Best Acne Skincare: Effective Skin Ingredients
The best acne skincare regimen? Using adaptogens in dermatologist formulated acne care
What is the best acne treatment? The ingredients in your skincare products are essential for acne treatment. In this first article of a series on adaptogenic skincare we will introduce the best skincare products for acne treatment. We cover the best face masks containing adaptogenic skincare ingredients targeting acne prone and oily skin types, used in Singapore.
Dr. TWL Pharmacy specializes in custom compounded therapeutic skincare dermatologist formulated for acne prone and sensitive skin. This article is written in conjunction with our chief scientific officer, board-certified dermatologist Dr. Teo Wan Lin, and is vetted for scientific accuracy. Dr. Teo is the author of “The Maskne Microbiome” a peer-reviewed scientific research paper in publication with the International Journal of Dermatology in 2021.
We cover the 5 best acne skincare products available in our pharmacy – incorporating adaptogens that regulate the skin microenvironment and improve skin resilience.
What is adaptogenic skincare?
Many ethnobotanical ingredients have been reported to have therapeutic dermatological effects, mostly from ingredients like flavonoids, saponins, polysaccharides, alkaloids, and others that are prevalent in botanical ingredients.
Adaptogens are plant extracts or natural compounds that increase the ability to adapt and respond to stress. These have been used in ethnobotany and borne out by modern dermatological research.
How is adaptogenic skincare beneficial for skin conditions such as acne and eczema?
Research shows that stress, whether emotional, physical or environmental, plays a large role in skin health. Inflammation caused by stress plays a key role in common dermatological conditions such as acne, psoriasis, eczema. Therefore, incorporating adaptogenic ingredients in your skincare that have anti-inflammatory, soothing properties can help to support the skin’s stress response.
Adaptogenic skincare- the best acne treatment?
Many treatments for acne, such as antibiotics, decrease inflammation or kill bacteria. However, many of these antibiotics also lead to side effects or antibiotic resistance. Therefore, dermatological research has increasingly focused on natural drug treatments with high antibacterial activity but fewer side effects to treat acne.
Adaptogenic ingredients are one of the best candidates for this. Rich in antioxidants, many of these ingredients have anti-inflammatory, antibacterial properties, making them one of the best acne treatment.
The science of an effective acne care regimen- active ingredients
This interview with Dr. Teo Wan Lin highlights the benefits of a key botanical extract in our mask peel series – tanshinone.
What is Tanshinone and how does it treat acne?
Tanshinone are a class of naturally-occurring chemical compounds isolated from the roots of the herb Salvia Miltiorrhiza, or red sage. Salvia Miltiorrhiza, was first recorded in “Puji Fang (Prescriptions for Common Benefit)” in 1406 for acne treatment. Since then, scientific research has shown that tanshinone is effective for anti-acne treatment.
Anti-Acne Treatment with adaptogenic skincare
What is the science behind the effective active ingredient that fights acne?
The main active compound in tanshinone is cryptotanshinone (CPT), which has demonstrated anti-acne effects through a few key pathways.
Firstly, CPT regulates glycolysis metabolism. Glycolysis is a key metabolic pathway that provides energy for cellular activities. Decreased glycolysis has links to a reduction in cell differentiation in keratinocytes, a type of skin cell. Excessive keratinocyte differentiation has been linked to acne. Research shows that mice treated with CPT had a negatively regulated glycolysis pathway, a decrease in keratinocyte differentiation, and improved cellular barrier function1.
Additionally, CPT upregulates linoleic acid. Linoleic acid is an essential unsaturated fatty acid that plays a key role in inflammation. Studies show that linoleic acid undergoes downregulation in acne subjects. CPT was shown to upregulate linoleic acid, which was consistent with the study’s histopathological analysis showing that acne mice returned back to normal after CPT treatment1.
Anti-inflammatory effect for acne-prone skin
The best acne treatment is one that also improves the microbiome without causing antibiotic resistance
Propionibacterium. acnes is a gram-positive bacteria that causes acne on the skin. The bacteria releases lipase, enzymes that break down sebum, which subsequently produces fatty acids. This accelerates the inflammatory response of acne. Inflammatory acne lesions usually develop into papules, pustules, nodules, or cysts.
Research has shown that tanshinone, or more specifically Tanshinone IIA, is effective at relieving inflammation caused by the bacteria P. acnes in vitro2. Tanshinone IIA had an inhibitory effect on key acne inflammatory pathways, which lead to reduced inflammation. To illustrate, this can lead to an inhibition of the growth of P.acnes.
A few scientific studies have explored combination therapy with tanshinones with traditional acne treatments. 5-Aminolevulinic photodynamic therapy (5-ALA PDT) describes the application of topical aminolevulinic acid (ALA) followed by red or blue light exposure for acne treatment. It is a well-tolerated, antibiotic free therapy that studies have found to be highly effective for acne treatment3. 5-ALA PDT is not usually the recommendation for patients with cystic acne as thick cyst walls result in ALA not undergoing absorption effectively. Clinical results have found that tanshinone combined with 5-ALA PDT was effective in the treatment of cystic acne, reducing the number of and improving the severity of acne lesions, with more significant clinical effectiveness when used in conjunction with each other4.
Review of the 5 Best Acne Treatment available at our Pharmacy
Acne Mask Peel Range
The mask peel series contains one formulate specifically for acne oil control, the Sebocontrol face mask peel. A mask that is also a peel? This series features a 2-in-1 formulation including potent adaptogens that target the root cause of acne.
