There’s no doubt about it: Acne can affect a patient’s emotional state and quality of life. In fact, the effects of moderate to severe acne on quality of life have been shown to be on par with those of asthma, diabetes mellitus and arthritis.1 In addition, acne has been shown to lead to issues with social behavior and body image.2,3
So, it comes as no surprise that many with acne turn to cosmetics to conceal blemishes and “blotches” left by healing pimples. Using makeup affords the acne sufferer a certain sense of relief by being able to, at least partially, cover up these imperfections.
What not all patients realize is that there are good and bad choices in the products they choose; some products can actually exacerbate their underlying condition (“acne cosmetica”) and hinder the healing process.
What many physicians may not realize is that designing a complete acne regimen, including detailed instructions concerning makeup and cleansing product choices and their use, in addition to any medications prescribed, may actually improve a patient’s quality of life more than prescription medications alone.4
Here, we will discuss acne cosmetica, methods for predicting comedogenicity and acnegenesis and advice on helping patients locate “noncomedogenic” products.
Determining Comedogenicity
Kligman and Mills first introduced the concept of “acne cosmetica” in 1972 to link the comedogenic potential of individual components of cosmetics and cosmetic formulations with acne development in young women.5 They used the rabbit ear model to grade comedogenicity on a scale of 0 (no potential) to 3 (severe potential).
Ten years later, Mills and Kligman used a human model to study the comedogenicity of the same chemicals they had studied with the rabbit ear model.6 Interestingly, the results of their initial animal studies and their later human studies were incongruent.
As a result of the confusion surrounding testing methodology, the American Academy of Dermatology sponsored the Symposium on Comedogenicity in 1989 to standardize testing methods. This consortium agreed on the following statement:
If the animal model does not show evidence of comedogenesis, the test material under consideration in unlikely to be comedogenic in human skin. One-plus reactions are also unlikely to cause reactions in humans. Two-plus or three-plus responses require sound scientific judgment. Reformulation should be considered, or the product should be adequately tested in humans before general use.7
In a recent study by Draelos, the comedogenicity of certain products was re-evaluated using a human model.8
Six patients with prominent follicular orifices were chosen to participate. Saturated patches of each product being tested, along with a positive and negative control, were placed on the upper back and under occlusion for 48 to 72 hours. This was repeated weekly for 4 weeks. After 4 weeks of product application, clinical and microscopic examinations were performed to determine the comedogenic potential of each formulation.
Products tested included face powder, facial cleanser, day and night cream, powder makeup, bronzing powder and facial moisturizer. All products tested had at least two ingredients reported to be acnegenic in previous animal models.
In spite of this, all products tested in Draelos’s human model were found to be noncomedogenic (defined as having a percent change from baseline that is within the normal range plus or minus 10% of the negative controls tested).
The study underlined the point that different models produce different results. The rabbit ear model predicts a hypersensitive result, compared with that of human skin. Nevertheless, the most-common method of testing comedogenicity is the rabbit ear assay, whose value is derived from its ability to distinguish absolute negatives.9
It is clear that a more accurate model to predict comedogenicity and acnegenesis is needed to clearly distinguish those products that have the potential to exacerbate acne-prone skin.
Despite the imperfections and imprecision of the current model, it is exclusive (of too many products, perhaps), but this exclusivity means that those products deemed “noncomedogenic” are, indeed, generally safe for acne-prone skin.
Educating Patients About “Good” and “Bad” Products for Their Acne
As mentioned previously, many acne patients find it necessary to use makeup on a daily basis, and most are not aware of the concept of comedogenicity or “acne cosmetica.” Thus, including a brief explanation of these concepts and stressing the importance of avoiding products that are not labeled “noncomedogenic” during initial patient visits may help them to avoid buying products that may exacerbate their underlying condition and frustrate both patient and physician.
Clear instructions and education on “good” and “bad” products for acne sufferers not only curtails such a situation, but it can also improve quality-of-life measures for these patients.
Matsuoka et al studied the effects of skin care and makeup instructions from dermatologists on the quality of life of female patients with acne.4 They found that not only did use of makeup not undermine acne treatment, but instructions on the use of skin care and cosmetics positively influenced their quality of life.
Moreover, the study found that in the group of acne patients given instructions, the mean scores of psychological and overall domains in the World Health Organization Quality-of-Life scale (WHOQOL26) improved significantly, while only the overall score was improved in the group without instructions, leading the authors to conclude that instructions for using cosmetics complement conventional treatment.
Some Products to Recommend
Because of these studies, our standard “Acne 101” lecture has been upgraded to include not only acne pathogenesis and a description of how the prescribed medications work, but also a brief explanation of comedogenesis and instructions on finding “noncomedogenic” products.
