Dermatology

Acne, Folliculitis, Keratosis Pilaris, etc

The Health Industry Benefits From Keeping Patients Sick

Don't underestimate commerce to prey on people's health needs and keep them in a cycle of spending.

There are some really helpful forum threads that acne.org has “archived”, maybe due to their helpful nature.

Example:
https://web.archive.org/web/20201203014332/https://www.acne.org/forums/topic/220222-tiny-tiny-rice-grains-in-every-pore-anyone-else-have-it/page/3/

Images from thread:

Milia On Skin

Keratin On Arms

Keratosis Pilaris

The keratin images are different from what you will find in a Google image search for the keratin based afflictions.

This is not in itself proof, just one more thing I noticed. If you need proof, then there is science for that.

Being Healthy is the Best Acne Preventative

I found the following post to be both funny and intuitively true to me:

Your skin has evolved over millions of years and knows how to regulate itself better than you do. Adding BP or any other chemicals that aren't natural will only cause problems logically because your skin wasn't designed to deal with chemicals.

Your skin will eventually become dependent and even start to break down after a while, not to mention lose its ability to fight off acne on its own. Notice how sooo many people have problems quitting medication. Do yourself a favor and NOT ruin your skin for the sake of killing a zit.

Basically eat healthy (Low GI) and exercise daily is the best way to clear up. Also, don't over wash your face; you NEED a lot of the oils your skin produces naturally. You have to understand that there's a reason that Americans have the most acne around the world, they sit on their asses and drink Mountain Dew and then wonder why they look like shit. Natural selection is brutal. Everyone isn't genetically supposed to go through acne because of “hormones”. source

All the things you keep hearing: diet, exercise, and rest, those things which keep you healthy, these are the best treatment for acne. There can be all kinds of reasons why you have acne, that are resistant to just being healthy, but trying anything too aggressively will likely cause a backlash.

Diet

Foods consumption resulting in an insulin response causes system-wide inflammation. Sugar is the worst culprit. Acne is all about inflammation to the presence of bacteria, even if the bacteria would do no harm if there wasn't inflammation.

One hypothesis is that if you become vegan, your skin will be less inflamed, less acne prone. Has to do with a lessening of the mtor or mtorc1 pathway. A research review here, with special emphasis on milk. A healthline article here showing that higher insulin and IGF-1 increase acne.

Cocoa can also affect acne::
https://www.healthline.com/health/does-chocolate-cause-acne

Having a food allergy increases keratin production?:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7676854/

For me, my skin health is directly correlated with my gut health. If I'm having an irritable bowel, I'm also having a breakout.

Staying hydrated and avoiding foods that trigger a breakout are key for me. I love milk. I can drink raw milk, but cooked/processed milk has me growing beneath the skin plugs. I think cooking may malform some milk proteins?

Stress

Acne is caused by many factors, including stress.

Compulsive Skin Picking

https://www.nbcnews.com/healthmain/when-you-cant-stop-pick-pick-picking-your-skin-777574
Motivational video: https://www.youtube.com/watch?v=rGmKsfA-T28

If my nails grow long, it's harder for me to feel for bumps, as it's my fingertips that are most sensitive. So I therefore lose some of the urge to isolate and raise the bump to behead (for me they are keratin plugs). Unfortunately I also hate having long fingernails.

Comedogenesis

Acne may be caused by oxidation of sebum 2 3 4. Maybe the harsh cleansers cause the sebum to oxidate? Even pollution has been implicated. A higher pH for the skin was associated with acne. Consider that harsh cleansers are defined by a high pH.

So let me think in terms of basic chemistry. Oxidation is defined as the loss of electrons. An alkaline cleanser has an overabundance of electrons compared to neutral water? Not necessarily. You would think an alkaline cleanser, having an overabundance of electrons, would actually reduce the sebum rather than oxidize it. But there is not a one-to-one correlation between the ph scale and oxidation-reduction reactions. The research claims that acne is caused by sebum oxidation, but the cause doesn't seem to be known. Squalene is the component of sebum that causes blockage upon oxidizing. There is a hypothesis that in people without acne, antioxidants, mainly vitamin E, are sufficient in the sebum to keep the squalene from oxidizing. Read more from this researcher.

Acne prone skin also lacking linoleic acid: https://www.ncbi.nlm.nih.gov/pubmed/2936775
Someone else looking up research: https://www.acne.org/messageboard/topic/314390-acne-prone-skinsebum-deficient-in-linoleic-acid-possible-topical-solution

Additional References

Research Quality Grading

Chinese Guidelines for the Management of Acne Vulgaris: 2019 Update

Acne Management Guidelines by the Dermatological Society of Singapore, Oon et al 2019

Personal Log Battling Acne, which can be skipped: preferable to read Skin Care Section Below

Personal Log Battling Acne

I get spots of hardened something, bumps, right under my skin (like hard little grains of rice) with little to no inflammation/redness, and 80% on my scalp. Like this: https://www.lighttherapydevice.com/hard-white-grains-pores, or this: https://www.dermascope.com/disorders/9481-sebaceous-hyperplasia-gaining-the-upper-hand-on-those-little-lesions

Update: I'm pretty sure they are Keratin Plugs.

