Dear Paula's Choice Research Team - Blemish Prone Skin

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Category: Blemish Prone Skin

Dear Paula,
What do you think of algae extract in skincare? It is rated as highly comedogenic and I'm wondering if it's problematic for acne-prone skin.

—Dhimitra

Dear Dhimitra,
Algae extract in skincare is fine, but it’s not a must-have or any sort of miracle, and it’s also not the least bit comedogenic. The biological and molecular structure of algae, whether in pure or extract form, is incapable of clogging pores because it’s completely water-soluble and thus easily removed from the skin. It cannot get “stuck” in the pore lining; it would be an issue only if you were allergic to it and used a product that contained it. Otherwise, although there’s no compelling reason to seek out products with algae extract, there’s no reason to avoid them, either.

Be wary of any rating system of the pore-clogging potential of cosmetic ingredients; they’re unreliable at best and misleading at worst. That’s because they typically rate ingredients based on the effects of 100% concentrations, which doesn’t apply to how ingredients like algae (or countless others) are used in skincare. Another issue that makes such lists of potentially comedogenic ingredients more useless than useful is that they do not account for the ingredient combinations in a given product or when multiple products are used, which pretty much describes an average skincare routine!

If you’re prone to clogged pores or breakouts, think texture, not comedogenic rating systems, which are truly unreliable. Gels, serums, and liquids, not creams, balms, or oils are what to look for to reduce your odds of products triggering more breakouts or clogs.

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Category: Blemish Prone Skin

Dear Paula,
I suffered from extreme acne throughout high school and part of college. It wasn't until I was prescribed Retin-A (Tretinoin Cream) and Sodium Sulfacetamide (Emollient Cream) that my skin completely cleared up (with the exception of the occasional pimple). For a little over 10 years I've been using the Retin-A at night and the Sodium cream in the morning, but have never used a moisturizer in fear that I will break out.

I just turned 30 and I keep hearing about the importance of moisturizing to maintain youthful skin. Do I need to include a moisturizer in my routine? If so, can you recommend a product that will not cause my skin to break out? I have normal to oily skin and price is not an issue.

—Jillian

Dear Jillian,
As someone who spent my teens and much of my adult life battling breakouts, I empathize with you and understand the concern that comes along with adding a moisturizer to your routine. First things first, though: Moisturizer alone isn't going to keep your skin youthful. You need to be sure you're protecting your skin daily with a product rated SPF 15 or greater (and greater is better). This is especially important when using Retin-A, as your dermatologist hopefully mentioned to you years ago!

You'll need a moisturizer for daytime (which includes sunscreen) and one for nighttime (no sunscreen necessary), but you don't need to get a "traditional" moisturizer—meaning a moisturizer that is thick or creamy. The ingredients in any well-formulated moisturizer that matter most in keeping skin youthful—antioxidants, skin-repairing ingredients, and cell-communicating ingredients—do not require a creamy, heavy, or greasy consistency. These ingredients can be formulated in any texture, including liquids, which is why I often just use my Skin Balancing Toner as my "moisturizer." Gels and lightweight lotion moisturizers are also options, as these are unlikely to clog pores.

There are dozens of good options with the textures I've mentioned, and the most effective products don't necessarily cost a lot of money. Here are some of my favorites for breakout-prone skin:


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Category: Blemish Prone Skin

Dear Paula,
I have dozens of little, needlepoint-like whiteheads on my chin. I've had them as long as I can remember. They are only visible when I flatten my chin (can't really see them when my face is in a natural, relaxed position). I use your Professional Blemish-Extracting Tool on this area and love it! It squeezes out the contents of all these little whiteheads. However, they fully reappear within 24 hours, even though I wash my face and use a salicylic acid treatment regularly. What are these little whiteheads and why do they keep coming back?

— Katie H.

Dear Katie,
Whiteheads, also known as closed comedones or milia, are tiny, hard bumps just at and somewhat below the skin's surface. They're a type of clogged pore, and they can be exceedingly difficult to treat. You didn't mention which salicylic acid treatment you're using, but I highly recommend trying the Paula's Choice RESIST BHA 9, as its relatively high concentration of salicylic acid and the sustained-release formula may be just the solution to finally get these bumps under control.

The other option is to see a dermatologist for a series of salicylic acid peels (which can also be performed elsewhere on the face). These peels can be great for eliminating whiteheads, and your at-home treatment can help keep them at bay.

