Does Moisturizing Help Acne?

Should you moisturize oily, acne-prone skin? Does moisturizer make acne worse? Or, does moisturizing help acne? The age-old myth that individuals with acne shouldn’t moisturize is a tough one to shake. Contrary to popular belief, regular moisturization is beneficial for all skin types – even oily, acne-prone skin!

So, how exactly does moisturizing help acne?

What Is Acne?

Acne is an inflammatory skin condition characterized by papules and pustules. It is caused by four main overlapping factors:

• An overproduction of oil.
• A build-up of dead skin cells on the surface of the skin.
• P-acnes bacteria.
• Inflammation due to an immune response.

Hormones can cause a number of issues for skin, one of which is an increase in oil production. Individuals with acne have a slower skin cell turnover rate which means that dead skin cells build upon the top of the skin. These skin cells can block the hair follicles (pores), trapping the oil inside. P-acnes bacteria feed off of oil and are able to multiply rapidly when there is an excess. The increase in p-acnes bacteria initiates an immune response from the body leading to inflammation.

Effective acne treatments usually target one or more of these factors in order to break this cycle.

Skin Hydration & The Stratum Corneum Barrier Function

Skin hydration is controlled by the outer most layer of the epidermis (and thus the skin) – the stratum corneum.

The stratum corneum maintains the vital barrier function of the skin by keeping water in the skin and keeping irritants out. When this barrier function is damaged, water is lost from the skin (transepidermal water loss/TEWL) and skin hydration is reduced ^[1].

Skin hydration is dependent on two main factors:

1. The presence of natural moisturizing factors (NMFs)
2. The structure and composition of the lipids in the stratum corneum (the lipid matrix).

NMFs consist of amino acids and their derivatives (e.g. lactic acid, urea, and sugars) and represent 5-30% of the dry weight of the stratum corneum. The lipid matrix is made up of 45-50% ceramides, 25% cholesterol, and 10-15% free fatty acids ^[2].

The stratum corneum is said to have a ‘brick and mortar’ structure, where skin cells (bricks) are held together by the lipid matrix (mortar). A number of studies have demonstrated that lipids, particularly ceramides, play a vital role in skin hydration by regulating water in and out of the skin. When there is a reduction in the levels of ceramides within the stratum corneum, skin hydration is reduced ^[3].

Altered Skin Barrier Function In Acne

Some research suggests that oily acne-prone skin is associated with an abnormal stratum corneum barrier function. Furthermore, some common acne treatments can cause more damage by excessively ‘drying’ skin.

Individuals with acne have been found to have higher levels of oil production, greater TEWL, and decreased stratum corneum hydration compared to those without acne ^[4]. In other words, the skin contains too much oil and not enough water. In addition, the degree of stratum corneum barrier damage appears to increase as the severity of acne increases ^[5].

Levels of free sphingosine, ceramides ^[4], and linoleic acid (a free fatty acid) ^[6] also appear to be significantly reduced in individuals with acne.

How Can Moisturizers Help?

Moisturizers help improve skin hydration via a number of different mechanisms, including:

• Reducing TEWL
• Increasing the water content of the skin
• Repairing the skin’s barrier
• Restoring the lipid barriers ability to attract, hold, and redistribute water ^[7].

There are three main types of moisturizers – Emollients, Occlusives, and Humectants.

Emollients: soften, smoothen, and condition skin by filling the gaps between cells/skin flakes and are mainly oils and lipids that are naturally present in the stratum corneum (e.g. ceramides).

Occlusives: create a barrier on top of the skin to prevent water from escaping (e.g. Vaseline).

Humectants: draw water from the dermis into the epidermis and, in humid environments, can draw water from the air into the skin (e.g. hyaluronic acid).

Most moisturizers will contain a combination of emollient, occlusive, or humectant ingredients ^[8].

Does Moisturizing Help Acne?

As mentioned earlier, moisturizing is important for all skin types – including acne-prone skin.

Moisturizing can help improve the appearance of acne both directly and indirectly. For example, in terms of indirect improvements, the use of a moisturizer alongside prescription acne treatments can improve the skin’s tolerance of such treatments and promote treatment compliance ^[9].

In terms of direct improvements, moisturizing may help acne by:

• Reducing oil production
• Increasing skin cell turnover
• Reducing Inflammation

Reduced skin hydration, or ‘dehydrated skin’ is often caused by the use of products that damage the skin’s barrier. For example, many cleansers contain surfactants that are very effective at removing oil and debris from the skin’s surface. However, surfactants can also damage stratum corneum proteins ^[10] and decrease skin surface lipids ^[11]. In turn, this can lead to the overproduction of oil and further acne breakouts.

This means that moisturizing may help acne by improving skin hydration and preventing the overproduction of oil – thus breaking this dehydrated skin cycle.

One of the characteristics of acne is a reduced rate of skin cell turnover, meaning that skin cells are shed from the skin less frequently in individuals with acne than in those without acne. The shedding of skin cells or ‘corneocyte desquamation’ requires the activity of proteases. Proteases are enzymes that break-down the connections between corneocytes in order for them to be shed from the skin. However, their activity is highly dependent on skin hydration and NMFs ^[12], specifically, these enzymes are unable to operate efficiently when water is below a threshold concentration.

This means that moisturizing may help acne by improving the rate of skin cell turnover.

