Clear Skin & Pore Perfecting

Procelain beauty means clear skin and perfect pores - achievable for you? Filters on our devices are there for a reason - you want that look!

First, we talk texture. Then we share with you Pulsar Health's Skincare 101. To learn more about refining skin texture, please refer to the Aging Skin section. The rest of this section focuses on banishing breakouts, clear skin ingredients, and drugs for acne.

If you want clearer skin, call Pulsar Health in West Palm Beach, FL today. 

Clear skin & pore perfecting

The fight for pore perfection has been raging for decades! Very little actually shrinks the pores permanently, but we have many treatment options now for unclogging pores and improving skin texture. Of all the signs of aging or an "imperfect complexion", skin texture is the most subtle and yet one of the most powerful parts of our appearance - hence the popularity of filters on our phones and zoom!!!

So how do you get great skin in real life, not just the digital world?

Clear skin is a balance of:

• adequate hydration for plump skin cells - that is both moisture and oil (see section on Dehydrated Flaky Skin) 
• even pigment or freckles that you adore (see section on Pigmentation Problems)
• the right amount of cell turnover helping with texture and glow - more on this below
• good elastic support underneath it to prevent cracks and folds (see section on Aging Skin)

Texture issues can happen in dry or oily skin, and breakouts in sensitive rosacea skin or combination acne-prone skin. Your basic skincare regimen is critical in getting the right balance of hydration, anti-oxidant protection and skin turnover happening. Spa treatments, like dental cleanings or more invasive fillings, treat and prevent for deeper issues, but in a much nicer way than visiting the dentist, not that we don't love our dentists!

Pulsar Health's Skincare 101:

1. Choose a cleanser based on your skin type and needs. They come in basic to complex varieties, and the best one for you depends on what other conditions are happening. At the simplest level, gel cleansers for more oily skins, cream cleansers for drier skin, and lightly exfoliating cleansers for aging skin are a general guideline. If you need a separate make up remover, start with that before the cleanser, and remember that cooler water is better for your skin.
2. Toners were big in the past, but these days more bio-active serums have replaced them as products tend to be fairly pH balanced without needing a specific toner. These serums target specific issues. This is where the Vitamin C / E / B3 or stem cells / peptides pack a punch. They can help with hydration, skin-barrier renewal, cell turnover, brightening skin or controlling pigment. The different ingredients listed in the Smooth Skin & Happy Hair Days educational sections of this website (Pigmentation Problems, Why the Red Face?, Dehydrated Skin, and Aging Skin) can help you assess what may be good for you, but if you aren't sure, come in for a skincare consultation and we can guide you as to which of your current homecare products are good for your particular skin condition, and if you are missing something significant that would help. 
3. Moisturizing creams are next if you need more coverage than a serum, and/or spot treatments such as peptide creams to soften fine lines or eye creams.
4. Sunblock in the mornings +/- make up (not make-up containing sunblock), non-comedogenic (won't clog your pores).

Avoid touching your face between washing it morning and night. If you sweat a lot, washing after working out may be helpful. You know to avoid popping pimples! You can get spot treatments that dry them up faster. Clean towels and sheets can reduce oils and mites (eeks) that may worsen breakouts and sensitivity. In the post-Covid era, make sure your masks are clean/fresh! The right amount of humidity also helps protect skin condition, as well as drinking plenty of water and eating well (see section on Dehydrated flaky skin). LED light at home can help some conditions, such as blue light for acne breakouts. Adequate recovery and relaxation in our busy lifestyles is important in giving skin space to heal, as well as allow our nervous system and hormones to reset.

That's basic daily skincare in a nutshell, but a deeper exfoliation and rejuvenating mask weekly is very helpful. For example, a sulfur mask can breakdown blackheads. Some exfoliators are used most days as they work as a very light chemical peel, whilst others are more intense and just done once or twice / week. Ingredients these may contain are glycolic acid or azelaic acid, which we will discuss in more details in the peels below. Retinols and retinoids in your basic skincare also help with cell turnover, which is so important for texture and avoiding breakouts.

To learn more about refining skin texture, please look at the section on Aging Skin. The rest of this section deals with breakouts.

Banishing Breakouts!

