Acne And Skin Aging

The relationship between acne and aging has several facets. It is well known that acne typically starts at a certain age (around puberty) and tends to either resolve or diminish in early to mid twenties. (Some people continue having outbreaks as late as the middle age.) Less known is the fact that untreated acne contributes to the process of skin aging. Furthermore, some acne treatments, even when they are effective, also accelerate skin aging.

Acne is a chronic inflammatory disease. Acne prone skin spends significant time in the inflamed state. Inflammation is a well-known accelerator of aging. Inflammation generates free radicals, activates matrix metalloproteinases (enzymes that break down the skin’s structural components like collagen and elastin), promotes excessive cell proliferation, etc., all of which contributes to skin aging. Treating your acne, at least to the degree of markedly reducing the number of inflamed lesions, is arguably the best skin anti-aging step you could make apart from sun protection.

How you treat your acne may have a major impact on the aging of your skin. As a general rule, any treatment that causes skin irritation and/or excessive skin dryness should be used cautiously. Irritation, by itself, promotes skin aging. Excessive dryness reduces the skin’s ability to heal itself. Certain acne treatments should be used with a particular caution (as far as skin aging is concerned).
Benzoyl peroxide

Benzoyl peroxide is a strong oxidizer that kills bacteria by generating oxygen free radicals. Topical benzoyl peroxide is one of the most effective topical acne treatments. It is highly effective in killing against P. acnes (acne-causing bacteria). Furthermore, benzoyl peroxide has an advantage over antibiotics because bacteria do not develop resistance to it.

Unfortunately, oxygen free radicals generated by benzoyl peroxide are damaging not only to bacteria but to your skin as well. They cause irritation and dryness, damage skin cells and skin matrix, and otherwise accelerate the rate of skin aging. An occasional, short-term use of benozyl peroxide produces relatively small long-term skin damage. On the other hand, long-term use of benozyl peroxide, especially at high concentrations, is likely to age your skin prematurely. It is worth trying safer alternatives first. Unfortunately, for many people, benzoyl peroxide is only effective topical treatment. In that case, it is prudent to find the lowest possible effective concentration. Concentrations of benzoyl peroxide as low as 2.5% may be effective, especially if combined with other treatments.
Topical retinoids

Topical retinoids are one of the common prescription acne treatments. Possible side effects include skin irritation, dryness, and sensitivity to UV light. Over the long run, chronic skin irritation may accelerate skin aging. Neglecting meticulous sun protection when using retinoids is likely to accelerate skin aging as well.

However, the situation with topical retinoids and skin aging is more complicated. In fact, tretinoin (Retin A), a widely used retinoid, is one of the very few drugs approved by the FDA as an anti-wrinkle agent. Indeed, when used prudently, retinoids actually reduce many signs of skin aging and may even inhibit some of the mechanisms of skin aging.

Some people with acne respond to the concentration of retinoids sufficiently low to avoid chronic, long-term skin irritation. In that case, one may get both anti-acne and anti-aging benefits. Others respond only to the formulations of retinoids strong enough to produce chronic irritation. In that case, other topical alternatives should be explored and/or steps be taken to reduce the irritation.
Exfoliation

Exfoliation with alpha or beta-hydroxy acids is a common component of acne treatment programs. Whether it is effective against acne and to what extend it debatable. Arguably, it may improve penetration of other treatments and, when done with salicylic acid, reduce the formation of comedones. Moderate exfoliation, especially with alpha-hydroxy acids, may also have some skin rejuvenation benefits. On the other hand, excessive exfoliation may lead to chronic irritation, skin dryness and sensitivity and actually contribute to the aging process.