Additionally, we like to recommend a few specific products that have worked well in our hands (namely, Almay Nearly Naked Touch-Pad Liquid Makeup and Prescriptives Flawless Skin Foundation), and we caution against heavier theatrical type makeups for those with acne-prone skin, as they tend to cause acne to flare.
In our experience, patients are genuinely pleased to learn that, as long as they make the right choices, they can use makeup without worrying that it will exacerbate their acne.
For those patients wanting a detailed regimen, or for those with other concerns (rhytids, pigment alteration) in addition to their acne, we also refer them to the book The Skin Type Solution by Dr. Leslie Baumann. This book enables patients to complete a questionnaire to identify their skin type and help them choose products specific to their needs. This has been a tremendous resource in our practice. It has helped educate our patients and has guided us to find our personal favorites. We recommend it very highly.
What Do We Tell Patients?
Here are some guidelines we use with our patients.
1. Acne visits should include the questions about makeup. Not just women, but men will also ask questions about how to cover acne.
2. In general it is fine to recommend noncomedogenic products. Some cases will always occur in which patients may get, or feel they get, acne from their products.
3. Remind patients that some products will say “won’t clog pores” but that this does not equate to a product being noncomedogenic. Some products will use this wording in place of “noncomedogenic.”
4. Choose a few products you feel comfortable with and recommend them to your patients.
5. If you feel uncomfortable making such recommendations or if the patient wants more details, refer them to Dr. Bauman’s book. That’s what we do
There’s no doubt about it: Acne can affect a patient’s emotional state and quality of life. In fact, the effects of moderate to severe acne on quality of life have been shown to be on par with those of asthma, diabetes mellitus and arthritis.1 In addition, acne has been shown to lead to issues with social behavior and body image.2,3
So, it comes as no surprise that many with acne turn to cosmetics to conceal blemishes and “blotches” left by healing pimples. Using makeup affords the acne sufferer a certain sense of relief by being able to, at least partially, cover up these imperfections.
What not all patients realize is that there are good and bad choices in the products they choose; some products can actually exacerbate their underlying condition (“acne cosmetica”) and hinder the healing process.
What many physicians may not realize is that designing a complete acne regimen, including detailed instructions concerning makeup and cleansing product choices and their use, in addition to any medications prescribed, may actually improve a patient’s quality of life more than prescription medications alone.4
Here, we will discuss acne cosmetica, methods for predicting comedogenicity and acnegenesis and advice on helping patients locate “noncomedogenic” products.
Determining Comedogenicity
Kligman and Mills first introduced the concept of “acne cosmetica” in 1972 to link the comedogenic potential of individual components of cosmetics and cosmetic formulations with acne development in young women.5 They used the rabbit ear model to grade comedogenicity on a scale of 0 (no potential) to 3 (severe potential).
Ten years later, Mills and Kligman used a human model to study the comedogenicity of the same chemicals they had studied with the rabbit ear model.6 Interestingly, the results of their initial animal studies and their later human studies were incongruent.
As a result of the confusion surrounding testing methodology, the American Academy of Dermatology sponsored the Symposium on Comedogenicity in 1989 to standardize testing methods. This consortium agreed on the following statement:
If the animal model does not show evidence of comedogenesis, the test material under consideration in unlikely to be comedogenic in human skin. One-plus reactions are also unlikely to cause reactions in humans. Two-plus or three-plus responses require sound scientific judgment. Reformulation should be considered, or the product should be adequately tested in humans before general use.7
In a recent study by Draelos, the comedogenicity of certain products was re-evaluated using a human model.8
Six patients with prominent follicular orifices were chosen to participate. Saturated patches of each product being tested, along with a positive and negative control, were placed on the upper back and under occlusion for 48 to 72 hours. This was repeated weekly for 4 weeks. After 4 weeks of product application, clinical and microscopic examinations were performed to determine the comedogenic potential of each formulation.
Products tested included face powder, facial cleanser, day and night cream, powder makeup, bronzing powder and facial moisturizer. All products tested had at least two ingredients reported to be acnegenic in previous animal models.
In spite of this, all products tested in Draelos’s human model were found to be noncomedogenic (defined as having a percent change from baseline that is within the normal range plus or minus 10% of the negative controls tested).
The study underlined the point that different models produce different results. The rabbit ear model predicts a hypersensitive result, compared with that of human skin. Nevertheless, the most-common method of testing comedogenicity is the rabbit ear assay, whose value is derived from its ability to distinguish absolute negatives.9
It is clear that a more accurate model to predict comedogenicity and acnegenesis is needed to clearly distinguish those products that have the potential to exacerbate acne-prone skin.