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Category: Blemish Prone Skin

Dear Paula,
I suffer from severe "bacne" (acne on my back) and am having a difficult time finding legitimate advice on ways to treat it. What can I do to help clear it?

-Rebecca

Dear Rebecca,
Although acne on the back (the dreaded "bacne") can be particularly frustrating, it's treated the same way as acne anywhere else on the body. That means gentle cleansing, exfoliating with a BHA (salicylic acid) product, and killing acne-causing bacteria with a topical disinfectant medicated with benzoyl peroxide. The key is to use those products consistently, as acne on the back can be very stubborn. You may want to consider spot-treating the larger blemishes with a potent yet gentle BHA treatment.

The unique issue with "bacne" is the difficulty most of us have reaching the entire affected area. Treating the back breakouts you can reach but leaving those that are out of reach untreated is frustrating! It helps to have a willing partner to assist you with applying the necessary treatment products. If that's not possible (or you just don't want to go there), consider a special applicator tool such as The Backhand Lotion Applicator ($7.95) or similar tools available online or in stores, such as Bed Bath & Beyond. These make it easy to apply anti-acne products on hard-to-reach areas.

A tip: Because benzoyl peroxide can bleach fabrics and linens, allow the products to dry before you put on your clothes, and, at night, sleep in an old T-shirt to protect your sheets.

If the over-the-counter options mentioned above don't improve matters after a few weeks, the next step is to consult your physician for prescription options—whatever you do, don't use body scrubs in this area! Acne isn't about skin being dirty and it cannot be scrubbed away. Good luck, and keep me posted on how you're doing!

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Category: Blemish Prone Skin

Dear Paula,
I have large pores all around my nose with much sebum that I remove with gentle squeezing. I use a product with 2% salicylic acid but it has alcohol in it, which I know is an irritant. I used to use toner but read in many past articles by you that this was not necessary--what changed?

Phyllis, via email

Dear Phyllis,
Large pores around and on the nose can be unsightly and endlessly frustrating. I've had this issue myself and tried all kinds of products to make my pores smaller, but nothing worked. However, after years of research and formulating my own products, I discovered that with effective yet gentle formulas enlarged pores can become smaller!

The 2% salicylic acid product you're using is likely making matters worse due to its alcohol content. Alcohol works great to de-grease oily skin, but the irritation it causes can stimulate more oil production at the base of pores. Guess what happens next? Pores begin producing more oil, and stay enlarged (or get even bigger). There's a better way, and it still involves using salicylic acid (which has an amazing ability to penetrate the pore lining, dislodging debris that causes pores to enlarge).

Paula's Choice is one of the only lines to offer an effective range of well formulated, alcohol-free salicylic acid (BHA) products. For enlarged pores on the nose, you will likely be amazed by the results from my RESIST BHA 9 for Stubborn Imperfections. This potent yet gentle treatment used time-released salicylic acid to refine pore size while reducing oily skin and dislodging blackheads. It's absolutely worth adding to your daily routine (applied in the evening, after cleansing and toning or as the last step in your routine).

As for toners, yes, at one point I was not in favor of them—but this was exclusively because there were so few well formulated toners available. For the most part, it's still hard to find a really good toner, which is why I formulated several for my line. In your case, I think you'll see great results from twice-daily use of my Skin Balancing Pore-Reducing Toner. It contains cell-communicating ingredients that help normalize pore function and refine skin's texture. Used with a gentle cleanser and the BHA 9, your pores are sure to go back to their normal size!

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Category: Blemish Prone Skin

Dear Paula,
I'm 40 with very greasy and highly sensitive skin that is prone to blackheads, whiteheads, and acne. I follow your recommendations for my daily skin-care regimen but I still feel the need to use a facial scrub daily. I just can't seem to get over the feeling that I'm not getting all the grime and dead stuff off without it. And, of course, the more "scrubby" the product is, the more I like it. I was using Origins Swept Away and didn't think I was having a problem with it until I read your list of irritating ingredients and noticed that many of these irritants are in this scrub. What I'm also finding is that most other scrubs that are otherwise fine contain fragrance. I tried your recommendation of baking soda, but it made my skin burn. Detergent and bacteria issues make using washcloths problematic. Can you recommend other options for cutting through the top layer of grease and grime that won't damage the skin?