Breakouts occur from a toxic combination of dead skin cells building up, sometimes with excessive sebum production, and bacterial infection. The major bacterial culprit is Cutibacterium acnes - cute new name for what was formerly known as Propionibacterium acnes. Below is a discussion on why clear skin and avoiding breakouts has a lot to do with proper peeling for pore perfecting!

So what are pores? This is a simple question that many people don't know the answer to. Your pores are the tiny openings onto your skin surface made by the "exit site" of your sebaceous glands and hair follicles. Sebaceous glands produce sebum, the oily substance that lubricates the skin and prevents it from losing moisture and cracking. Sebum is also antimicrobial, both antifungal and antibacterial.  Dry skin is associated with underproduction of sebum (or loss of it). Sebum functions as an emollient, so people with dehydrated skin benefit from having emollients, humectants, and products that restore the skin barrier put back in (see section on Dehydrated flaky skin), but even dry skin can have breakouts because dehydration can thicken sebum leading to clogged pores. Oily skin tends to produce more sebum. Sebum production is affected by diet and hormones, such as increases in response to male hormones (androgens like testosterone). This is one of the reasons why puberty triggers acne.

Sebum secretion can get blocked by the buildup of dead skin cells, which shows up on your skin as a blackhead (comedo). If the upper portion of the opening is also blocked by more skin cells, it is called a whitehead, and requires a lancet in the hands of a skilled aesthetician to release it. If the blocked pore then gets infected, you have a pustule. Pustules can develop into larger nodules and cysts, and even cause scarring and hyperpigmentation (darkening of the skin color). 

Before you turn to medication for breakouts and acne, spa treatments are important in gently exfoliating and peeling your skin without stripping it of the right balance of oils and moisture. If you have regular breakouts, you need regular facials!!! Getting the pores unclogged and cells turning over in a healthy way without exacerbating the inflammation is one the skills of a great aesthetician.

We use vapor (either cold or steam depending on the skin condition), enzymes, and / or light peels to loosen up the skin surface and start unclogging pores. Blackheads and whiteheads are then addressed, followed by other methods to gently unclog pores and remove the top surface of cells. Calming and nourishing the skin follows, and often we use LED lights to further kill bacteria and gently stimulate the skin.

Peels designed for breakouts and acne are more intense, but there is definitely a time and place for them in improving your skin's condition. The VI Peel is good for all skin types and has specialty peels such as VI Peel Purify for active acne and oily congested skin, as well as VI Peel Purify with Precision Plus for acne with hyperpigmentation or scarring. Glytone's Salicylic acid peels are a great way to get on top of active acne, and control the situation in a series of four peels each spaced two to three weeks apart. 

Clear Skin Ingredients

Ingredients to look out for in getting clear skin and preventing breakouts are:

• Salicylic acid - aspirin converts to salicylic acid in the body, but here we are talking about topical application (on the skin) of various concentrations of salicylic acid. It is a beta hydroxy acid (BHA) that is excellent at unclogging pores and releasing the top dead layers of skin cells. It also, like our old friend aspirin, decreases redness and swelling if used correctly. At higher concentrations, it is used in spa peels, and at lower concentration, in home skincare. For example, Image skincare uses salicylic acid in their Clear Cell line in the cleanser, acne spot treatment, and clarifying masque.
• Benzoyl peroxide - another common ingredient of acne skincare lines, benzoyl peroxide produces free radicals that kill the bacteria contributing to breakouts. It can have a bleaching effect as the name peroxide suggests (so don't use your best pillowcases!), as well as be quite drying and irritative, so may be combined with soothing ingredients such as aloe vera or arnica (pineapple extract) to counteract this. Consider using benzoyl peroxide as more of a spot treatment. It can also sensitize to the sun, so be sure to wear a sunblock. Blue LED light can reduce bacteria and may be easier for your skin to tolerate.
• Azelaic acid - a dicarboxylic acid antioxidant that is useful for calming inflamed skin in acne, rosacea and melasma, but it can initially irritate the skin until the skin gets used to it. It is "weaker" than benzoyl peroxide in treating acne, but better over the long term as the concentration or frequency can gradually be increased, and it can help reduce hyperpigmentation from acne scarring by inhibiting tyrosinase. Tricks to help tolerate it better initially are to start by using only a small amount after your moisturizing cream to slow down penetration and hence irritation. We carry it at Pulsar Health in Glytone's Enhance Brightening Complex, where it is combined with glycolic acid
• Glycolic acid - an alpha hydroxy acid (AHA) found in foods such as sugarcane. In skincare and peels, it is used in a variety of different concentrations. Like other AHAs, it removes dead skin cells (unclogging pores!) to improve texture, skin tone and the appearance of fine lines. It penetrates deeper into the skin than the other AHAs (see section on Pigmentation Problems for more information on Mandelic Acid and Lactic Acid), so is used in stronger peels. Anti-aging peels even go up in strengths such as 30%, 50% and 70% glycolic, but we only use the strongest peels in light skin tones. Glycolic acid is great for skin turnover, but use it carefully to avoid irritating the skin.
• Gluconolactone - a polyhydroxy acid (PHA), gluconolactone can be derived from corn and is gentler than glycolic acid at exfoliating. Additionally, it binds free radicals and strengthens the skin barrier function, helping with hydration and protecting from UV damage.
• Niacinamide (Vitamin B3) - an all-star player that is helpful in many skin conditions. It is broken down to the coenzyme nicotinamide adenine dinucleotide (NAD) which carries out the work. Some of the mechanisms are not clear, but it appears to reduce pore size by an effect on the pore lining, brightens skin and reduces sallow color, helps restore the skin barrier function, and reduces chronic inflammation. It plays well with many other skincare ingredients.
• Retinoids, Retinols and Bakuchiol - these Vitamin A derivatives are powerful at creating skin turnover (promote keratinocyte differentiation whilst reducing proliferation) which cuts down on the number of dead skin cells and blackheads. Retinoids include prescription and over the counter medication, whilst retinols are usually topical over the counter products as they are weaker. Bakuchiol is a naturally derived ingredient (from the Babchi plant) which can function as an alternative to retinol, and tends to be more anti-inflammatory and soothing whilst still helping with cell turnover. production. See the medications for acne section below for more details on prescription products used in acne treatment.
• Resorcinol - related to plant phenolics (contain phenol), it has antioxidant and numbing properties as well as functioning as an antiseptic to reduce the bacterial issues in acne. It can be irritating / sensitizing at higher concentrations. Hexylresorcinol can inhibit sebum overproduction.
• Tea tree oil and cinnamon bark - natural substances which are antimicrobial so can help in acne. Botanical ingredients are often added to other formulations to augment results.

Doctor prescribed Drugs for Acne

Medications for breakouts are based on antibiotics or retinoids, although sometimes hormone therapy (oral contraceptives or spironolactone for women to reduce sebaceous gland activity via blocking androgens) or steroids (to calm extreme inflammation) are used. Medications can come in topical (apply on the skin) or oral forms. 

The biggest gun in the gun cabinet is Isotretinoin, an oral retinoid that is prescription only as it can be dangerous for the fetus in pregnancy, as well as being linked to inflammatory bowel disease and depression. It is used to treat very severe acne, and treatment usually lasts months to years. A side effect is very dry flaky red skin. It can work in conjunction with antibiotics or by itself. 

Topical retinoids are applied as creams, gels or lotions, and include tretinoin (Retin-A), adapalene (differin), tazarotene and trifarotene.

Commonly used oral antibiotics in the management of acne are the tetracyclines minocycline or doxycycline, or the macrolide antibiotics erythromycin, azithromycin or clindamycin. Topical forms are often combined with benzoyl peroxide to minimize creating resistance to the antibiotic. Topical clindamycin (cleocin) and erythromycin (erygel), minocycline foam (amzeeq), and dapsone (aczone topically; a sulfone antibiotic used for leprosy orally) are some topical forms of antibiotics that can be used.

Once breakouts have formed scars or hyperpigmentation, that warrants further treatment. Please see the sections on "Pigmentation Problems" and "Wounds, Scars and Surgery for Moh's" for more detailed information on these. In brief, acne scars can be treated with peels, microneedling (with or without radiofrequency), dermabrasion, carbon dioxide laser resurfacing, PRP "bio-fillers" /fillers, or surgery. Come in for a consultation for your personalized recommendations.