Pas poses this puzzler: I’m currently using Murad’s acne treatment kit and was curious about its use of sulfur, which I have not seen before. How does sulfur help treat acne?

The Right Brain unravels the riddle:

The Murad line of anti-acne products are proud of the fact that they don’t use benzoyl peroxide, an approved over the counter drug that can be drying to your skin. Instead Dr. Murad formulated his Acne Spot Treatment with sulfur, an approved over the counter drug that can be drying to your skin. Go figure!

Why sulfur?

Sulfur is a yellow crystalline mineral that has long been used for its medicinal properties. It’s considered an essential element for life because it’s present in two amino acids.

Sulfur has been used for a loooooong time to control acne even though we don’t know the exact mechanism that makes it work. It’s suspected that it causes the skin to peel and shed excess cells. Some researchers, according to Skincarephyscians.com, believe that it can actually make acne worse by promoting blackhead and whitehead formation through increased cell adhesion. If you haven’t heard of sulfur in acne products before, that’s probably due to the fact that it’s not commonly used today because it has an unpleasant odor and it can discolor the skin (in addition to being drying.)

The Beauty Brains bottom line

If you’re sensitive to products that contain benzoyl peroxide and you’re looking for an alternate active ingredient, then Murad Acne Spot Treatment might be a good option for you. But be warned, some of the items in the Murad line are a bit expensive! (See below for some examples.)

What do YOU think? Do you have a favorite anti-acne active that you’d like to share with the rest of the Beauty Brains community? Leave a comment!

References:
Skincarephysicians.com
Acne.org

Sarah (no relation to Sarah Bellum) says: You guys are great– the Mythbusters of Makeup!! I’m concerned about my acne cover-up. The salicylic acid in Maybelline Pure Concealer is supposed to be good to banish zits, but are the other things that make it a waxy stick actually worsening my acne? Is a cream concealer better? Thank you!

The Right Brain responds:

Thanks for the kind words, Sarah. If the Left Brain wasn’t so afraid of getting sued, we probably would change our name to “Makeup Mythbusters.” But for now, you’re stuck with the Beauty Brains.

You raised a good question about concealer sticks. Will all those heavy, waxy chemicals clog our pores? The answer lies in the acnegenic nature of the specific chemicals in the formula. Allow me to explain:

Does the product claim to be non-comedogenic?

First of all, read the label. The only way to tell FOR SURE if the product will cause acne is to test it, and if the company spent all that time and money on testing, they’ll most certainly put “non-comedogenic” on the label. (”Comedogenic” is the sciencey way to say “causes acne.”) Looking at Maybelline Pure Concealer we do NOT see this claim on the label so we have to assume it’s not tested. So now what do we do? We need to dig a little deeper.

Does the product contain any comedogenic ingredients?

The next approach is to see if any of the ingredients in your product cause acne. Each chemical used in a cosmetic can be tested individually for comedogencity, They are generally rated on a 5 point comedogenic scale: a 0 means non-comedogenic. 1 - 2 means slightly. 3 means moderate and 4 or 5 means zit city! So if you know where to look, you can check the ingredients listed on the label on the back of the pack to see if they cause acne.

Let’s look at our Maybelline example again: Are there ingredients in the formula that are moderately or severly comedogenic? Here’s what’s in the product:

Cyclopentasiloxane; Cetearyl Behenate; Laureth-2 Benzoate; Octyldodecanol; Synthetic Beeswax; Nylon-12; Tocopherol; Caprylic/Capric Triglyceride; Chamomilla Recutita (Matricaria) Extract; Aloe Barbadensis Leaf Extract. May Contain: Titanium Dioxide; Iron Oxides; Mica. Active ingredient is salicylic acid.

Checking some online lists of comedogenicity ratings we see that Octylodecanol and Caprylic/Capric Triglyceride can be “moderately” comedogenic. (Keep in mind there are literally thousands of ingredients and it’s impossible to find test data on every single one.) So does mean you shouldn’t use Pure Concealer? There’s one more question we need to ask.

Does the product contain large amounts of those ingredients?

Once you’ve identified that a product does have one or more comedogenic ingredients, you need to figure out how much of those ingredients are in the product. Low levels of acne causing chemicals may not cause breakouts at all. You can’t tell for sure without seeing the percentage of each ingredient in the formula, but you can make a pretty good guess if you know that in the US, cosmetics ingredients are listed in order of descending concentration above 1%. Below 1% they can be listed in any order. So if a couple ingredients with moderate to severe comegenicity scores show up on the first 5 or 6 ingredients in the formula, there may be cause for concern.