Moisturizers can also have anti-inflammatory effects, particularly those containing lipids. For example, the topical application of ceramides can improve skin barrier function, reduce TEWL, while also having an anti-inflammatory effect on skin ^[13]. In addition, combinations of fatty acids, cholesterol, and ceramides improved skin barrier function and reduced erythema within 30 minutes of application ^[14].

This means that moisturizing may help acne by reducing inflammation and erythema.

Moisturizing Ingredients That May Be Particularly Beneficial In Acne.

Now that we have established that moisturizing does help acne, are there any particular ingredients that may be better than others?

Research suggests that the majority of moisturizers that are specifically targeted toward acne-prone skin combine the humectant glycerine with the occlusive dimethicone. These are usually classed as ‘oil-free’ moisturizers. The term ‘oil-free’ refers to the fact that a product contains neither mineral oil or vegetable oil ^[15].

Glycerin is one of the most effective humectants but it can actually increase TEWL by 29% when used alone. For this reason, it is suggested that humectants such as glycerin are used in combination with occlusive agents.

Dimethicone is a derivative of silicone and can reduce TEWL without making skin feel greasy. It can work as both an occlusive and an emollient and is noncomedogenic and hypoallergenic.

A number of other ingredients that are often added to moisturizers can be beneficial for individuals with acne due to their anti-inflammatory effects. These ingredients include:

• Green Tea
• Aloe Vera
• Allantoin
• Ginkgo Biloba
• Centella Asiatica (Cica)
• Vitamin C
• Vitamin E
• Vitamin A
• Niacinamide (Vitamin B3)
• Resveratrol

Many of these ingredients also have antioxidant effects and, as some research suggests that free radicals and oxidative stress may play a role in acne, they may help improve the appearance of acne.

Green tea and niacinamide are antioxidants that are also able to reduce sebum production. In addition, niacinamide can improve skin hydration when used alone. This is likely due to the fact that it increases the levels of ceramides, fatty acids, and cholesterol in the stratum corneum ^[16].

Summary

Does Moisturizer Make Acne Worse?

No, moisturizer does not make acne worse. In fact, it is quite the opposite. Moisturizing can help acne by preventing the overproduction of oil, improving adherence to prescription treatments, and reducing inflammation.

Does Moisturizing Help Acne?

Yes, moisturizing does help acne. Particularly oil-free moisturizers that contain a combination of glycerine and dimethicone. Some ingredients can be combined into moisturizers for even better results, including ceramides, antioxidants, and anti-inflammatory ingredients. One of the best ingredient options is niacinamide as multiple studies show that it can increase skin hydration, reduce sebum production, reduce inflammation, and has antioxidant effects. This makes it an excellent all-round skincare ingredient for acne-prone skin.

Should You Moisturize Oily, Acne-Prone Skin?

Yes. You absolutely should moisturize oily, acne-prone skin!!

References

1. Wickett, R. & Visscher, M. (2006). ‘Structure and function of the epidermal barrier’, J. Infect. Control. 34(10), Supplement, pp. S98-S110. Available at: https://www.sciencedirect.com/science/article/pii/S0196655306009503
2. Tfayli, A., Jamal, D., Vyumvuhore, R., Manfait, M. & Baillet-Guffroy, A. (2013). ‘Hydration effects on the barrier function of stratum corneum lipids: Raman analysis of ceramides 2, III and 5’, Analyst, 138(21), 6582-6588. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23951566
3. Kahraman, E., Kaykin, M., Bektay, H. & Gungor, S. (2019). ‘Recent advances on topical application of ceramides to restore barrier function of skin’, Cosmetics, 6(3), 52. Available at: https://www.mdpi.com/2079-9284/6/3/52/htm
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5. Thiboutot, D. & Del Rosso, J. (2013). ‘Acne Vulgaris and the Epidermal Barrier’, J Clin Aesthet Dermatol. 6(2), 18-24. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3579484/
6. Downing, D., Stewart, M., Wertz, P. & Strauss, J. (1986). ‘Essential fatty acids and acne’, J Am Acad Dermatol., 14(2), 221-225. Available at: https://www.ncbi.nlm.nih.gov/pubmed/2936775
7. Lynde, C. (2001). ‘Moisturizers: What they are and how they work’, Skin Therapy Letter, 6(13). Available at: https://www.skintherapyletter.com/eczema/how-moisturizers-work/
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9. Laquieze, S., Czernielewskin, J., Reuda, M. (2006). ‘Beneficial effect of a moisturizing cream as adjunctive treatment to oral isotretinoin or topical tretinoin in the management of acne’, J Drugs Dermatol., 5(10), 985-990. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17373148/
10. Levin, J. & Miller, R. (2011). ‘A guide to the ingredients and potential benefits of over the counter cleansers and moisturizers for rosacea patients’, J Clin Aesthet Dermatol., 4(8), 31-49. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3168246/
11. Draelos, Z. (2008). ‘Clinical situations conductive to proactive skin health and anti-aging improvement’, J Invest Dermatol Symp Proc., 13(1), 25-27. Available at: https://www.ncbi.nlm.nih.gov/pubmed/18369336/
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13. Carneiro, R., Salgado, A., Raposo, S., Marto, J., Simoes, S., Urbano, M. & Ribeiro, H. (2011). ‘Topical emulsions containing ceramides: Effects on the skin barrier function and anti-inflammatory properties’, Eur J Lipid Sci., 113(8), 961-966. Available at: https://onlinelibrary.wiley.com/doi/full/10.1002/ejlt.201000495
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