“Traditional acne treatments focus on reducing oil production. Tretinoin, a vitamin A derivative for example targets the oil glands. Similarly with Isotretinoin, a medication that stops oil production altogether. However, increasingly we know that overactive oil glands is not the only cause of acne. Rather it is a combination of factors including excessive inflammation and factors that affect the local skin microenvironment. For example, the bacterial balance called the microbiome. Oxidative stress caused by environmental damage, air pollution, UV damage worsen lipid peroxidation. For acne prone oily skin, the excess sebum does not just cause a shiny complexion, it actually worsens inflammation. Inflammation is the driving force behind whiteheads and blackheads forming eventually causing acne cysts and papules. Adaptogens are key molecules that target inflammation and are hence important in an acne skincare regimen. To illustrate, this is also the foundation of our mask peel series, developed for resilient skin,”
High Potency Spot Therapeutics -Blemish Spot Treatment
The focus of the high potency spot therapeutics series is replacing the need for traditional acne spot treatments which frankly have become much less effective and relevant due to antibiotic resistance. To illustrate, the emerging concept of the acne microbiome means broad spectrum antibiotics are actually harmful. Much more concerning is the effect on the human body overall, breeding resistance to antibiotics because of acne treatment is not a good trade-off.
Besides, the clear message is this. All antibiotic-based acne creams, lose effectiveness within a short period. The reason is that acne is not a problem with bad bacteria alone. Cutibacterium exists on the skin of healthy patients without acne as well. The key here is that the entire skin ecosystem works against those with acne prone skin. From the oil production perspective, bacterial balance to inflammatory processes in place. The high potency spot therapeutics Blemish Spot Mask Peel incorporates adaptogens that impact on skin resilience. Therefore, this means that it can target multiple pathways described in acne development.
Papain Enzyme Chemical Peel
Papain developed from the tropical papaya plant is a key example of an adaptogen with good acne treatment effects. Chemical peels are used in acne treatment because it exfoliates dead skin cells. In addition, effective acne treatment strategies include reducing follicular hyperkeratosis. This refers to the retention of dead skin cells around the hair follicles. The pores on the face for example are actually hair follicles associated with pilosebaceous glands. The pilosebaceous glands are oil producing glands. For effective acne treatment, dermatologists prescribe ingredients that reduce acne inflammation and oil production.
Benefits of papain
A more effective strategy is to regulate oil production rather than stop it altogether. For example, isotretinoin is regarded as the gold standard for cystic acne. However because it stops the action of oil glands completely, severe eczema especially of the lips is a common side effect. Papain checks all the boxes of reducing inflammation, without causing dryness, in fact, it has a moisturising effect. At the same time, it increases skin exfoliation. This helps prevent follicular hyperkeratosis in acne prone individuals. Additionally, papain peels contrast with traditional AHA, BHA peels which cause increased sun sensitivity, skin redness, and irritation. The papain peel is developed especially for Asian skin types living in tropical climates like Singapore. Singapore’s climate with year round UV exposure increases the risk of sun sensitivity after chemical peels, a problem for those who undergo regular office peels for acne.
Another benefit is that papain peels can also treat and improve acne scars. Post inflammatory redness occurs immediately after acne resolves. This can quickly turn into hyperpigmentation. Hyperpigmentation is worse in Asian skin types. Hence, using papain enzyme peels achieves a dual purpose of treating acne and scars.
Blemish Spot Cream
The Blemish Spot Cream is the best-selling plant-based pimple cream in our local Singapore pharmacy. It is the first spot therapeutic developed on the adaptogen concept and launched in 2018. The key here is that it addresses sebum control, inflammation, and oxidative stress with plant actives. We successfully phased out antibiotic gels and benzoyl peroxide in our practice with this. However, one must bear in mind that topical acne treatments are sufficient for mild to moderate acne treatment, and for severe acne, oral medications or light therapy will be required. Topical acne treatments are essential for all types of acne. In summary, it is the key step that ensures successful acne care and maintenance after oral treatments stop.
SilkPeel with Medifacial Essence
This acne care product fuses an office procedure- microdermabrasion, with adaptogenic skincare. The custom medifacial solutions with key actives such as CICA allow for careful selection of antioxidants that improve skin resilience for acne prone patients. The resurfacing process is ultra gentle, and suitable for home use. Evidently, this is proven to improve skincare absorption. Furthermore, resurfacing achieves the skin cell renewal required to improve acne skin.
 Zhu, Z., Chen, T., Wang, Z., Xue, Y., Wu, W., Wang, Y., Du, Q., Wu, Y., Zeng, Q., Jiang, C., Shen, C., Liu, L., Zhu, H., & Liu, Q. (2021). Integrated Proteomics and Metabolomics Link Acne to the Action Mechanisms of Cryptotanshinone Intervention. Frontiers in pharmacology, 12, 700696. https://doi.org/10.3389/fphar.2021.700696
 Li, Y., & Zhou, Y. (2018). The therapeutic effect of tanshinone IIA on Propionibacterium acnes-induced inflammation in vitro. Dermatologic therapy, 31(6), e12716. https://doi.org/10.1111/dth.12716
 Tao, S., Wang, Z., Quan, C., Ge, Y., & Qian, Q. (2021). The effects of ALA-PDT on microbiota in pilosebaceous units of patients with severe acne: A metagenomic study. Photodiagnosis and photodynamic therapy, 33, 102050. https://doi.org/10.1016/j.pdpdt.2020.102050
 Yao, Y., Zuo, J., & Chen, L. (2021). Clinical efficacy of tanshinone capsules combined with varying concentrations of 5-ALA-PDT in the treatment of cystic acne. American journal of translational research, 13(9), 10816–10822.