Despite the imperfections and imprecision of the current model, it is exclusive (of too many products, perhaps), but this exclusivity means that those products deemed “noncomedogenic” are, indeed, generally safe for acne-prone skin.
Educating Patients About “Good” and “Bad” Products for Their Acne
As mentioned previously, many acne patients find it necessary to use makeup on a daily basis, and most are not aware of the concept of comedogenicity or “acne cosmetica.” Thus, including a brief explanation of these concepts and stressing the importance of avoiding products that are not labeled “noncomedogenic” during initial patient visits may help them to avoid buying products that may exacerbate their underlying condition and frustrate both patient and physician.
Clear instructions and education on “good” and “bad” products for acne sufferers not only curtails such a situation, but it can also improve quality-of-life measures for these patients.
Matsuoka et al studied the effects of skin care and makeup instructions from dermatologists on the quality of life of female patients with acne.4 They found that not only did use of makeup not undermine acne treatment, but instructions on the use of skin care and cosmetics positively influenced their quality of life.
Moreover, the study found that in the group of acne patients given instructions, the mean scores of psychological and overall domains in the World Health Organization Quality-of-Life scale (WHOQOL26) improved significantly, while only the overall score was improved in the group without instructions, leading the authors to conclude that instructions for using cosmetics complement conventional treatment.
Some Products to Recommend
Because of these studies, our standard “Acne 101” lecture has been upgraded to include not only acne pathogenesis and a description of how the prescribed medications work, but also a brief explanation of comedogenesis and instructions on finding “noncomedogenic” products.
Additionally, we like to recommend a few specific products that have worked well in our hands (namely, Almay Nearly Naked Touch-Pad Liquid Makeup and Prescriptives Flawless Skin Foundation), and we caution against heavier theatrical type makeups for those with acne-prone skin, as they tend to cause acne to flare.
In our experience, patients are genuinely pleased to learn that, as long as they make the right choices, they can use makeup without worrying that it will exacerbate their acne.
For those patients wanting a detailed regimen, or for those with other concerns (rhytids, pigment alteration) in addition to their acne, we also refer them to the book The Skin Type Solution by Dr. Leslie Baumann. This book enables patients to complete a questionnaire to identify their skin type and help them choose products specific to their needs. This has been a tremendous resource in our practice. It has helped educate our patients and has guided us to find our personal favorites. We recommend it very highly.
What Do We Tell Patients?
Here are some guidelines we use with our patients.
1. Acne visits should include the questions about makeup. Not just women, but men will also ask questions about how to cover acne.
2. In general it is fine to recommend noncomedogenic products. Some cases will always occur in which patients may get, or feel they get, acne from their products.
3. Remind patients that some products will say “won’t clog pores” but that this does not equate to a product being noncomedogenic. Some products will use this wording in place of “noncomedogenic.”
4. Choose a few products you feel comfortable with and recommend them to your patients.
5. If you feel uncomfortable making such recommendations or if the patient wants more details, refer them to Dr. Bauman’s book. That’s what we do
There’s no doubt about it: Acne can affect a patient’s emotional state and quality of life. In fact, the effects of moderate to severe acne on quality of life have been shown to be on par with those of asthma, diabetes mellitus and arthritis.1 In addition, acne has been shown to lead to issues with social behavior and body image.2,3
So, it comes as no surprise that many with acne turn to cosmetics to conceal blemishes and “blotches” left by healing pimples. Using makeup affords the acne sufferer a certain sense of relief by being able to, at least partially, cover up these imperfections.
What not all patients realize is that there are good and bad choices in the products they choose; some products can actually exacerbate their underlying condition (“acne cosmetica”) and hinder the healing process.
What many physicians may not realize is that designing a complete acne regimen, including detailed instructions concerning makeup and cleansing product choices and their use, in addition to any medications prescribed, may actually improve a patient’s quality of life more than prescription medications alone.4
Here, we will discuss acne cosmetica, methods for predicting comedogenicity and acnegenesis and advice on helping patients locate “noncomedogenic” products.
Determining Comedogenicity
Kligman and Mills first introduced the concept of “acne cosmetica” in 1972 to link the comedogenic potential of individual components of cosmetics and cosmetic formulations with acne development in young women.5 They used the rabbit ear model to grade comedogenicity on a scale of 0 (no potential) to 3 (severe potential).
Ten years later, Mills and Kligman used a human model to study the comedogenicity of the same chemicals they had studied with the rabbit ear model.6 Interestingly, the results of their initial animal studies and their later human studies were incongruent.
