Is acne caused by dirt or not washing my face enough?

Facial Cleansers are Popular OTC Acne Products

Answer: Not really.

Topical facial cleansers are generally ineffective treatments for all but the most mild cases of acne (Acne Type: 1). Medicated and non-medicated acne washes are widely available in grocery, drug and department stores as Over The Counter (OTC) products.

In most acne lesions (pimples, nodules, cysts, etc.), the site where the infection and inflammation is centered is not near the surface of the skin. Instead, it is near the base of the hair follicle where the sebaceous gland attaches. This is a region of the follicle that is not readily accessible from the surface. Therefore, cleansers and their active ingredients are unlikely to impact the inflammatory processes that drive moderate to severe acne symptoms (Acne Types: 2-4).

Topical Face Wash Acne Cleansers
Topical Face Wash Acne Cleansers

Commercials for acne cleansers often have animations that show their product blasting out the debris from deep within pores (follicles). In reality, this does not really happen because the follicle shaft is quite narrow relative to its depth. In addition, individuals with acne often have sticky “hyper-keratinized” plugs that are firmly lodged in the follicle. These plugs prevent surface-applied treatments from reaching the interior of the follicle. The inside of the follicle is mostly an anaerobic environment (low levels of oxygen). The interior of the follicle has a different composition of resident bacteria than the surface of the skin.

The plugs that clog follicles and contribute to acne do not usually come from dirt or grime on the surface of the skin. Rather these pore-clogging plugs come from sebum, keratin and cell debris which is all produced deep within the follicle. Sebum is a natural product of the sebaceous glands and is responsible for lubricating and protecting healthy skin.

Propionibacterium acnes (Toyoda, et al)
Propionibacterium acnes (Toyoda, et al)

It is important to recognize, however, that foreign debris and bacteria on the surface of the skin can aggravate acne symptoms. This is especially true if you pop a pimple or damage the skin, which allows surface debris and bacteria to enter the open wound. This can potentially cause increased inflammation and even a secondary infection, both of which can exacerbate existing acne symptoms.

Cleansers and Acne: The Positives

Salicylic Acid Cleanser Wash (Neutrogena)
Salicylic Acid Cleanser Wash (Neutrogena)

Twice daily use of non-medicated gentle facial cleansers was shown to decrease the number of open-comedos (blackheads) in a small study. However, non-medicated cleansers had no measurable effect on closed comedos and inflammatory acne (whiteheads, nodules, cysts). This is most likely due to the concept mentioned above, that the plug blocking the follicle is not easily accessible from the surface in closed comedo and inflammatory acne lesions.

In the case of a blackhead (open-comedo), the plug is very near the surface of the skin, and is therefore more susceptible to to the action of cleansers. Another study by the same research group showed that a medicated cleanser that contained Triclosan, Salicylic Acid and Azelaic Acid (antibacterial and keratolytic agents) was capable of decreasing the number of acne lesions when compared to a non-medicated control.

Salicylic Acid Cleanser Pads (AcneFree)
Salicylic Acid Cleanser Pads (AcneFree)

Triclosan, Salicylic Acid and Benzoyl Peroxide are common ingredients in Over The Counter (OTC) acne treatments. The available research indicates that when cleansers are used in moderation they can be helpful in reducing minor acne symptoms for some patients.

It is important to note that most of the OTC medications have the same ingredients, and many acne sufferers use several of these products at the same time. This can easily lead to excessive use of this class of acne product. The most common result of overuse of these products is dry and irritated skin. The positive effects of keratolytic agents and mild anti-bacterial compounds like triclosan are not cumulative and excessive use is likely to lead to more damage than benefit.

Cleansers and Acne: The Negatives

The primary concern associated with acne face and body washes is overuse. When you have acne, you want to do something about it. That’s a natural response, but all too often that desire to act translates into an over-kill approach, like excessive face washing. Most of the research studies on acne and acne facial/body cleanses found that using these products more than twice a day causes more harm than benefit.

Excessive use of acne washes can leave your skin dry, cracked and irritated.
Excessive use of acne washes can leave your skin dry, cracked and irritated.

Excessive use of cleansers or other abrasive products the skin is likely to aggravate acne symptoms. Excessive washing or use of harsh products can damage and irritate the skin, leading to cracking, redness, inflammation, discomfort and ultimately worsen acne symptoms. The general rule of thumb is to use gentle cleanser in moderation to keep the skin clean. Washing the skin more than that is unlikely to provide much benefit and is more likely to make symptoms worse.

It is also important to limit your expectations for how helpful cleansers and face washing are going to be for your acne. Keep in mind that even the studies that show that cleansers help acne are only talking about moderate improvements for people with mild acne.

Overall, the consensus of scientific research does not suggest that cleansers help moderate to severe inflammatory acne. At no point do any of these research results indicate that cleansers can “cure” acne. At best, cleansers can only be expected to marginally improve acne symptoms.

References and Sources

How to Wash Your Face: America’s Leading Dermatologist Reveals the Essential Secrets for Youthful, Radiant Skin. Kenet, et al. 2002.
A Consumer’s Dictionary of Cosmetic Ingredients, 7th Edition: Complete Information About the Harmful and Desirable Ingredients Found in Cosmetics and Cosmeceuticals. Winter. 2009.
Acne Vulgaris. Shalita, et al. 2011.
A systematic review of the evidence for myths and misconceptions in acne management: diet, face-washing and sunlight. Magin, et al. 2004.
A Single-Blinded, Randomized, Controlled Clinical Trial Evaluating the Effect of Face Washing on Acne Vulgaris. Choi, et al. 2006.
A study of the efficacy of cleansers for acne vulgaris. Choi, et al. 2010.