Carol, via email search

Dear Carol,
Believe me when I say I totally understand your need to feel squeaky clean, because I feel exactly the same way. Lots of women with our skin type do. I also appreciate your recognizing the need to avoid irritating skin-care products. I am tempted to recommend you start using the Origins product again, because you didn't have any problems with it; however, just because you don't feel or see irritation on the surface doesn't mean there aren't problems taking place (Sources: Archives of Dermatological Research, October 1996, pages 684-690; Contact Dermatitis, May 2004, page 265; and Microscopy Research and Technique, volume 37, issue 3, pages 193-199).

You mentioned in your letter that you were using an alpha hydroxy acid and a beta hydroxy acid topical exfoliant. Adding baking soda as part of the same routine with those topical exfoliants would certainly be too irritating. However, there are lots of gentle, but effective, scrubs I recommend that can provide the extra sensation of clean you're looking for with minimal to no risk of irritation. Examples include Neutrogena's At Home Microdermabrasion System ($37.99), Olay Daily Facials Clarity Scrub ($6.99 for 6 ounces), and pHisoderm pH2O Anytime Nurturing Scrub with Gentle Microbeads ($5.95 for 5 ounces).

You may want to consider just using a washcloth with your daily cleanser. It is my favorite way to make sure I've gotten all my makeup off every night and it gives me that extra feeling of clean I love. If you are worried about bacteria (a valid concern), use a fresh washcloth daily. As for the risk of transferring irritating laundry detergent to your skin from your washcloth, consider using All Free & Clear laundry soap, which has a low risk of problems for sensitive skin.

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Category: Blemish Prone Skin

Dear Paula,
I've been reading about a new device approved by the FDA in June 2005 called Zeno (www.myzeno.com). It claims to get rid of 90% of pimples within 24 hours of treatment! The device is about the size of a cellphone and apparently uses heat to destroy the bacteria in the clogged pore. It costs $225, which is a lot, but if it actually works I'd gladly pay that much to be rid of my lifelong acne problem! Do you have any additional information or evidence on whether this product works as well as it claims?

Ella, via email search

Dear Ella,

After looking at www.myzeno.com I can see why you would be tempted to spend $225. The claims and promises about eliminating 90% of breakouts are remarkable. However, I admire your skepticism, because something that sounds too good to be true often is. I emailed Dr. Jonette Keri, Assistant Professor of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, who is known for her expertise in the treatment of acne. Her information was enlightening and might save you money and time. What follows includes her responses to my questions.

"Indeed this device was approved for the treatment of acne by the FDA in June 2005 after completion of a double-blinded study with 51 patients where improvement of their acne was found to be statistically significant. The Zeno treated lesions improved faster and more often in this small study. After five days 100% of the Zeno lesions had improved versus 76.5% of the placebo group."

Before you get overly excited about a 100% improvement, keep in mind that the placebo group also had an impressive amount of improvement""a 76.5% change for the better is impressive too. Also, the study compared Zeno only to using nothing on the breakouts, so you have to ask, what if you used benzoyl peroxide or salicylic acid on the placebo side? What would those results have been? Getting approval from the FDA does not mean Zeno is a slam-dunk. I'm sure you have tried lots of other acne treatments approved by the FDA, but as you note, they haven't eliminated the problem.

How does Zeno work? The premise is that the bacteria responsible for blemishes, Propionibacterium acnes, can't survive a temperature of 119°F. Zeno delivers 121°F of heat to the skin. Heat serves as a form of stress to the bacteria, which then produce "heat-shock proteins" that trigger death of the bacteria. P. acnes does contain heat-shock proteins (Source: FEMS Microbiology Letter, October 2000, pages 183-186), so theoretically they may be involved in the death of the bacteria and dissolution of the pimple.

Even if you are still curious to give this a try, it is important to realize that using Zeno can be incredibly time consuming, depending on the extent of your breakouts. The directions explain that you should hold the device on "the pimple" for 2 1/2 minutes. Each individual pimple must be treated in this manner. You can treat the same pimple up to three times a day, at intervals separated by four hours, but not everyone will be able to tolerate that much heat on their face. (Think about getting into a hot tub at 104°F! And this device generates 17 degrees more heat.) No information is provided about burns or other possible heat damage, but Zeno has only been for sale for a short three months, so it's hard to know what problems could occur.