As a result of the confusion surrounding testing methodology, the American Academy of Dermatology sponsored the Symposium on Comedogenicity in 1989 to standardize testing methods. This consortium agreed on the following statement:
If the animal model does not show evidence of comedogenesis, the test material under consideration in unlikely to be comedogenic in human skin. One-plus reactions are also unlikely to cause reactions in humans. Two-plus or three-plus responses require sound scientific judgment. Reformulation should be considered, or the product should be adequately tested in humans before general use.7
In a recent study by Draelos, the comedogenicity of certain products was re-evaluated using a human model.8
Six patients with prominent follicular orifices were chosen to participate. Saturated patches of each product being tested, along with a positive and negative control, were placed on the upper back and under occlusion for 48 to 72 hours. This was repeated weekly for 4 weeks. After 4 weeks of product application, clinical and microscopic examinations were performed to determine the comedogenic potential of each formulation.
Products tested included face powder, facial cleanser, day and night cream, powder makeup, bronzing powder and facial moisturizer. All products tested had at least two ingredients reported to be acnegenic in previous animal models.
In spite of this, all products tested in Draelos’s human model were found to be noncomedogenic (defined as having a percent change from baseline that is within the normal range plus or minus 10% of the negative controls tested).
The study underlined the point that different models produce different results. The rabbit ear model predicts a hypersensitive result, compared with that of human skin. Nevertheless, the most-common method of testing comedogenicity is the rabbit ear assay, whose value is derived from its ability to distinguish absolute negatives.9
It is clear that a more accurate model to predict comedogenicity and acnegenesis is needed to clearly distinguish those products that have the potential to exacerbate acne-prone skin.
Despite the imperfections and imprecision of the current model, it is exclusive (of too many products, perhaps), but this exclusivity means that those products deemed “noncomedogenic” are, indeed, generally safe for acne-prone skin.
Educating Patients About “Good” and “Bad” Products for Their Acne
As mentioned previously, many acne patients find it necessary to use makeup on a daily basis, and most are not aware of the concept of comedogenicity or “acne cosmetica.” Thus, including a brief explanation of these concepts and stressing the importance of avoiding products that are not labeled “noncomedogenic” during initial patient visits may help them to avoid buying products that may exacerbate their underlying condition and frustrate both patient and physician.
Clear instructions and education on “good” and “bad” products for acne sufferers not only curtails such a situation, but it can also improve quality-of-life measures for these patients.
Matsuoka et al studied the effects of skin care and makeup instructions from dermatologists on the quality of life of female patients with acne.4 They found that not only did use of makeup not undermine acne treatment, but instructions on the use of skin care and cosmetics positively influenced their quality of life.
Moreover, the study found that in the group of acne patients given instructions, the mean scores of psychological and overall domains in the World Health Organization Quality-of-Life scale (WHOQOL26) improved significantly, while only the overall score was improved in the group without instructions, leading the authors to conclude that instructions for using cosmetics complement conventional treatment.
Some Products to Recommend
Because of these studies, our standard “Acne 101” lecture has been upgraded to include not only acne pathogenesis and a description of how the prescribed medications work, but also a brief explanation of comedogenesis and instructions on finding “noncomedogenic” products.
Additionally, we like to recommend a few specific products that have worked well in our hands (namely, Almay Nearly Naked Touch-Pad Liquid Makeup and Prescriptives Flawless Skin Foundation), and we caution against heavier theatrical type makeups for those with acne-prone skin, as they tend to cause acne to flare.
In our experience, patients are genuinely pleased to learn that, as long as they make the right choices, they can use makeup without worrying that it will exacerbate their acne.
For those patients wanting a detailed regimen, or for those with other concerns (rhytids, pigment alteration) in addition to their acne, we also refer them to the book The Skin Type Solution by Dr. Leslie Baumann. This book enables patients to complete a questionnaire to identify their skin type and help them choose products specific to their needs. This has been a tremendous resource in our practice. It has helped educate our patients and has guided us to find our personal favorites. We recommend it very highly.
What Do We Tell Patients?
Here are some guidelines we use with our patients.
1. Acne visits should include the questions about makeup. Not just women, but men will also ask questions about how to cover acne.
2. In general it is fine to recommend noncomedogenic products. Some cases will always occur in which patients may get, or feel they get, acne from their products.
3. Remind patients that some products will say “won’t clog pores” but that this does not equate to a product being noncomedogenic. Some products will use this wording in place of “noncomedogenic.”
4. Choose a few products you feel comfortable with and recommend them to your patients.
5. If you feel uncomfortable making such recommendations or if the patient wants more details, refer them to Dr. Bauman’s book. That’s what we do
