Hormonal Acne Routine Part 3: The Surge

This post is a continuation of my Hormonal Acne Series:

Click to Read > Part 1: Philosophies
Click to Read > Part 2: First Line of Defense

I have discovered the following about my own skin from years of trial and error and plenty of research. If you do not have the basics of skincare covered yet, then you have no business moving on to targeted acne solutions, especially not exfoliating actives. Please use great caution when introducing a new acne-fighting product. My routine is the result of many years of slow introduction and cautious experimentation. It should not be used as a shopping list for a newbie. Please read Part 1 for a summary of my acne troubles and my philosophies!

The Surge

Even though my cysts are reduced in number and aggravation by my azelaic acid treatment, the clogs that result from my skin's inability to shed quickly remain, dotting my cheeks like little molehills. For these types of "surface" clogs I like to use a gentle, low-level acid formula. For me, salicylic acid, glycolic acid, or mandelic acid are all good choices. I've used all of them in the past (not at the same time) and they have been great for different reasons and for different phases of my skin.

Currently I'm in a phase of using 2% salicylic acid three times a week. I find that this is a good sweet spot for my oily/combo skin, but if I overdo it, my skin takes on a beef jerky texture and becomes prone to flakes and irritation.

In the past, I have successfully used 10% glycolic acid or 10% mandelic acid as my other regular treatment. If you have dry skin, you can explore the gentler acids with larger molecular size (for lower penetration and hence irritation) like lactic acid but if you have hardier and resilient skin you can slowly work up to the stronger acids as I have done.

As I mentioned in Part 2, I have a rule of thumb to not exceed two exfoliating actives in my routine at any one time. I experience diminishing marginal utility for each additional acid added. By the time I've incorporated my azelaic acid with my salicylic acid, I've addressed both my deep clogs and my surface ones. Adding a third acid will create 1 of 2 situations:

  • I have to use acids every single day: My skin looks much better with 4 or 5 days of exfoliation per week, less if the weather is particularly harsh.
  • I have to forgo using one acid for the new one: This is the "crowding-out" effect that usually happens, whereby I have to sacrifice the number of days using one of my established acids to introduce my new one to avoid overexfoliation. Sometimes it can work, but for me, using fewer acids more times a week trumps using more acids fewer times a week. 

Neither of these situations is ideal for my skintype, problems, or lifestyle. I fear overexfoliation because it always results in worse acne and increased discomfort. For me the signs of overexfoliation begin with a preternatural smoothness- my skin becomes glowy to the point where it looks like glass. Makeup stops adhering to my skin and it looks almost nice, but...too nice. Typically if I keep exfoliating past that point (by using more acids that week or more treatments closer together) my skin will tip over into rough, papery, scaly, and I will actually suffer increased acne breakouts. Fine spiderweb lines will appear and if I try to make a grinning face, I can feel the skin on my cheeks and forehead tighten.

I do have to juggle my azelaic acid with my salicylic acid, and sometimes that means skipping one or the other. There is no rule that says you must use actives daily- in fact my personal philosophy is that skin is not meant to be chemically exfoliated every day. I think that 5 days of chemical exfoliation per week counts as robust and even for my severe acne it has been plenty. Depending on the week, the weather, and how I feel, I will also back off to use my acids less if I feel like it. Sometimes I will double up on using both the same day and then skip a few days. Sometimes I just skip a few days and leave my skin alone. I have learned to listen to my skin and be flexible with its demands. Too much of a good thing, in the case of acids, is very much a bad thing. Dehydrated skin can take a long time to recover, and it's best to avoid causing dehydration in the first place.

Continued in Part 4...


  1. I hear you on the over-exfoliation thing. My acne is pretty mild so I'm a little more haphazard with my routine than it sounds like you are, but I try to respond to how my skin is feeling on a given day.

    1. Just yesterday I had Stridex on my schedule and a *few* surface whiteheads that I could have knocked out with it. But I also had a hint of flake/tightness and I abstained. It's nice to listen to your skin, it rewards you when you don't just steamroll it with actives.