I thought maybe if I stop being aggressive on my skin, and only use water, that in an ideal world my skin would return to its blemish-free natural balance, but it seems that the natural state of my skin is with bumps. I've used accutane in the past, so perhaps I changed the natural state? Accutane affects epigenetics, or the expression of DNA. I actually found some support for this idea: 1 2 3.

I've also been rather aggressive with the acne in the past, having tried to “kill” acne with isopropyl alcohol and hydrogen peroxide. Because I tear off those hard little bumps whenever I feel one, my scalp often looks like I have chicken pox.

I think I need to exfoliate, but, how to exfoliate, yet keep the supposed beneficial acid mantle?

Washing With Warm Water Three Times a Day

My preventative maintenance is to have consistent and gentle exfoliation. I wash my hands with soap, and fully rinse them first. Then I use my hands to wash my entire head with plain warm water. This keeps some of my natural oils so I don't overdry, without stripping it all off.

If there is inflammation of acne, it is at night. There appears to be a relation between fatigue and inflammation. I can cause damage by picking at them at night when they are inflamed. Picking at them when they are *not* inflamed feels more like exfoliation than surgery.

Aloe Vera and Vitamin C Serum

I had always used soap for shaving. I didn't really want to use anything else, for the sake of simplicity. My stepfather let me try his shaving cream: Aveeno Therapeutic Shave Gel, and although it is “artificial”, it seems gentle. It's non-messy and convenient.

As an aftershave, I cut off a portion of an aloe vera plant I have in a pot at my window. Aloe vera naturally has salicylic acid 1.

Alternatively, I use vitamin C serum I buy. I have tried a vitamin C serum that also contains every other popular ingredient you can think of: Aloe Vera, Retinol, Niacinamide, Hyaluronic Acid, Salicylic Acid, MSM (this one is particularly strong so I didn't use it every day). I have also bought a vitamin C serum that also contains: Aloe Vera, MSM, Hyaluronic Acid, Arginine amino acid, Vegetable Glycerin, Jojoba Oil.

In using the search engine Mojeek, I found one of the top articles was how someone is making there own serum: http://imcelebratinglife.com/skin-care-make-your-own-homemade-vitamin-c-serum

I dropped the use witch hazel and apple cider vinegar, and the waffle weave pads. Instead, I fulfill the psychological need for rubbing my skin with the aloe vera plant leaf.

I didn't give the oils or some of the other products a full try, but it seems I don't have to, as I prefer the aloe vera plant or the aloe-based vitamin C serum.

I found the following related article after the strategy that I settled into. It also describes a balance between exfoliation and gentleness: https://www.healthline.com/health/skin-disorders/how-to-get-rid-of-milia

Update: The aloe vera plant was too much work. The vitamin C serum is too pricey and lemons are more effective (as noted previously). Settled on using oils.

Sebaceous Hyperplasia

I've been trying to figure out what my acne is exactly. First I thought it was folliculitis, then I thought it was milia, and now I think it may be sebaceous hyperplasia. Hints this might be the right conclusion:
Some of the recommended treatments on Quora are similar to what I've been trying.
The explanation that it starts deeply in the skin, and can reform in the same spot sounds familiar.
That it happens for older people.
That a history of sun exposure is a cofactor.

Linking diet to acne metabolomics, inflammation, and comedogenesis: an update
Sebaceous hyperplasia: systemic treatment with isotretinoin
Why Topical Retinoids Are Mainstay of Therapy for Acne

Sebum Plugs

https://www.healthline.com/health/beauty-skin-care/sebum-plugs

Logs lacking beneficial conclusions

20180707:

I've been traveling and forgot to pack oil. So I have been using, exclusively, the witch hazel, apple cider vinegar, and salicylic acid (ACV+WH+SA) pads. The pads are too drying for my skin, so I'm trying to figure out something else. The witch hazel I'm using has 14% alcohol, but perhaps even the use of an alcohol free witch hazel may be too harsh, since it is still an astringent 1. I may just go full paleo and use only water. That would be the simplest solution. I can wash my face and head with water as much as I please. For shaving, face cream or even hair conditioner as a lubricant seems to work best. I will use the pads as an aftershave. From my experience, aftershave is very necessary, even if it is drying. The shaving tears up the acid mantle, so a disinfectant/astringent is called for, followed by adding a layer of oil on the newly unprotected skin. My original plan to use both the pads and the oil as moisturizer could still work, like it did for her. Aha, I didn't pack oil, but I packed a vitamin C serum which I will start using pronto!

20180721:

My skin is finally recovering from the drying effects of using only the pads 2-3 times a day. I've been following usage of pads with a vitamin C serum I got in Feb 2015 (probably expired enough to where it's not as effective as it could be). Ingredients list:
Organic Herbal Infusion, Organic Aloe Barbadensis Leaf (Aloe), Sodium Ascorbyl Phosphate (Vitamin C), Methylsulfonylmethane (MSM), Cassia Angustifolia Seed Polysaccharide (botanical acid), Hamamelis Virginiana (Witch Hazel), d-Alpha Tocopheryl Acetate (Vitamin E), Carbomer, (2s)-2-Amino-5-guanidinopentanoic Acid, Ferulic Acid, Kosher Vegetable Glycerin, Organic Simmondsia Chinensis (Jojoba Oil), Phenoxyethanol, Ethyl Hexyl Glycerin.
I'm not thrilled that it has Phenoxyethanol, but it has preserved the product.
I haven't been able to find any serum without Phenoxyethanol. In a 1998 study, phenoxyethanol caused an allergic reaction in 2% of the population. But even if it doesn't cause an allergic reaction, does it get absorbed past the skin barrier? 1 2 3 The 3rd study from 2011 states: “ The systemic impact of the high absorption rate of 2-phenoxyethanol and a potential toxicological risk have to be investigated in further studies or should lead to conclusion to avoid 2-phenoxyethanol in disinfectants used for topical treatment of the investigated species. ” 2-phenoxyethanol is just the chemical nomenclature of phenoxyethanol.
The hemp oil I have is probably expired too, though less than a year old (doesn't smell bad, but probably not the freshest). Even if it was fresh, psychologically, I'm having a hard time putting oil on my skin, so I opted for the serum above instead. I got to sample a product called “Organic Coffee Bean Caffeine Eye Cream”, and it feels good and the ingredients are good, but it's too pricey. After I'm done with the serum, I'm going to switch to a new bottle of hemp oil.

20180727:

Interesting take from a skin care products store about not needing a toner / astringent. Interesting take from a skin care products store about not using soap, and using cleansing oil and toner instead. I can't give up using toner just yet, as I am using it as an antiseptic. My psychology is that if it stings, it's good. My skin is slowly getting better, with only one new deep pimple of small diameter, and the remaining scars that will fade in a few weeks. If I get a major breakout I will be very disappointed, but I think I won't. I'm becoming a believer in moisturizing. I always hated putting gunk on my face, but my opinion is shifting. Moisturizing now has new meanings for me: 1) putting a covering over your skin so your own sebum isn't exposed to air, reducing oxidation, and 2) using a moisturizing product with antioxidants, for the same purpose of reducing oxidation (if only I could find such product that didn't have a preservative in it's ingredients). Well, the solution for 2) is that many oils have antioxidants 2 3 in them, naturally. So the cleansing oil method is both cleanser and moisturizer with antioxidants. Some toner may be good if your skin somehow has an off-balance pH? I'm still convinced I need something toner/astringent/antispectic after shaving.

I'll be using hemp oil again. In looking up hemp oil, do not confuse it with CBD cannabidoil, which is also high in antioxidants: “ Although all of the antioxidants attenuated glutamate toxicity, cannabidiol was significantly more protective than either a-tocopherol (vit e) or ascorbate (vit c) ”. The antioxidant percentage of hemp oil is highly variable based on the genotype.

20180808:

I had a major breakout in using the oil instead of serum. Yesterday I started mixing a drop or two of tea tree oil into the teaspoon of hemp oil in the cup of my hand. The acne is deep, so it will take a couple of weeks to heal. I will continue with the two oils, hoping it works in the long run.

20180812:

OMG it's bad. I turned to the net to research. Things I found out looking up “acne breakout vs purging”. If I get acne in a new area, it's not purging. The skin cycle takes 6-8 weeks before it finally sheds off in the outer layer, so what I see now may not be the result of what I just started using. Acne turnover during a purge is much faster than a new breakout. But here's one thing I read, which raises a red flag for me: “ Purging only occurs when using products that increase skin cell turnover. ” Does using oil increase cell turnover? Products that increase cell turnover are exfoliants like salicylic acid or retinol. However, if an oil contains antioxidants then it can also increase cell turnover (based on my reading of advertising-like web pages for rose hip oil… in fact, I'm not providing links because most of what I'm stating may not be accurate).

In any case, to to get a clearer answer, I'm going to stick with the hemp oil for a bit longer, and see if things get better. The advice is to stick with a product for at least a month, but I don't know if I can hold out that long! Is it any wonder people never figure out what product helps if they have to stick through getting worse before getting better. I don't like the idea of purging, and if I hadn't heard it from so many different sources, I would be really skeptical. I would next try grapeseed oil or argan oil 1. I have peppermint essential oil, which I'll use when I run out of tea trea oil.

Also, escalating the flare could be caused by me irritating the skin, because the more acne I get, the more I am picking at it and then scrubbing(!) it with the ACV+WH+SA and reapplying the oil. It's hard for me to let things be, especially under the amount of stress I am going through. I've only been able to stop picking momentarily, or because I'm too busy to do so. I thought that if there wasn't anything to pick at, then I'd stop picking, so I just needed to find the cure. Which is true! The times I've had clear skin I enjoyed running my fingers over the smooth skin and feeling satisfaction that it was clear. Sometimes it was just randomly clear. I think there is no cure and I'll always have a slight amount of acne. I can't be hard on myself, but it's really the best decision to stop picking if I can.

20180813:

I'm diluting the ACV+WH+SA with water to 50%. I need to be more gentle to my skin. Started using peppermint essential oil, one drop per 5 drops of hemp oil. It feels wonderful: tingly.

