How to tell if your acne is linked to dry skin

“Acne linked to dehydration or a compromised skin barrier tends to present with other signs of barrier dysfunction, such as increased sensitivity, stinging, or burning with product application. Patients may also experience persistent redness and irritation beyond the areas of acne.

Another clue is worsening acne after starting acne treatments like retinoids and chemical peels, or in patients who use multiple active ingredients at the same time.

A common mistake is viewing acne as solely a problem of hygiene. Although it is caused by congestion, and poor skin hygiene can contribute to existing acne, excessive washing and scrubbing does not improve acne and can worsen irritation.

Another mistake is skipping moisturiser because the skin is oily. Oily skin can still be dehydrated. A lightweight moisturiser is often what allows patients to tolerate acne treatment long enough to see results.

Hydration plays an important supportive role in calming inflammation and supporting skin clarity. Firstly, adequate hydration reduces inflammation by normalising inflammatory signalling pathways triggered by barrier disruption. Studies have shown that adjunctive barrier creams that restore the skin barrier result in reduced inflammatory lesion counts compared to treatment alone without barrier support.

Secondly, skin hydration improves treatment tolerance of active acne medications, reducing dryness and irritation that can lead to premature discontinuation due to symptoms such as peeling and stinging.

Lastly, skin hydration is a fundamental aspect of skin clarity. Hydrated skin is often brighter and firmer, whereas dehydrated skin may appear dull and crepey.”

Why over-drying skin worsens breakouts and how hydration helps acne

Cleansing twice daily:

- If you have dehydrated skin or a compromised skin barrier, use a gentle cleanser.

- If not, use cleansers containing salicylic acid, an oil-soluble exfoliating acid that helps to decongest excess oil and unclog pores. Usage of scrubs or astringents is not recommended, as those can strip the skin barrier. 

Active treatments:
- Apply actives to clean, dry skin before moisturiser.

- Topical retinoids for their comedolytic and anti-inflammatory properties

- Benzoyl peroxide as an antimicrobial agent with anti-inflammatory effects

- Azelaic acid for its anti-inflammatory and comedolytic effects, especially suitable for sensitive skin

Moisturiser:
- Use moisturisers with hydrating and barrier-repair ingredients.

- Ceramides and beta glucan for barrier restoration

- Humectants (e.g. panthenol, glycerin, hyaluronic acid)

- Niacinamide for anti-inflammatory benefits

Sun protection:
- Daily broad-spectrum sunscreen with at least SPF 30 to reduce post-inflammatory hyperpigmentation from acne.

Dr Rachel Ho is the founder of The Skin Longevity Clinic.