Looking the ingredient list for Maybelline we see that Octyldodecanol is the 4th ingredient so it’s probably in the formula at a fairly high concentration. The Triglyceride is 8th ingredient, behind tocopherol (which is Vitamin E.) Vitamins are typically used at less than 1%, so we can assume that the Triglyceride is present at a fairly low level.

The Beauty Brains bottom line

What does this tell us about Maybelline Pure Concealer? It contains (at least) two comedogenic ingredients, one of which appears to be at a significant level in the formula. If you’re prone to breaking out, this may be a product to avoid.

What do you think and sticks and zits? What are you favorite concealers? Leave a comment and share your faves with the rest of the Beauty Brains community.

Sherry’s peroxide predicament: I have extremely oily skin and have experimented over the years with several different face washes in an attempt to find one that cleanses deeply without over-drying. I have discovered that botanical based gel washes followed by a moisturizer rich in dimethicone work best in my case. I have also discovered that mixing in a little hydrogen peroxide with my face wash works even better. It completely removes any traces of excess oil and makeup without drying me out completely, and it’s completely eliminated my occasional breakouts. I’ve been using this cocktail with great results for a few years now with no problem. Is this safe for my skin?

Fore Brain’s free radical reply:
Sherry, it seems that most of the ingredients in your skin regimen are quite safe with possible exception of hydrogen peroxide. Although not totally conclusive, scientific evidence points to the fact that long term use of hydrogen peroxide on your face may result in skin damage. The quick answer is that if you are concerned about wrinkles and skin damage, hydrogen peroxide may not be for you.

A little about hydrogen peroxide

Hydrogen Peroxide (aka H2O2) is the liquid you get in a brown opaque bottle at the pharmacy, and for years has been used for all sorts of bleaching as well as an antiseptic to clean wounds. However, as of a few years ago, this practice has been discontinued since hydrogen peroxide was deemed too harsh for wound treatment. This is probably indication that it can’t be that good for your face either. The primary concern with hydrogen peroxide is its oxidative effect when it contacts other materials. The oxidation is what kills the bacteria; however, as per recent discoveries in free radicals and skin damage, it may also result in skin cell destruction and premature skin ageing. The free radical theories can get pretty complicated but I’ll try to explain it in simple terms.

Free radicals are just lonely

A molecule like hydrogen peroxide (H2O2) is basically a water (H2O) combined with an oxygen (O) and it takes energy to hold that extra oxygen molecule onto the whole structure for several chemistry-related reasons that are too advanced for the scope of this article. The bottom line is, when the hydrogen peroxide molecule touches other materials, it gets a chance to fall apart to a more relaxed state of H2O (water) and the O (oxygen) that it nearly always takes. The problem however, is that oxygen molecules like to travel in pairs, and the newly released oxygen molecule will look for another oxygen to attach itself to. While the oxygen molecule is alone and looking for its pair, it is quite unbalanced, and can result in damage to the cells, DNA, as well as other cell components. The lone oxygen molecule looking for its partner is an example of a free radical.

Unfortunately, according to this theory, when we apply hydrogen peroxide to our skin, on a very tiny molecular level, it breaks down into water and the lone oxygen molecule that causes damage to the skin cells resulting in premature aging. (This kind of damage also happens normally with time from effects of the sun or the environment.)

The Beauty Brains bottom line

So is an acne spot treatment of hydrogen peroxide once in a while going to ruin your skin? Probably not. However, long-term use over large areas of skin (ie. your whole face), is something I wouldn’t recommend if you want your skin to stay healthy for a long time. If you do want some tips on how to manage your oily skin without the use hydrogen peroxide, check out this site.

Fun Fact: Highly concentrated hydrogen peroxide is often used in rocket fuel because of its oxygenating abilities!

References:

Meneghini, R., (1991) Iron homeostasis, oxidative stress, and DNA damage. Free Radical Biology and Medicine, 23, 783-792.
http://en.wikipedia.org/wiki/Hydrogen_peroxide
http://en.wikipedia.org/wiki/Oxidative_stress
http://en.wikipedia.org/wiki/Reactive_oxygen_species

Here’s a special treat for all you Beauty Brainiacs out there: our special guest-blogger for today is none other than Nicki, from Futurederm.com. If you’re a fan of the Beauty Brains, you’ll love Futurederm. Check it out! And now, on with Nicki’s post…

Want Clearer Skin? See the Light.