20180818:

Still looks a mess, but it isn't swollen all over the place, just in one or two spots. I read on one non-scientific website that peppermint oil is good at reducing swelling, so maybe that's part of it. There were new spots though. While skin turnover takes 6-8 weeks, I think formation of pimples can happen a lot faster, and this guy does too. A lot of people on the acne.org forum swear that acne occurs a lot faster after eating something or changinng regimes or taking a break from a regime. One guy will get a pimple after shaving, within a day, just like I do. So the range is anywhere from 8 hours to 8 weeks of effect to an incident.
I could say the serum I was initially using is more helpful than the hemp oil, but there are other variables, including that the outer skin I have now was the inner skin when I wasn't using any moisturizer.
Maybe I've been having more dairy recently, or however long ago it takes for acne to form from it.
Maybe I haven't been as good at timing my fiber supplement recently, such that I've had insulin spikes.
I'm going to quit milk for a couple of months (to reduce dairy intake), while keeping the current regime.

20180820:

Started using argan oil I bought from whole foods, because the hemp oil was feeling tacky upon application (one sign that oil is rancid). When it arrived in the mail, it was on a hot summer day. The bottle was hot, so it could have gone rancid all the sooner.

20180823:

My skin is still a total mess. I think the essential oils I've been using, namely tea tree oil and peppermint, are actually pretty harsh on the skin. So I'm back to just trying to be gentle to my skin, and I'm messing up by using the essential oils. I like the feel of the cooling effect of peppermint, but I think overall it's irritating my skin. All the more reason to simplify. I read lavender essential oil may be a good option, but, I want to simplify.

20180828:

Skin is starting to heal faster in the old outbreak region, I believe from dropping the essential oils, but I am also getting new outbreaks with swelling. What I notice when I'm using the harsh products is that my open acne develops flaky coverings that I peel off. The coverings are like a bunch of dead skin cells that have hardened. I imagined it's the effect of a chemical peel on an open wound, so I'm going to dilute the ACV+WH+SA to 20%, and not use the essential oil. Again, I'm going for being gentle to my skin. Honestly, it's embarassing that I've been so hard headed, but I want to be open and honest in case it helps others.

I have ordered “ToLB Ultimate Wrinkle Serum - Nighttime - Vitamin C - Retinol - MSM - Hyaluronic Acid - Salicylic Acid - Niacinamide”. It has artificial preservatives, but I am growing impatient with the oils. Though I'm still curious about grapeseed oil. I wonder if some oil manufacturers are behind all the non-scientific web pages (and even some scientific research), that I've been reading.

20180830:

The old outbreak region is looking bad again, the one that was starting to heal. I need to lose my habit of picking at acne, fast. I've not been able to stop, ever. I do it without thinking, and I just do it. I hoped to find a cure, because, I don't pick at acne in the rare times that it's not there! I'm not alone in this problem. A google search turns up a lot of stories, including this one: https://greatist.com/live/skin-picking-what-it-took-for-me-to-stop. I found the following advice here: “When you’re feeling the urge to pick, check in with yourself to examine the thoughts and feelings that are driving that urge. Is it anxiety? Stress? Boredom? Try to identify the underlying reason behind your picking habit, then consider how to address the root problem.” For me that would be a little different on each occasion. Part of it, perhaps, is that we have a natural inclination for grooming, much like chimpanzees groom each other. I notice that applying oil loosens the acne scabs, which in turn ends up with me scrubbing them off, even though the scabs may serve a good purpose. So it's not that the oil is bad for my skin so much that it's aiding in me picking at the acne? Perhaps that's why the serum was working better for me, because the main ingredient was aloe vera, which is known for its wound healing properties. I failed to notice that the ToLB serum doesn't have aloe vera (my mistake).

20180902:

Most spots are healing, with only 1 new big zit, maybe a few small ones and 3 old flat swollen areas. I started using the ToLB on 20180831 and have applied it 3 times, but I will slow down to twice a week because the directions state that it is a strong product that shouldn't be used daily. I stopped using the ACV+WH+SA pads. I continue using only argan oil, but will run out soon (note to self: 1oz/30ml lasts 2-4 weeks). I will be shopping for aloe vera gel.

20180906:

I have 3 swollen painful zits, but they aren't new, and they aren't huge, and the rest looks awful too, but it's all small spots that are fading away. Too soon to tell, but I think it's working. “It” being the ToLB serum, and the continued more seldom use of the acne pads, and the argan oil, which I will use up as of tomorrow. I haven't slowed down on the picking, but my skin is hopefully getting better anyway. It's too soon to tell: I will know in about a week's time. Keep in mind, I am no longer drinking milk in my home, so that could be a factor, but I still have dairy, and I still have a milkshake once in a while.

I got 3 new products, which I think are going to be awesome: aloe vera gel, grapeseed oil, and vitamin C serum. The vitamin C serum has aloe as the second ingredient after water (different brand, but comparable to the expired one I started off with at the beginning of this log). I'm not going to be using all of them at the same time, but I think they will all be quite good for my skin. For some reason I feel optimistic, which is great considering how depressed I've been feeling lately. I hope I can be optimistic towards other things which I have a hard time being optimistic about. I may just use water and the vitamin C serum by itself. Or if I just want to use the vitamin C serum once a day, I can also re-moisturize with oil or aloe vera later in the day, including after using the acne pads. I wanted to try both the aloe vera and the grapeseed oil as moisturizers; I couldn't decide so I got both. Maybe one will work better for my skin than the other, and I won't know unless I try, or maybe both will work great.