It is best to remember that acne is a multifaceted disease. While Zeno may help after a pimple develops (though it's not necessarily better than benzoyl peroxide or salicylic acid because that wasn't part of their study), it does not reduce the occurrence of breakouts. Zeno was approved as an after-the-fact treatment, which may serve a purpose for some people.

Suffering from any amount of breakouts is emotionally difficult and Zeno may be worth the cost to see if it works for you, but the $225 cost doesn't include the need for the replacement tips after 90 treatments, for an additional $35 each.

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Category: Blemish Prone Skin

Dear Paula,
I'm writing to thank you for the improvement in my skin after following your pointers for battling blemishes. I'm one of those people who made it through my teens without developing acne, and I was well into adulthood before bothersome blemishes started appearing. My "adult acne" became worse after I stopped using oral contraceptives. I tried product after product, and would see some initial improvement, but it never lasted. Shortly after a new product or routine showed promise, it would disappoint.

I have been following your advice now for about three months, and your regimen is the only one that has consistently come through for me. As you suggested, I began using a gentle, water-soluble cleanser, a benzoyl peroxide product, and an effective salicylic acid (BHA) product.

In closing, thank you, Paula. I was feeling so frustrated, dreading the sight of my face's latest surprise for me. It's great to feel that I am finally coming out ahead in the battle against blemishes!

Jackie, San Diego, CA search

Dear Jackie,
What a wonderful thank you letter! I'm thrilled to hear you found a routine that works for you. Though frustrating, it takes experimenting to find the right blend of products that work for your skin type, which is why I recommend many options and combinations for the treatment of breakouts because it can be such a stubborn condition. If anyone suggests there is only one best option for treating acne, they are not telling you everything you need to know.

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Category: Blemish Prone Skin

Dear Paula,
I'm 52 with slightly oily skin that has always been prone to occasional breakouts. Over the past few years I have found that within 3 to 5 days of beginning treatment with any product containing salicylic acid, my chin breaks out in a series of extremely hard whiteheads and/or inflamed pimples. Usually I get so frustrated that I stop using the product, but I've wondered each time whether the breakouts are just part of the natural process of deep exfoliation, or a definite sign that the product is too harsh for my skin. Any suggestions?

MJ, via email

Dear MJ,
Any product with active ingredients (such as salicylic acid or tretinoin) can have an instant irritant reaction, where application causes the skin to produce an unfavorable response (such as breakouts). How long a consumer is willing to tolerate this in an effort to see positive results is hard to judge, though as a rule, no more than four to six weeks. In many cases, the skin needs to get used to the active ingredient, which may mean not-so-smooth sailing in the beginning. Yet with time, the skin acclimates and the results are often remarkable, and worth the brief period when the skin seems unbalanced. It is possible in your case that you are allergic to salicylic acid. A clue to this is the fact that the reaction on your chin seems to occur every time you use a product that contains salicylic acid. A visit to an allergist to determine if you are indeed allergic to salicylic acid would be a wise move. If you already know that you are allergic to aspirin (which salicylic acid is closely related to), then you can be confident that your skin's reaction to salicylic acid is also part of this allergic response.

Once allergies are ruled out by your doctor, I generally recommend staying with an active product for at least six weeks, unless the side effects are such that you don't want to tolerate them. If no positive improvement is seen at or near the six-week mark, I advise you to discontinue use of the product and consider other options.

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Category: Blemish Prone Skin

Dear Paula,
Have you come across the recently completed study by Dr. Jennifer Gan-Wong, which tested the efficacy of a 3% green tea cream on acne lesions as compared to a benzoyl peroxide cream? Here is a link describing the study in brief: www.applesforhealth.com/PersonallyYours/greteaextha4.html.

My question is this: I have very sensitive, inflamed, oily, fair skin with rosacea. I also have acne because of the rosacea. Acne on rosacea skin must be treated very differently from acne on regular skin, and the skin of people with rosacea cannot tolerate benzoyl peroxide. If you have read the work of Dr. Geoffrey Nase, Ph.D., a Microvascular Physiologist who specializes in rosacea (see www.drnase.com; Dr. Nase also suffers from rosacea), he discourages the use of any inflammation-producing product on rosacea skin. Many dermatologists concur with this sentiment. Green tea might be a less irritating alternative for those with rosacea who also have acne.