And no, I’m not talking about sunlight, sorry everyone! What I am talking about is the new Tanda Skincare System ($395.00, Amazon.com). The system emits visible wavelength (not UV) light from an LED source (414 nm blue light and 660 nm red light), to treat acne. According to a study by Tanda, the use of their light treatment was “significantly more effective” than treatment with a 5% benzoyl peroxide cream over the same period.

Yet, the use of LED has been recently shown to have anti-aging effects for the skin as well. With skin-clearing and firming benefits, is an at-home LED treatment center worth the money? FutureDerm investigates…

Acne-clearing benefits

According to Kansas City dermatologist Dr. Audrey Kunin’s DERMADoctor site, the Tanda Skincare System is only to be used on patients with mild to moderate acne, not cystic acne. The site says that the way to know the difference is simply by counting the lesions: no more than 125 total lesions across the treatment area (100 whiteheads/blackheads, or 15-50 inflammatory lesions). According to a 107-person 12-week study by Tanda, a 63% mean reduction in inflammatory lesions and a 45% mean reduction in comedones was exhibited by those patients who completed the study.

It is speculated that the reason LED is effective against acne is two-fold. One, LED light may have anti-bacterial properties, and there is a small amount of evidence that suggests that light disrupts P. acnes, the primary bacterial species found in acne cases. Two, LED light may have anti-inflammatory properties, which may calm existing lesions and prevent new lesions from forming.

Collagen and Elastin Production Stimulation

According to a recent study, LED phototherapy repairs sun damage and increases collagen and elastin production, although “lasers and peels have faster, more substantial results, but more side effects,” according to Seung Yoon Lee, a dermatologist at the National Medical Center in South Korea. With regards to LED therapy’s fewer side effects, Lee adds, “LED is safe for dark skin, unlike some lasers.”

According to Allure magazine, in the study, the researchers treated one side of 61 subjects’ faces with a light-emitting diode machine, while 15 others received a one-sided placebo treatment. Twelve weeks later, only the LED-targeted skin had a decrease in wrinkles (26-36 percent) and an increase in elasticity (14-19 percent). LED therapy seems to increase collagen and elastin production, although less significantly than dermatologist-administered lasers and peels.

Overall Thoughts and Opinions

LED therapy has been proven more effective at fighting acne and promoting collagen and elastin production than other at-home procedures. However, greater effects are still available through prescription medications and treatments (lasers, peels) at your dermatologist’s office. At the present time, it is probably a better idea to spend your money on a dermatologist-administered treatment. Hopefully, however, the cost of at-home LED therapy systems like the Tanda Skincare System will decrease. At any rate, the treatment is certainly novel and exciting, and if you want the best in at-home treatments, then this is definitely worth a try!

Hillary’s concerned question: I’m hoping the Beauty Brains can help clear up an issue for me. I use benzoyl peroxide to help treat my acne. Recently I’ve been hearing a lot of buzz about how it might cause cancer and promote premature aging. Some of the sources of this information are suspect as they seem to be pushing products that do not contain benzoyl peroxide, however, a quick search in Pub med did turn up some studies that benzoyl peroxide combined with ultraviolet light caused cancer in Swiss mice. Is this an issue that you can help shed some light on? Thanks!

The Left Brain’s acne answer:
Hillary, kudos to you for looking up articles on Pub med rather than believing what you read on some company’s website.

Benzoyl Peroxide and cancer

We looked at the article you found and it does indeed implicate benzoyl peroxide in both papillomas and carcinomas. However, the article is a bit vague. It says benzoyl peroxide was carcinogenic only when used with an initiator, which doesn’t occur with normal use. Secondly, it said benzoyl peroxide produces an effect similar to another compound that causes tumors but there is not directly link to cancer. Finally, I noticed that this study is from 1981 so there’s been plenty of time for follow up research.

The latest research

Further literature review turns up several sources that show benzoyl peroxide has been cleared in later studies. To be fair, one reference did say scientists should keep their eye on the subject, just to be safe. In addition, it is also true that in 1995, the FDA changed the status of benzoyl peroxide from Category I (safe) to Category III (more data is needed.) I have not been able to find a current update on the status of benzoyl peroxide.

References

“Acne and Rosacea: Third Completely Revised and Updated Edition”, 2000:

Following application to the skin, benzoyl peroxide is rapidly metabolized to benzoic acid, a harmless chemical. Extensive use in human beings has failed to demonstrate absorption. The drug is eminently safe.