20180909:

My skin is doing a lot better. I think the aloe helps tremendously with the acne “wounds”. The swelling is under control. Also I'm hoping the serums keep new acne from forming. Don't have enough experience to know for sure. I'm going to keep using the serums and the aloe. I like the grapeseed oil better than any of the other oils, as it feels lighter, but it's still messy the way an oil is, and seems to cause the acne scabs to soften and swelling to take place.

20180912:

Yeah, the aloe vera is awesome. Reduced swelling equals less picking. I've had new acne pimples, whose clogged-pore dome I promptly tear off. With the aloe vera, the resulting hole is much less inflamed, and much less likely to form a new dome to tear off again. However, it's not fool-proof. Yesterday I went for a run, and I showered beforehand (I like to sweat starting with a clean body, so sometimes I shower beforehand). My skin was dry, and I didn't put aloe on it, because I was going to run. After running, I had a pint of chocolate milk, because that's what I most wanted from whole foods. I didn't shower, and treated my skin with the ToLB serum without washing my face before going to sleep. In the morning I was a mess. Still better than before aloe, but quite a setback. Some takeaway thoughts:
1) Always moisturize: I have it in my head that I don't want to block my sweat glands, but that may not be correct at all.
2) Don't drink milk, I don't need another variable at this point.
3) Rinse off sweat and nyc grime with water after running.
4) I am very skeptical about acne taking 4-8 weeks in forming. Maybe some attributes can start at that point, but overnight influences do happen. I don't have science to back it up, but I'm going to go by this.

20180916:

Same amount of acne going on, but they don't get as huge with the aloe vera, so I look more normal. Still using the serums and the aloe, and sometimes the “20% ACV+WH+SA 80% H20” pads. I have a lot less dried-out and thick flakes of skin, I believe because the acne pads aren't so severe when watered down. I use the ToLB retinol serum (ultimate, nighttime) twice a week, and the vitamin C serum on the other evenings. I wonder what things will be like in 2 weeks: the acne is still bad, but at least the wounds aren't gigantic.

20180918:

Acne is swelling up again, despite the aloe vera. Have the bacteria developed an immunity? Am I just having a reaction to something I don't know? This is really frustrating. I'm not precise in making the ACV+WH+SA+H20 mixture, so maybe this last batch was a little strong? I diluted it plenty today.

20180924:

Aloe vera still reduces swelling, excluding certain bad days like the last log entry. The acne wounds end up being less in diameter. However, I have as many eruptions as ever and it still looks bad. I am going to cut out the salicylic acid from the pads, and use only ACV+WH+H20. I've been using the serums infrequently but plan to continue their use. At least they are not super huge diameter red spots.

20181001:

Skin is still the same. I should just throw in the towel. Continue with ACV+WH+H2O pads, with the exception that after shaving (once every 3-4 days), this solution isn't strong enough to disinfect. This conclusion because I broke out badly once after using the diluted mixture. Also continue with the aloe vera. Also with the serums once every other day on average.

20181007:

Skin is still the same. Will continue same as last entry, except I won't use the “ultimate age defying serum” because it is damaging to the open wounds. It looks like I've managed to make my skin better but the problem still remains. My hope for a solution is almost gone. I haven't been using the Vit C serum very often, so I will now commence to use it every other day.

Skin Care

Sorry about this section being a disorganized mess. I wrote this a long time ago and am slowly improving my writing skills, I hope.

Topicals

Doing nothing is better

Obsessing over acne can rob you of time you could be doing other more positive things. A healthy lifestyle will likely be your cure for acne.

This section exists because I can't follow my own advice. Also, maybe after decades of being horrible to your skin, it needs extra help from topicals.

Aloe Vera Plant

Especially useful if you've been bad and picked at your acne, as it will help in healing the wound.

Aloe Vera Plant Care, Meservy on wikihow.com

Grow a big aloe plant, or two, and cut a piece off the end of a leaf for immediate use. You only need 1-2 square inches. Trim the edges, then tear apart the two sides by putting your fingers into the flesh. Rub the flesh side directly on the skin.

I think you should take from the bottom leaves first. Keep cutting the same leaf until you get to the trunk, before starting another.

Based on the present studies, it is concluded that dose and duration of treatment with Aloe vera is crucial for reproductive response. Low dose and lesser duration have been shown to have positive effect on reproductive system in both male and female, but high dose and longer duration of aloe vera treatment has antifertility effect on reproductive system. Impact of Aloe vera consumption on reproductive system: A review, Bisen et al 2024

Natural is better

DIY products can be more effective than pharmaceuticals or store bought skin care products. There is lots of advertising and even lots of research that will push society towards artificial products. Store bought products need to have a long shelf life for companies to gain the most profit, so they will often have less active ingredients (active ingredients tend to be unstable), or will have toxic preservatives to increase shelf life.

Case in point, rubbing your skin with a lime is more effective than serum products touting 20% Vitamin C. These store bought products use Sodium Ascorbyl Phophate as a source of Vitamin C, which is effective, but not as effective as the less-shelf-stable Citric Acid, as found in a lime.

Unorganized Thoughts

Whatever you use, it will likely work for a while and grow less effective with time, so it's good to alternate skin care with healthy options.

