Most acne treatments work by drying out skin — with the logic that eliminating sebum eliminates acne. The usual result: dry, irritated skin and paradoxically more compensatory sebum production. Modern dermatology's approach is different: treat inflammation and the microbiome, not just sebum.

Acne Pathogenesis: Why Understanding It Matters

Acne isn't just excess sebum. It's inflammation of the hair follicle with four simultaneous factors:

1. Sebum overproduction — from androgens, stress, diet
2. Follicular hyperkeratinisation — dead cell accumulation blocking the follicle
3. Colonisation by C. acnes (formerly P. acnes) — opportunistic bacteria that multiply in anaerobic sebum
4. Inflammatory response — cytokine production causing redness and pustulation

A treatment that only attacks sebum without addressing the other three factors is incomplete.

Actives With Evidence for Mild to Moderate Acne

• Salicylic acid (BHA) — lipid-soluble, penetrates the pore, dissolves the sebaceous plug, reduces comedones
• Niacinamide at 4–5% — anti-inflammatory, reduces sebum, mildly antibacterial
• Prebiotics — rebalance the skin microbiome that favours C. acnes in imbalance
• Azelaic acid — antibacterial + anti-inflammatory + depigmenting for post-acne marks

What Worsens Acne and Appears to Improve It

High-concentration alcohol visibly dries active blemishes — creating the illusion of improvement. In reality, it dehydrates the barrier, increases compensatory oiliness and worsens the cycle.