Acne treatments and a dry, irritated barrier: finding the balance

Acne treatments that work well often come with a catch: tight, flaky, stinging skin. It’s frustrating to fight breakouts and dryness at the same time, and it’s one of the main reasons people give up on a treatment before it has a chance to work. The good news is that you don’t have to choose between clear skin and a comfortable barrier.

Why acne treatments dry out your skin

Two of the most widely used acne ingredients are retinoids and benzoyl peroxide.

• Retinoids are vitamin A derivatives. They help normalize how skin cells are shed inside the pore, so pores are less likely to clog.
• Benzoyl peroxide reduces the bacteria involved in acne.

Both are effective, and both can irritate. The American Academy of Dermatology lists dryness, irritated skin, peeling and burning among the possible side effects of benzoyl peroxide combinations. Retinoids commonly cause redness, dryness and flaking when you start, especially if you use them every day from the beginning.

What’s happening underneath is barrier damage. A 2014 review explains that the dryness from acne treatments disrupts the skin barrier and increases transepidermal water loss (TEWL), the water that evaporates through your skin. A leakier barrier lets in more irritants, which feeds more redness and stinging.

There’s also a second hit: acne itself. A 2023 study notes that facial acne already damages the barrier, and that treatment can magnify that damage.

Why it matters for results

Irritation isn’t just uncomfortable. It gets in the way of treatment.

The 2014 review points out that irritation from topical acne treatments leads many people to stop using them. And acne treatment is slow: the American Academy of Dermatology says it takes at least 6 to 8 weeks to start seeing fewer breakouts. If the stinging makes you quit in week three, you never find out whether the treatment would have worked.

For people with darker skin, irritation carries an extra risk. The American Academy of Dermatology notes that irritation can trigger dark marks, and that starting slowly and using moisturizer help lower that risk.

What the evidence says about adding a moisturizer

Moisturizers used alongside acne treatment are sometimes called adjunctive skin care. Here’s what studies have found.

• The 2014 review reports that some doctors recommend moisturizers alongside acne treatment, especially with benzoyl peroxide or retinoids. It cites a study in which a moisturizer improved how well people tolerated a retinoid gel, and another in which moisturizers improved dryness and comfort in people taking oral isotretinoin, a strong acne medication.
• A 2023 double-blind study gave everyone the same prescription gel combining a retinoid and benzoyl peroxide. One group also used a ceramide-containing cleanser and lotion; the other used a basic face wash. Over 12 weeks, the moisturizer group had lower water loss through the skin and less dryness, redness and scaling, and also fewer inflammatory spots. It’s a single study that compared a moisturizing routine with no moisturizer, not with another moisturizer, so it can’t tell you which product to pick.

The overall picture is consistent: a moisturizer makes acne treatment easier to live with, and it doesn’t appear to cancel out the treatment.

What kind of moisturizer?

The American Academy of Dermatology recommends that people with acne use a moisturizer every day when their skin feels dry, and choose one labelled oil-free, non-comedogenic or “won’t clog pores”. The 2014 review found that dimethicone, a silicone that reduces water loss without a greasy feel, and glycerin, a humectant that draws water into the skin, were common in moisturizers made for acne-prone skin.

Look for something light and fragrance-free. A fragrance-free moisturizer is a sensible starting point.

Practical ways to find the balance

Dermatologists use a few simple adjustments to keep skin comfortable while treatment works.

Start slowly

The American Academy of Dermatology suggests starting a retinoid every other night and building up gradually, and using the gentlest formulation you can. Jumping straight to daily use is a common reason skin gets red and raw.

Moisturize, and consider moisturizing first

When skin is irritated, the American Academy of Dermatology says dermatologists may recommend applying a smaller amount of medication, using the retinoid less often, or applying moisturizer first, especially with a stronger retinoid. Follow your prescriber’s instructions on the details.

Keep the rest of your routine gentle

The American Academy of Dermatology advises people with acne to use gentle, alcohol-free products and to avoid astringents, toners and exfoliants, which add irritation on top of treatment. Wash with a mild cleanser, don’t scrub, and hold off on extra actives while your skin adjusts. A gentle cleanser helps.

Protect from the sun

The American Academy of Dermatology recommends using retinoids at night and always protecting your skin during the day: shade, a wide-brimmed hat and sunscreen. Look for a sunscreen labelled non-comedogenic.

When to check in

Some dryness and peeling in the first weeks is common. But talk to your doctor or pharmacist if:

• your skin is burning, cracked or very red
• irritation isn’t settling after a couple of weeks of adjustments
• you’re developing dark marks where your skin was irritated
• you’re pregnant or planning to be, since some acne treatments aren’t suitable

Don’t stop a prescribed treatment without checking first. There’s usually a way to adjust it.

Acne treatments like retinoids and benzoyl peroxide work, but they often dry and irritate the barrier. Studies suggest a gentle cleanser and a non-comedogenic moisturizer ease dryness and redness without undermining treatment. Start slowly, moisturize, keep the rest of your routine simple and protect your skin from the sun, so you can stay on treatment long enough to see it work.