Maybe it would be fun to try some bentonite clay or dead sea mud masks, but I don't know what these things do to the acid mantle. I'm trying to simplify, after all. It's hard not to want to do something to take care of your acne. But in the end, if I stopped spending any time on it, including picking my skin, the skin would be in much better condition.

I used to use home-made acne pads, similar to stridex or oxy. I kept the pads in a bath of witch-hazel, apple cider vinegar, and salicylic acid (yes, you can buy salicylic acid in powder on the internet) ACV+WH+SA.

Note: The pads I used are thin, waffle weave pads 2, made from polypropylene and rayon. They are hard to come by, but I liked them better than cotton rounds.

More toners:

Pharmacological Effects of Rosa Damascena
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586833

Antibacterial Activity of Ethanolic Extract of Cinnamon Bark, Honey, and Their Combination Effects against Acne-Causing Bacteria
https://doi.org/10.3390/scipharm85020019

I was considering using a soap alternative. There is a Quora suggestion to use “besan or gram flour mixed with curd/lemon” which I guess means besan with curdled milk. However, I would like something I don't have to prepare. Something “ph balanced” to match the skin's ph of around 5.5? How about apple cider vinegar with some flour? At this site someone used apple cider vinegar with oatmeal, and she stores the extra in the fridge. I'd want at least a week supply! My wanting convenience is leading me towards Amazon.

Alternatively, you can try using any water based moisturizing cream like a soap. I think these water based creams are called oil-water emulsions. You rub the emulsion on your face, and the oil in the creme mixes with the oil on your face, creating a new emulsion with the two oils. You then wash off that emulsion with water. This has been my experience using moisturizing creme to wash off dirty mechanic's hands. It's less drying on the hands than soap, but surprisingly more drying than not having gotten your hands dirty in the first place.

There is, of course, the oil cleansing method. You will not want to do this in the shower, or you will leave the bath tub oily. It's common sense that this does not happen in the shower, but lifetime habits can be hard to think around. In the shower or at the sink, you only rinse with water. Afterwards when your skin dries, you massage the oil about your face, and wipe off the excess with a paper towel. Sites describing the oil cleansing method, often mention using a comfortably-hot rag to hold against your face once you've applied the oil, that will help the oil penetrate, but that's too much work for me. My way involves even less time, especially compared to the marketed three: cleanser, toner, moisturizer. You only use one product: oil. There are many types of oils like olive and coconut. Make sure they are first cold pressed. In case of olive oil, a low acidity level means the olives were in good condition (0.5% or less).

I tried hemp oil because it is supposedly non-comedogenic. See: skincareox.com holistichealthherbalist.com. However, these two sites provide no references to research. They likely fabricate data to make money using referral profits. The Truth About Comedogenic Ratings And Acne, Anjali Lobo 2018.

The skin takes time in adjusting to a new regiment. It may take up to and over a month for the skin to normalize from a transition in skin care, so don't be quick to give up on a new regiment.

Bacteria are a normal part of your skin. There is one hypothesis, that says the bacteria cause a problem, when, in the process of “cleaning” your skin, you remove the acid mantle. The acid mantle is a protective barrier, and having removed it by aggressive cleaning, bacteria can enter the hair follicle and sebaceous glands. Here the bacteria can cause inflammation and produce by-products that leads to blockage of the follicle which leads to acne.

I stopped having acne on my back and shoulders, when I stopped using soap in those areas. I just left it alone. Now I only use soap under the arms and the groin area. But I still have acne, or keratosis pilaris, on my scalp, most likely because I keep picking at it. My skin produces excess keratin on my scalp because the skin is damaged.

I used to think my face would feel disgusting if I didn't use soap. I exfoliate my face and scalp without soap by cleaning my hands with soap and using my fingertips. I liked how clean my face felt with soap, but I've read on some sites that the “squeeky clean” feeling I like is equal to having destroyed my protective acid mantle. Other sites say the acid mantle recovers within a short time after using an alkaline soap, but I'm going to assume that stripping the acid mantle has unwanted end effects. Exfoliation without soap is gentler than stripping the acid mantle.

Some recommend harsher exfoliation, chemical peels, and everything possible to prevent clogging of the pores. They also support a three step process that involves a cleaner, a toner, and a moisturizer (capitalism rejoice). The toner can be used to re-acidify the skin. The moisturizer to replenish the protective barrier that was lost in the first step. This may work for some people who's sebum lacks antioxidants. This antioxidant lacking sebum clogs easily.

A different affliction is keratosis pilaris, where there isn't excess sebum with low levels of antioxidants (see comedogenesis above). Instead there is excess keratin production.

Coconut oil + tea tree oil

Retinoids

I found isotretinoin gel effective, but it is no longer made. There is a 2002 study comparing isotretinoin gel and adapalene gel that has no COI declaration, which states that adapalene gel is just as effective with lesser side effects.