This leads me to my next question, regarding your product recommendations. I have bought your products for years, read all of your books, and get all of your email updates. I do not understand why you still recommend beta hydroxy acid preparations for rosacea skin. I have tried your mildest BHA formulation and it irritated my skin so badly that I could not leave my house for a week. Normally I trust your advice, but I vigorously disagree with you on this one. You should not be wholeheartedly recommending BHA for rosacea-afflicted people. Dr. Nase discusses this in depth in a couple of articles he has written. Rosacea is a vascular disorder, which is not that well understood, but anything that contributes to inflammation or irritation should NOT be used on rosacea skin. BHA is an irritant, despite its supposed anti-inflammatory properties. We have discussed your recommendations for BHA on rosacea skin often in the Yahoo! Rosacea email list, which has over 3,000 members, and the consensus seems to be that anyone who has tried BHA has had bad experiences with it. Please be careful with what you recommend.

In addition, MetroGel is only effective for some people--you should NOT be recommending it to everyone who has rosacea. Some individuals cannot tolerate MetroGel, and others see no remission or reduction in their symptoms. Again, I can point you to several articles by Dr. Nase that dissect the MetroGel studies, and the findings are such that MetroGel should not be recommended for everyone with rosacea.

So, why not investigate and perhaps formulate a green tea product that isn't irritating for sensitive skin?

Annie, Berkeley, CA

Dear Annie,
I am always extremely careful with what I recommend and I do not wholeheartedly recommend any one product or skin-care routine for rosacea or acne. I have been very careful to explain that rosacea is an extremely difficult-to-treat skin disorder that is not well understood. I have done the same for acne, clarifying what is known and unknown. For both skin problems, I have listed a diverse range of medical options, over-the-counter choices, skin-care alternatives, and some dietary considerations. As I have stated repeatedly, it takes experimentation to find out what works, whether it's for acne or rosacea. There is no one treatment that will work for everyone, and that includes Dr. Nase's recommendations as well.

I agree 100% that it is of vital importance for those with rosacea to stay away from ingredients or products that promote inflammation. Actually, I have advocated that for all skin types, which is why I zealously try to avoid those types of ingredients in my products. Yet despite the fact that there are many ingredients that should absolutely be avoided to prevent inflammation, the outcome with others is far less clear, as they react differently for different people.

It is also important to realize that there are many people who experience wonderfully positive results from using MetroGel or MetroLotion, as well as those who cannot tolerate the treatment. My recommending beta hydroxy acid (salicylic acid, which is an exfoliant and disinfectant that also has anti-inflammatory properties) for rosacea was a result of feedback I received from my customers, who told me it worked wonders for them, something I explain on my Web site. Again, it does not work for everyone. If there were something that worked for everyone, there wouldn't be chat rooms to discuss the pros and cons of treatment modalities and lengthy studies evaluating treatment options. Even Dr. Nase mentions the need for more research and pharmaceutical development of products.

In regard to green tea being an option for rosacea, the study you mentioned from Dr. Gan-Wong was a 12-minute presentation at the March 2003 meeting of the American Academy of Dermatology. It is not a published paper, so we don't know many details of the study. For example, what else was in the green tea product? What else was in the benzoyl peroxide product? If the benzoyl peroxide product contained alcohol or harsh cleansing agents, that could account for the irritation and dryness the participants experienced. It would also explain why those who used the green tea cream might have seen an improvement in their complexion. That is, the difference in the skin's complexion and appearance might have merely been because the green tea cream did not include the alcohol and other skin irritants that are usually present in benzoyl peroxide products and that can have an overall negative impact on the skin's complexion and appearance. Further, the paper is not clear as to which product provided the most reduction in acne lesions or blackheads.

I will keep my eyes open for other research on green tea, but for now the research is way too preliminary to make any decisions about it being an option other than as an antioxidant and anti-inflammatory agent. However, there is no reason for you not to consider drinking green tea or using it as a toner on your face to see how it works for you. There is a small amount of research showing that a particular green tea tannin (specifically, epigallocatechin-3-gallate) can modulate the production and biological actions of the male hormones (namely testosterone, which women have, too) that can stimulate acne (Source: Hong Kong Medical Journal, December 2001, pages 369-374).

