From Angela Palmer,
Your Guide to Acne.
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About.com Health's Disease and Condition content is reviewed by Casey Gallagher, MD

Anyone interested in skin care will have heard the term exfoliation. What exactly is exfoliation? Why is it so important for those with acne?

Exfoliation is the removal of dead skin cells. An exfoliant is a product or procedure that reduces the amount of dead cell build-up on the skin. Whether your acne is mild or more severe, regular exfoliation will smooth and soften the skin, brighten the complexion, and lessen breakout activity.

But before you run out and buy a scrub, take the time to learn about all the exfoliating products and treatments available. Making the right exfoliant choice is essential to getting the results you are looking for.

Skin's Natural Exfoliation

The skin naturally sheds dead skin cells through a process called desquamation. Every 28 days, on average, a new skin cell is "born" in the stratum germinativum, the deepest layer of the epidermis. The cell travels up through the epidermis until it reaches the uppermost layer of the skin, the stratum corneum. Once the cell reaches this layer, it is essentially dead. Ideally, new skin cells arrive at the skin's surface, pushing older cells off.

Where do the old skin cells go once they have been sloughed away? They settle on your furniture, in the form of dust. Yes, that's right. Most of the dust in your home is not dirt, but rather dead skin cells.

Acne and Dead Skin Cells

In those with acne, the natural desquamation process goes awry. Acne-prone skin produces more dead skin cells than is typical, and these cells aren't properly shed. This condition, called retention hyperkeratosis, is the reason regular exfoliation is so important for acne prone skin types.

In normal functioning skin, excess dead skin cells are constantly being sloughed away naturally. In acne-prone skin, dead cells remain stuck on the skin's surface and within the follicle, creating a clog (impaction). This plug of cellular debris and excess oil forms a blackhead or, if bacteria invade, an inflamed blemish.

Because of the inability of acne-prone skin to naturally shed dead skin cells, an outside means of exfoliation is necessary to help the process along. Regular use of an exfoliant can inhibit the formation of blackheads and blemishes by keeping the follicles free of blockages.

Physical Exfoliants

There are literally hundreds of exfoliating products and procedures available today, but all are found in one of two forms: physical or chemical.

Physical exfoliants work by manually removing dead skin cells with the help of an abrasive ingredient or implement. Physical exfoliants may be as simple as an over-the-counter scrub, or as involved as a professional procedure, such as microdermabrasion.

Physical exfoliants leave your skin feeling soft and smooth, but they may not be the best choice for acne-prone skin. The friction involved in using a physical exfoliant can irritate already inflamed skin, exacerbating redness and promoting additional breakouts. Those with acne, especially inflamed acne, should avoid physical exfoliants altogether, unless otherwise advised by a doctor.

Examples of physical exfoliants include:

• Scrubs
• Abrasive pads and cloths
• Microdermabrasion

Chemical Exfoliants

Some of the most popular exfoliating treatments use chemical exfoliants. Chemical exfoliants dissolve or loosen the bonds that hold dead cells on the skin's surface by means of an acid or enzyme. Abrasive agents are not needed. Exfoliating acids and enzymes can be incorporated into lotions, gels, masks, toners, and more.

Chemical exfoliants can be found over-the-counter at your local retail store, and many are gentle enough to be used daily. Stronger daily and weekly treatments, as well as light chemical peels, are available at day spas and skin spas. The estheticians working at these establishments can help you decide which treatments will be best for your skin. For the most powerful chemical exfoliant products, ask your dermatologist. He or she can provide you with a prescription treatment, or perform stronger chemical peels, if needed.

Most chemical exfoliants, whether over-the-counter or doctor prescribed, will dry the skin to some degree. Incorporating an oil-free moisturizer into your daily skin care routine will help ward off excessive dryness, peeling, and irritation.

Some common chemical exfoliants include:

• Alpha hydroxy acids (AHA)- glycolic, lactic, and tartaric acid
• Beta hydroxy acids (BHA) - salicylic acid
• Retinoids - Retin A (tretinoin), Differin (adapalene), Tazorac (tazarotene)
• Chemical peels - trichloroacetic acid (TCA), carbolic or phenol, AHA and BHA peels

Exfoliant Safety Tips

• If you need help choosing an exfoliant, don't hesitate to ask your dermatologist for guidance. Your doctor will be able to recommend a product or procedure that is both safe and effective for your skin.
• Unless recommended by your doctor, avoid using several exfoliating products at the same time. Doing so may cause redness, excessive dryness, peeling, and considerable irritation.
• If you are currently using any acne medications, especially Accutane (isotretinoin), retinoids such as Retin A (tretinoin) or Differin (adapalene), or any other topical or oral medications, talk with your doctor before beginning any exfoliation treatment.
• If a product causes considerable irritation or discomfort, discontinue use and consult your doctor.

_Sources:

"Cuttting Through the Clutter: Making the Most of Your Facial Cleansing Routine." American Academy of Dermatology. 21 Feb 2005. American Academy of Dermatology. 18 Sep 2007.

Gerson, Ph.D., Joel. Standard Textbook for Professional Estheticians. 8th edition. Albany, NY: Milady Publishing, 1999.

"Unclogged Pores: What's New in the Treatment of Acne." American Academy of Dermatology. 02 Nov 2005. American Academy of Dermatology. 18 Sep 2007.