In different therapeutic schemes, ADP is more effective in combination with other active substances. New topical combinations with adapalene include ketoconazole (antifungal), mometasone furoate (anti-inflammatory corticosteroid), nadifloxacin (fluoroquinolone), and alfa and beta hydroxy acids. Recent Advances Regarding the Therapeutic Potential of Adapalene, Rusu et al 2020

There is a natural retinoid that causes less irritation than pharma retinoids called bakuchiol. According to an article on harvard.edu, more research is needed to prove its efficacy. “File bakuchiol under the “promising, but unproven” category.” Bakuchiol: Does it make skin look younger?, Stephanie Watson 2022. There is a more upbeat article on draxe.com: Bakuchiol: A ‘More Natural Retinol’ That’s Equally Effective for Skin, Christine Ruggeri 2020

Antivirals

Facial Herpetic Folliculitis Should Be Concerned in the Clinic: A Retrospective Case Series, Cao et al 2022

Radio Frequency (RF) Treatments

It is unlikely I will be finding high quality studies for light and RF therapies, given that the Singapore review rates these treatment modalities as Level 2 Grade D.

Examples

Shower Filters

https://chriskresser.com/is-your-daily-shower-making-you-sick/

For those that don't have water filtration for the entire home, a shower filter can reduce the amount of chemicals reaching your skin. The sources I have for information may be biased since they are commercial, but it's what I have for now.

According to tappwater.co, which sells filters, shower filters do not filter chloramines:

Chloramines are used instead of chlorine by some public water suppliers. Many of the shower filter brands and especially vitamin C ones claim that they can also remove chloramines.

There are no conventional shower filters that will remove more than a small amount of chloramines from your shower water.

San Francisco Public Utilities Commission states on their website that only Vitamin C can be used to remove chlormaines from municipal water but the test was carried out using 1000 mg of Vitamin C in bath water,

On the other hand there is plenty of evidence that it will not be as effective for a shower filter. Screw on type of shower filters that claim to eliminate choramines are unlikely to work. While they may reduce chloramines slightly, it is highly dubious that they actually eliminate chloramines because the flow of water through a shower filter is too high to result in contact of the water with the filtering compound for a long enough duration of time.

Be sure to check out the claims of these chloramine filter manufacturers. Ask for independent research that proves the effectiveness of their shower filters. You probably won’t find it. We haven’t been able to find any. Facts about water in your shower are very important to be known.

The only way to effectively remove chloramines in your shower is to have a whole house filtration system.

Also on the same page:

9. Vitamins C infused shower filters are better for the skin

Probably false.

According to Patricia Farris, a doctor that specialises in dermitology Vitamin C has lots of benefits for the skin. It can be absorbed through the skin if it is formulated properly. Vitamin C can soften lines and wrinkles by boosting collagen production, lighten hyperpigmentation, and protect the skin from UV damage.”

But will it work with a shower filter? “Most likely not. While a vitamin C-infused shower sounds good in theory, it will probably provide very little skin benefit,” says Farris. “Vitamin C must be formulated and packaged in a very careful way in order to stabilize it and prevent it from becoming oxidized [which makes it ineffective]. If it’s just sprayed out of the shower, the majority of it will be inactivated rather quickly as it is exposed to air.”

There is no scientific evidence that Vitamin C showers benefit the skin.

I found a 3 stage shower filter by Pelican that claims to remove chloramines. On Amazon, in the Q&A, someone tested the chloramine removal and answered that it was only a 50% reduction, which I guess is about as good as it's going to get for a shower filter.

Laundry Detergent

Do not use standard laundry detergent. Not only does it add toxins to your clothes that transfer to your skin, it leaves a residue that builds up over time. I have been using only “washing soda” (I've only found the arm and hammer brand), plus a small amount of laundry detergent (labelled “for sensitive skin” “free of dyes and fragrance”). I use a shout brand stain remover to treat stains before washing (or if I find a stain that didn't come out in the wash). Stain removers have enzymes to clean other types of stains not covered by washing soda.

DIY laundry detergent:
Approximate ratio of 5 parts washing soda to 1 part “free and clear” type laundry detergent and/or a tablespoon of dishwashing soap.

DIY fabric softener:
Vinegar + essential oil.

Also see: Tub Clean Cycle

Notes that went into forging the above:

Differences between baking soda, washing soda, and borax, onegoodthingbyjillee.com

There are many DIY recipes for making laundry detergent, and they are overly complicated. I don't have scientific proof. I read this one post by Edward and followed his advice:

I’ve read over your post with interest, however can I offer my humble opinion. I think you have several unnecessary ingredients here that are actually doing the same thing, which you can see when you consider what they break down to once they are put in water. Let me illustrate. Firstly, the sodium bicarbonate or baking soda, NaHCO3, is just producing a single protonated form of the carbonate ion CO3 which is just acting as a buffer to the alkalinity and counteracting the effect of the washing soda, Na2CO3, which when it hits the water will also form HCO3 by increasing the pH. So unless you really need the pH to be neutral (if you are washing extremely delicate fabrics), you are actually reducing the efficacy of your other washing soda ingredient.

However, with that removed you are still doubling up on ingredients here because when you add the sodium percarbonate (oxyclean, 2Na2CO3.3H2O2) to the water it decomposes into hydrogen peroxide (oxygen bleach) and washing soda (Na2CO3), so you could leave out the borax (source of oxygen bleach and water softener) and washing soda (anion to ~~lower~~ raise pH and water softener) since sodium percarbonate decomposes to produce both. Alternately, you could leave out sodium percarbonate and washing soda and use borax (Na2B4O7·10H2O) alone to produce oxygen bleach, lower the pH with the [B4O5(OH)4]2- ion and act as a water softener. Thirdly, you could leave out both the percarbonate and borax and use washing soda (Na2CO3) to get a high pH and soften water if you didn’t want oxygen bleach, or use half the washing soda and half of ONE OF the borax OR percarbonate to get a smaller oxygen bleach effect. It seems to me all you really need is one of these three combined with the actual soap (zota or fels) to get the effect you want, obviously using more to ensure that you still end up with the same effect. Hope this might help anyone tweak their mix to make it simpler.