By the way, although I do not agree with everything Dr. Nase asserts, I strongly encourage those looking for other skin-care options and treatment modalities for rosacea to visit Nase's Web site (www.drnase.com) or read his book Beating Rosacea: Vascular, Ocular, & Acne Forms. The book is available for purchase on Dr. Nase's Web site.

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Category: Blemish Prone Skin

Dear Paula,
I saw the Question of the Month on your Web site regarding cystic acne. I appreciate having that information, but noticed that you did not discuss tetracycline or doxycycline in your response. I am a 45-year-old woman who had no acne as a teen, and began to have cystic acne in my twenties. It is totally hormonal, with eruptions occurring before my period and then lasting 6 to 8 weeks before receding. Just as one is receding, another one is erupting on the other side of my chin or cheek. I have marked discoloration around my chin and mouth from the repetitive breakouts, and this is compounded by melasma. I have been using an over-the-counter 2% hydroquinone product with your alpha hydroxy acid and beta hydroxy acid solutions, but have not seen any real decrease in the discoloration.

Presently, I am taking 500 milligrams of tetracycline twice daily, but of course, the rules surrounding tetracycline--the empty stomach, the dairy, and so on, make it difficult to comply 100% each day. It has helped with severe breakouts, in the sense that the eruptions are not as bad as they are without the tetracycline, but I am concerned about the chronic use of an antibiotic, as well as the continued discoloration and spots from previous blemishes. Any suggestions you could offer would be appreciated.

Nancy, via email search

Dear Nancy,
I am concerned about the repetitive use of tetracycline, too. Not only because of health issues but also because the bacteria that cause the acne can become resistant to the treatment, though the risk of that with tetracycline is considered to be lower than that from clindamycin or erythromycin (Source: British Journal of Dermatology, March 2003, pages 467-478).

Cystic acne is incredibly hard to treat. Assuming that you've tried a variety of treatments such as Retin-A, Differin, Tazorac, and topical antibiotics, and have been tested for allergies to milk (dairy), nuts, and/or wheat, the only other treatment left to consider is isotretinoin. It doesn't always work for cystic acne either, but it is a consideration you should discuss with your physician. isotretinoin is a risky medication, but its use is short-term and the chance of a cure is better than 50 percent.

For the acne discolorations and melasma you are doing everything right (assuming, of course, that you are being religious about using sunscreen, because melasma worsens with unprotected exposure to the sun). However, hydroquinone won't have much, if any, effect on the marks left from the acne. That discoloration is unrelated to the way hydroquinone works on skin, which is to block melanin production. Discolorations left over from breakouts (called post-inflammatory hyperpigmentation) are going through a healing process and that has little to do with melanin production. Be patient--they will get better with time. However, your dermatologist or a plastic surgeon can talk to you about chemical peels or laser treatments that can help improve the appearance more quickly.

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Category: Blemish Prone Skin

Dear Paula,
I was wondering if you could tell me anything about a new acne product called BenzaClin. It contains 5% benzoyl peroxide and clindamycin. I have been using clindamycin with some success. My dermatologist gave me a sample of BenzaClin to try. However, I have had an allergic reaction to the ProActiv product that contains benzoyl peroxide so I am a little leery of trying this. Have you heard anything good or bad? Any information would be greatly appreciated.

Natalie, via e-mail

Dear Natalie,
In the arsenal of products aimed at fighting breakouts, BenzaClin is a fine prescription option to consider. BenzaClin is a combination of two topical antibacterial agents in a gel formulation. Clindamycin is a topical, prescription-only antibiotic, and benzoyl peroxide 5% is a topical antibacterial agent typically found in over-the-counter blemish-prevention products. I should mention that the gel formulation contains no alcohol or other sensitizing ingredients. According to Dermik, the company that makes BenzaClin, "BenzaClin has been found to work better than either clindamycin or benzoyl peroxide alone for the topical treatment of acne." Their controlled, double-blind, multiclinic study of 287 subjects and another with 480 patients with at least Grade II acne showed a 63% improvement for BenzaClin, versus a 53% improvement with just benzoyl peroxide and a 45% improvement with just clindamycin. The placebo had an interesting 42% improvement.

However, for you, there is every reason to believe that if you were once sensitive to benzoyl peroxide, this combination would have the same effect.

It is important to point out that BenzaClin is not inexpensive. At $45 for less than an ounce or $75 for a little over 2 ounces this is a pricey option. My suggestion for my readers would be to consider a 2.5% or 5% benzoyl peroxide product to see how that works before jumping into this prescription item.