The British Journal of Dermatology, 1990:

So far no skin malignancies after the clinical use of benzoyl peroxide has been reported. A possible relationship between the use of the compound and the occurrence of malignant melanoma has been looked at in two case-control studies, both with negative results…However, since the average latent period for skin carcinogenesis is of the order of 15-25 years, this requires further follow-up…Thus, the question of carcinogenic potential of benzoyl peroxide is as yet not fully answered, but at the present time it seems likely that this compound is safe to use.

Regulatory Toxicology and Pharmacology, 1995:

Topical benzoyl peroxide has been used in the treatment of acne for over 30 years, with no reports of adverse effects that could be related to skin carcinogenesis. Two case-control epidemiological studies have found a lack of association between the specific use of benzoyl peroxide and skin cancer. In addition to these findings in humans, 23 carcinogenicity studies in rodents with benzoyl peroxide, including 16 employing topical application, have yielded negative results. An increase in skin carcinomas was reported in 1 study in which benzoyl peroxide in acetone was applied to the skin of SENCAR mice for a 1-year period; however, this study did not employ adequate control groups to fully understand the unusual findings, and the results were inconsistent with those of 6 other similar studies.

The moral of this story is to never believe any single scientific study. Any one study can be flawed, you need to look at body of work of the research to be sure.

Leah sees spots: My grandmother always says to put a drop of Visine on spots. I’ve never done it, but was curious as to whether there is any truth in this. And would it damage the skin?

The Right Brain’s red-eyed reply:
Visine reduces red eye because its active ingredient, tetrahydrozoline hydrochloride, constricts the superficial blood vessels in the eye. But skin spots, like acne blemishes, scars and age spots, are not caused by dilated blood vessels. Therefore, there doesn’t appear to be any benefit to applying Visine to your skin. In fact, there’s at least one good reason NOT to use Visine any place else except your eyes. And that reason is related to a nasty practical joke.

Visine and potty humor

Supposedly, you can prank someone by someone by putting a few drops of Visine in their drink to give them an amusing case of diarrhea. (This is assuming of course, that you’re the kind of person who finds diarrhea amusing.) But according to Snopes.com, this prank is actually an urban legend; Visine will NOT give you the runs. But it will cause vomiting, seizures, difficulty breathing, blurred vision and it can even induce coma. Now THAT’S entertainment!

Visine ruined my love life

What does this have to do with your skin? Imagine the following scenario: The night of your Big Date you discover a nasty pimple on your face. Taking your kindly old grandmother’s advice, you dab a few drops of Visine on the zit. Later that night in the throes of passion, as your main squeeze’s lips brush across your rosy cheek, he gets a tiny taste of tetrahydrozoline hydrochoride. Sometime after the vomiting and tremors subside, but before he slips into a coma, he drives you home. You do NOT get a good night kiss.

The Beauty Brains bottom line

Visine may or may not ruin your date, but it won’t do anything for your skin spots. Slather on some Clearasil or cover up with some Face Spray Foundation instead.

Does anyone else have a favorite grandma’s home remedy they’d like to ask about? Vomit your comment for the rest of the Beauty Brains community.

Annie’s asking: I’ve noticed that a lot of skincare products have one or the other of these acids in them, and I’m not sure what they’re used for. What’s the difference between alpha hydroxy acid and beta hydroxy acid?

The Left Brain’s alphabet soup:

AHAs and BHAs, as they’re affectionately known, belong to a class of chemicals known as organic acids. They’re both characterized by a carboxylic acid group and a hydroxyl or OH group. The difference between the two is the location of the OH group: in Alphahydroxy acids the OH group is on the first carbon next to the acid group, in Beta hydroxyacids it’s on the second carbon. Common examples of AHAs include lactic, glycolic, and citric acids. The primary BHA used in cosmetics is salicylic acid.

What do AHA’s do?

AHAs are water soluble and act on the upper layers of skin. They help break down the “cement” that holds cells together so they are good at peeling off old, dead cells and speeding up the production of fresh skin. You can find them in anti-aging products like Neoteric’s AHA Souffle and Alpha Glycolic Face Cream. AHAs can be dangerous if over used because they make your skin more sensitive to sun exposure. (Here’s a good reference that gives more details.)

What do BHA’s do?