I'm confused because both borax and washing soda are alkaline, so they both raise the pH.

I chose washing soda to use on all my clothes without worrying about the oxygen bleach in the other two products. I thought “bleach, oh no!”. I just looked up oxygen bleach: “Oxygen bleach is known as “color-safe” or “all fabric” bleach, since it does not degrade most fabric or strip most color if used correctly, though you must still test colorfastness before using.”1

There are sites that have sprung up that say DIY laundry detergent creates a buildup of dirt that you may not notice right away. They show picture examples of how dirty the water looks when they use regular laundry detergent on supposedly clean DIY laundry. For example, sheets that have been in service and washed in DIY laundry detergent repeatedly for a year. In this example, the sheets are first washed in the DIY laundry detergent, and then washed with regular store-bought laundry detergent like Tide brand. During the wash, the water looks dirty even though the sheets should be clean. I think these sites overlook the fact that they are using shaved bar soap as one of the ingredients, that may not rinse off quickly, and requires and extra rinse cycle. That they fail to think of this idea makes me suspicious of their motives: maybe these sites are backed by the manufacturers of laundry detergent. Tide costs a lot more per load than DIY. As mentioned above, my DIY is not 100% DIY, since I use plain washing soda with a little bit of store bought laundry detergent. I believe only the bar soap shavings would be hard to rinse off, not the washing soda. Another reason for a build-up occurring on laundry, is that you are using too much soap, regardless of the type. To test if this might be the case, after washing your laundry as you normally do, run the washer again without adding any soap, and halting the wash before the first rinse to see if the water looks murky. On the other hand, maybe the buildup is actually from dirt that cannot be cleaned by the DIY laundry detergent. Keep in mind, there is no such thing as living without dirt or bacteria, so if it looks clean, that's good enough. You can still wash with regular washing detergent once in a while, and enjoy the benefit of using less chemicals most of the time.

Non-Invasive Facial Cosmetics and Body Contouring

High Intensity Focused Ultrasound HIFU

Aloe Vera Gel instead of Ultrasound Gel

Ultrasound gel is used as a coupling medium in all ultrasound procedures to replace air between the transducer and the patient’s skin, as ultrasound waves have trouble in traveling through air.
…
At the borderline between media of distinctive acoustic impedances, some of the wave energy is transmitted and some is reflected. The larger the gap in acoustic impedance between the two media, the more prominent will be the reflection, and the less there will be the transmission. For diagnostic ultrasound (US), ultrasound gel having acoustic impedance comparable to soft tissue (1.6 Mrayl) is necessary for the complete transmission of ultrasound waves.
…
The acoustic impedance of the selected formulation (S1) was 1.45 Mrayl and the acoustic impedance of commercial gel (CG) was 1.5 Mrayl. The results showed that the acoustic impedance of both was very close and similar to the impedance of soft tissues (1.6 Mrayl). The intensity reflection coefficient tells us that 0.6% of sound waves reflect at the boundary between gel and human skin, while 99.4% transmit through the skin, and it is opposite without ultrasound gel. Preparation and Evaluation of Polymer-Based Ultrasound Gel and Its Application in Ultrasonography, Afzal et al 2022

Images recommended as acceptable by raters was 91.7% for Aloe vera lotion and 81.7% for commercial gel. Aloe vera Lotion Used as a Potential Alternative Couplant for Sonography, in a Low-Resource Health Care Facility, Paulinu et al 2022

Aloe vera- based gel is a feasible alternative to commercially available ultrasound gel on diagnostic ultrasound imaging Aloe vera (L.) Burm.f.-based gel as an alternative to commercially available ultrasound gel on diagnostic ultrasound imaging: a phantom study (pdf) Cabataña et al 2020

Household Cleaners

Easy DIY All-Purpose Cleaner, becauseturtleseatplasticbags.com, Marie Cullis

Safe and clean: 8 Non-toxic alternatives to common household cleaning products that contain harmful ingredients

Homemade window cleaner: vinegar, alcohol, drops of dish soap, drops of essential oil. Best DIY Window Cleaners and Tips for a Streak-Free Result, pella rush.com

Preventing Poison Ivy Rash

A rash develops not because you got the ivy on you in the first place, but because you fail to wash off the oil that the plant transfers to your skin. If you wash between 2 to 8 hours after exposure, you will avoid the rash.

Most people wash with only soap and water. Dish soap cuts through oil better than soap. But the secret is that you must use friction. A damp soapy wash cloth scrubbed on the skin will remove the poison ivy oil better than any soap alone.

source:
https://www.deeranddeerhunting.com/content/blogs/southern-hunting-for-whitetail-deer/how-to-never-again-suffer-from-poison-ivy

Personally, I have no experience with the rashes, as I am immune to poison ivy.

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