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Category: Blemish Prone Skin

Dear Paula,
Over the past few weeks I've heard a radio advertisement for a product called EpiClear. This is supposed to clear up acne within three days. I immediately called EpiClear to get information but it was like pulling teeth. I was told that no information was available unless I bought the product. After making sure I could receive a refund (I could), I placed an order. The pressure to order more than one bottle was intense but I refused. I also refused to be added to the EpiClear club and receive automatic shipments. I am sending you the information I received and would appreciate your comments.

Teresa, via e-mail

Dear Teresa,
This overly expensive product is another of the many treatments aimed at those struggling with breakouts. It is incredibly seductive to promise blemish-free skin. Regrettably, there are no topical products that can provide the kind of satisfaction EpiClear is trying to convince you of. The hard sell aside, EpiClear's relatively basic formulation contains water, glycerol, lecithin, vitamins, menthol, and chlorhexidine salt. The ingredient that may be beneficial for blemishes is the chlorhexidine salt, a topical disinfectant used primarily in dental work that may be effective against the bacteria in skin that cause breakouts. It is important to point out that there are no studies demonstrating the effectiveness of chlorhexidine salt on acne, but theoretically it does fall under the category of topical disinfectants, and that can be helpful for breakouts. (EpiClear sells for $59.95 for 4 ounces.)

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Category: Blemish Prone Skin

Dear Paula,
Thanks for the years of advice. You have often been able to help me when advice and prescriptions from dermatologists have failed. And there have been many failures!

Now some advice for you in return for your efforts and help. I was recently diagnosed with Polycystic Ovarian Syndrome. While there are many symptoms and a person with this condition can have any combination of them, one of the most common symptoms is severe acne and extremely oily skin. To keep things short, PCOS alters a woman's hormonal balance and creates high levels of male hormones, which can result in severe acne and oily skin. I started having skin problems in the fourth grade and have battled acne all through my teen years and adulthood. (I will be 40 this fall.) I first began trying to find answers for my health concerns when I was 25, so it has taken me 15 years to find a doctor willing to help me discover the answers. Since starting treatment for this condition, I have seen an improvement in my skin and other symptoms. However, my search for answers and help has made me painfully aware of how few women and people in the medical community are aware of PCOS. As PCOS can lead to diabetes and infertility, please pass on this information to your readers. There may be others in your sphere of influence that could benefit from an awareness of PCOS. Check out the Polycystic Ovarian Support Association's Web site at www.pcosupport.org for more information. I've spent years trying to improve the appearance of my skin when the answer was much deeper. Maybe others who have looked to you for help need to be searching deeper as well.

Ann, via e-mail

Dear Ann,
I think your letter says it all, and I thank you for giving me the chance to share you information with my readers.

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Category: Blemish Prone Skin

Dear Paula,
What do you think of Clinac OC for treating oily skin? I pulled the ingredient list off the Internet and it has acrylate copolymer, which I seem to remember from your book/newsletter is nothing more than hairspray and will clog pores and possibly cause breakouts.

Theresa from Chicago, IL

Dear Theresa,
The new multifunctional forms of acrylates (film formers) are not the same problem they were several years back when they were first being used in cosmetics. The new types of acrylates being used in skin-care products place an imperceptible, smooth barrier over skin that allows it to breathe but also keeps moisture in the skin. Some new developments have created a generation of acrylates that have good absorbent properties.

However, as I wrote in the new edition of my book, Clinac Oil Control Gel ($19.50 for 90 grams) is a topical gel that uses a film-forming agent that provides a matte feel on the skin and has some absorbent properties. It contains mostly water, slip agent, film formers, thickeners, and preservatives. This product is not unique in the range of matte gel formulations (which include those from Clinique, MAC, and Lancome), that make claims of absorbing oil. This one is as good an option as any. But please keep in mind that the single study about Clinac OC (that's all there is) that is being touted in ads and quoted on dermatology Web sites to demonstrate that this product works was done by the company selling it.

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Category: Blemish Prone Skin

Dear Paula,
I came upon a Web site called www.dermalux.com. The Dermalux is supposed to be a light emitting machine that claims to control acne by destroying the bacteria that causes blemishes. From what I can tell the light produces oxygen that the bacteria don't like, which kills them. It is supposed to work better than oral antibiotics. I was also wondering if the oxygen would create more free-radicals and hurt the skin?