BHAs are more soluble in oils than in water. That’s why salicylic acid is used in acne products: it can penetrate oil-filled pores and break down the dead skin cells that clog pores and cause inflammation that leads to pimples. If you want to learn more, read our post on the causes of acne. Sal Acid can be found in products like Neutrogena Salicylic Acid Acne Treatment and Nature’s Gate Organic Body Wash.

The Beauty Brains bottom line:

Beta hydroxy acids are better for battling acne on oily skin. Alpha hydroxy acids are for good for refreshing damaged skin.

Sarah Bellum Says:

Damn, I hate science sometimes.

Contrary to the old wives’ tales that say chocolate is bad for skin, I’ve chosen to believe the prevailing scientific evidence that says diet does NOT contribute to acne. (See our candy post from last Valentines Day). But now a new study says that those old wives may know best after all.

Australian acne study

NPR reports on an Australian research study that evaluated 54 acne patients, ranging in age from 15 to 25. Half of the patients were given a low blood sugar diet while the other half were allowed to feast on Doritos and M&Ms (and other starchy, sugary foods). After 12 weeks, dermatologists evaluated the skin of all the panelists with out knowing which diet they were on (so it was a well blinded study.) Guess what? The patients on the sugary diet had significantly worse skin.

Final proof?

This certainly contradicts what previous studies have shown. So is this proof beyond a shadow of doubt that sugar causes acne? Not quite, the report acknowledged that while this study strongly suggests a causal connection between sugar intake and acne there are other factors to consider as well. For example, the patients overall caloric intake and degree of weight loss were not the same. So there may have been other factors at play here beyond sheer sugar consumption. Still, it makes me think twice before gorging myself on my post-holiday stash of Lake Champlain gourmet chocolates.

The Beauty Brains bottom line

Looks like more research is needed. I hope they hurry up and settle this before Valentines Day!

What do YOU think? Does your skin break out when you indulge your inner chocolate demons? Leave a comment and share your sweetness with the rest of the Beauty Brains community.

Meredith muses: Can you give me the scientist’s perspective on Neem? It’s a plant that has been called the “corner pharmacy” in India for ages. I’ve found a lot of information about it from Ayurvedic and naturopathic stores, and I’m not seeing a ton of hard science behind the claims. I’m looking specifically for info regarding its healing properties for acne and eczema.

The Left Brain’s not sure about Neem:
Like you, I’m always VERY skeptical of naturopathic remedies unless there is clinical data to back up their claims. Sometimes, these remedies do contain active, effective ingredients. Other times they do not. Interestingly, the effectiveness of Neem, or Azadirachta indica, as it is technically known, is pretty well documented.

Neem, the wonder drug

A search of Pubmed reveals over 400 different studies on Neem oil most of which deal with its antibacterial, antifungal and anti-inflammatory effects. The data indicates that Neem does live up to its reputation as a wonder drug, at least in many respects.

There are studies showing that it gets rid of camel ticks, it’s a spermicide, stops hamsters from getting cheek cancer, it’s good for sheeps’ digestive systems, kills head lice, helps against some types of diabetes, repels mosquitoes, and stops mange. It’s also effective against plaque and cavities, can interrupt the breeding cycle of the diamondback moth, and guards against some forms of gastic cancer. To name a few.

Not for acne?

However, in all these studies (and I reviewed all 448 of them!) I couldn’t find a single reference to any testing on acne or eczema. Now, that doesn’t mean necessarily mean that Neem DOESN’T work. It is a plausible theory since it does have antibacterial properties. But there maybe other effects to consider. For example, it could kill the bacteria that cause acne (P. acnes) but it could also contribute to acne by clogging pores. Without some kind of test data it’s all speculation and hearsay.

The Beauty Brains bottom line

Unless someone out there can direct me to further studies showing Neem works on acne, this Beauty Brain remains skeptical. But if you want to buy some Neem oil and give it a try there’s probably little risk. But then again, why not use some acne medications that are proven to work?

What do YOU think? Do you trust the over the counter acne medications or do you prefer natural remedies? Leave a comment and tell us what you think about neem or any other natural cures you’ve tried.

If you thought your acne problems would be gone after your 20’s, think again. In an acne study of over 1000 people, 73% reported dealing with adult acne. And while there was no difference in frequency of acne in their teenage years, adult women experienced far more acne than men. The good news is that when you hit your 40’s, only a quarter of women get acne.

Are YOU still fighting the battle with acne? Do you think men get all the breaks? Leave a comment to see how you compare to the rest of the Beauty Brains community.

—Mid Brain