplements known to trigger acne, especially biotin, maca root, conjugated linoleic acid, seaweed, kelp, blue green algae, spirulina, chlorella, iodine, didehydroepiandrosterone, and whey protein powders, should be avoided.

Medications
Some medications can cause acne, including, but not limited to, lithium, hormones and birth control pills, devices and shots, systemic steroids, performance-enhancing steroids, topical prescription steroids, anti-rejection medications, testosterone and its precursors, and anti-convulsive drugs. Cold and flu medications with bromide can also aggravate acne.
Female clients can consult their doctor about birth control. Hormones have been linked to acne breakouts and hyperpigmentation; some birth control is safer for acne than others. Low-estrogen birth control pills should be avoided. Clients should also be made aware that there are no acne-safe birth control devices or shots.

REDUCING SKIN CONTACT
Fragrance
Fragrance, which can trigger acne and rashes on the face and body and cause sun sensitivity, dark blemishes and dark staining on sun-exposed skin, should be avoided. Clients can check skin care and hair and body products for fragrance, and stay away from scented aftershave, aromatherapy products, perfumed detergents, soaps, lotions, and fabric softeners.

Rubbing Objects
Pressure, friction, and occlusion can result in deep acne, tons of whiteheads, and chronic dark or red blemishes. This rubbing includes leaning on the hands, sleeping on a hand or arm, and wearing tight scarves, hats, caps, visors, and headbands and moving them up and down on the forehead. Instruct clients to pay attention to ill-fitting glasses, football helmets, bra straps and bands, leaning and putting more pressure on one side of the butt while sitting, and heavy shoulder bags and backpacks.

Phones
Do not lean on the phone. Pressure and friction irritate pores and cause inflammation by pushing acne deeper into the follicle. Advise clients to clean their phone often to remove makeup and hair and skin product residue left behind.

Workout Attire and Sports Gear
Occlusive workout and sports gear, like helmets, chin straps, shoulder pads, synthetic fabrics, and tight garments, can aggravate acne by rubbing, irritating the follicles, and not allowing the skin to breathe. Clients should wear loose-fitting cotton when possible, even under pads, latex, spandex, and uniforms. Advise clients to shower after games and workouts with sulfur soap, salicylic acid cleanser, or benzoyl peroxide wash.

Toothpaste
Toothpaste ingredients, such as sodium lauryl sulfate, fluoride, dyes, and aromatic flavors, can cause breakouts and darkening around and below the corners of the mouth. Toothpaste should remain in the mouth. Furthermore, clients should not brush their teeth in the shower. If it gets on their skin, advise them to use a cleanser to remove it. The best option for acne-prone clients is to use a mild white sodium lauryl sulfate-free toothpaste at the health food store.

Pore-Clogging Ingredients
Clients should be aware of pore-clogging ingredients like red dyes and fatty acids, such as isopropyl myristate, and its chemical cousins, isopropyl palmitate, isopropyl lanolate, myristal myristate, isopropyl isothermal, and isostearyl neopentanoate. Other pore cloggers include algae, algin, seaweed, kelp, potassium chloride, sodium chloride, decyl oleate, oleic acid, oleyl alcohol, octyl stearate, octyl palmitate, isocetyl stearate, PPG myristyl propionate, sodium lauryl sulfate, sodium laureth sulfate, laureth-4, lanolin and acetylated lanolin, and many butters and oils.

Hair Products
All hair products should be evaluated for ingredients like sulfates, comedogenic oils, fatty acids, and aromatherapy oils, especially if breakouts are concentrated around the hair line on the forehead, temples, sideburns, scalp, or on the back and shoulders. If the client weaves with human hair, they should wash it before they weave. Synthetic hair, on the other hand, can cause itching, rashes, and acne flare-ups. Pore cloggers like pressing creams, oil-sheen, hairspray, braid spray, mousse, locking wax, curl activators, scalp grease, pomade, brown gel, scented gel, keratin treatments, protein conditioners, and hot oil treatments should be looked out for. The following oils and butters are pore-clogging and should be avoided: coconut oil, cocoa butter, shea butter, sweet almond oil, carrot oil, olive oil, apricot kernel oil, palm kernel oil, castor oil, argan oil, Moroccan oil, vitamin E oil, wheat germ oil, aromatherapy oil blends, jojoba waxes and esters, and scented oils. Dye and fragrance-free sunflower oil and quality mineral oil are considered acne-safe and should be given preference.

Makeup
Red dyes are often found in foundations, blushes, and lipsticks. Oil-free makeup that feels oily may contain fatty acids and other pore cloggers. Clients should re-evaluate cosmetics and moisturizers if breakouts continue. They should also avoid makeup that sticks to the sink when it is washed off. Acne-safe red dye includes iron oxides
and carmine.

Although there are a number of factors and triggers that can cause acne, this comprehensive guide encompasses many of the common homecare choices that can either aggravate or alleviate acne.

Kat Leverette is a licensed aesthetician, acne specialist, and ethnic skin care expert in the San Francisco Bay Area. Her skin care practice, Clinically Clear™ Skin Rehab Center, is dedicated to acne, pigmentation, and ethnic skin.