Jodie, via e-mail

Dear Jodie,
This machine was news to me. It turns out the light from the Dermalux machine is the same as that emitted by the sun-simulating lamps that are used to treat SAD, or seasonally activated depression.

It is true that the bacteria thought to cause acne (Propionibacterium acnes or P. acnes) don't like oxygen, which is why 3% hydrogen peroxide works as a disinfectant. As the Dermalux accurately states, "Most treatments for acne, whether they be creams or tablets, work by killing [this] bacterium. This results in suppression of the inflammation and clears up the typical spots of acne."

What Dermalux does is a bit more tricky to understand. Purportedly "P. acnes... uses a chemical called porphyrin to help it "breathe". Porphyrins, if they are exposed to certain wavelengths of light, will become excited and produce oxygen that will eventually lead to the death of this bacterium." Even if that is true, their contention is a bit muddled when they say that "The wavelengths of light used in the DermaLux AV are outside those that will cause damage to the skin. There is, therefore, no risk of sunburn, sun aging of the skin or the induction of skin cancer." Because there is no UV light being produced, there is truth in the statement that there is no risk of sunburn or sun-aging effects. But oxygen in skin absolutely does generate free-radical damage and is a risk for skin when it comes to wrinkles. That may be a necessary tradeoff to fight acne, but the potential for skin damage is still there.

The rest of the notion about this light is based on a study published in the British Journal of Dermatology for May 2000. However, the results are not as stunning as the Dermalux Web site states. That study stated that though the initial improvement at "weeks 4 and 8" was superior to the benzoyl peroxide, it was not the case at "week 12... [and] the differences did not reach significant levels." (Note that this study did not compare the machine with the effect of oral or topical use of antibiotics but only with benzoyl peroxide.)

Keep in mind that the other issue the study didn't address is one of compliance. It takes just seconds to apply benzoyl peroxide, but the Dermalux requires 15 minutes a day of exposure to garner results. None of this is to say that the Dermalux isn't an option, but it should also be pointed out that killing the bacteria that cause acne is only one aspect of treating breakouts. You would still need to consider a gentle cleanser, a gentle exfoliant, and an oil-absorbing product.

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Category: Blemish Prone Skin

Dear Paula,
I am a 43-year-old woman who has suffered from severe acne from the fourth grade until my late 30s. After more than a decade of weekly visits to a dermatologist and trying over-the-counter products by Bonne Belle, Clinique, Neutrogena, Estee Lauder, Murad, Aveda, and many more I found Arbonne International. I am amazed at how good my skin looks! I haven't had a single cystic blemish since I switched to Arbonne. I am frequently complimented on my "beautiful skin" ...if only people could've seen me before! As you have probably guessed by my e-mail address, I was so impressed I became an Arbonne Independent Consultant myself. I read your review of our products and beg to differ with your opinion that our products are overpriced and unimpressive. I have probably tried as many different lines as you have and have never before found products of this quality at such affordable prices. Lucky for me, all of my clients feel the same way!

Debbie, District Manager, Arbonne International

Dear Debbie,
I don't expect everyone to agree with my reviews. However, I try very hard to avoid commenting on my personal feelings about a product. Even when I do test a product I rarely comment on my own reaction. My personal preferences would not help a woman make a decision for her skin type or needs. I offer my opinions based strictly (well, as much as I can be unbiased) on formulations and claims versus published research on what ingredients and different formulations can and can't do. I can't account for a wide variety of personal preferences (after all, lots of women like things that are bad for their skin, ranging from tanning and smoking cigarettes to using products that are highly fragranced or contain other irritating ingredients). Also keep in mind that if popularity were an indicator of success, there would only be two or three cosmetics companies and those would be Lauder, L'Oreal, and Avon. Those are the most popular cosmetics lines out there.

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About the Experts

Paula Begoun is the best-selling author of 20 books on skin care and makeup. She is known worldwide as the Cosmetics Cop and creator of Paula's Choice. Paula's expertise has led to hundreds of appearances on national and international television including:

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The Paula's Choice Research Team is dedicated to helping you find the absolute best products for your skin, using research-based criteria to review beauty products from an honest, balanced perspective. Each member of the team was personally trained by Paula herself.

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