The American Academy of Dermatology (AAD) advises people to limit washing to twice a day and after sweating: once in the morning, once at night, and again after sweating heavily. The NHS gives the same twice-a-day advice for people with acne, with a gentle cleanser.
Washing more often than that doesn't earn you extra credit. The AAD's list of habits that can worsen acne includes washing your face throughout the day, because washing your face several times a day can further irritate your skin, leading to more breakouts. The same page warns against drying acne-prone skin out on purpose: "Dry skin is irritated skin."
The research on frequency is thinner than the advice. A randomised, single-blinded trial in males with mild to moderate acne had them wash once, twice or four times a day for 6 weeks with a standard mild cleanser. At the end, no statistically significant differences were noted between the groups. Even so, the twice-a-day group showed significant improvement in open comedones and non-inflammatory lesions, while the once-a-day group got worse, with significant increases in redness, papules and inflammatory lesions. The authors called this slight support for twice-daily washing, and added that excessive washing may not be as culpable as previously thought. A later systematic review of 14 studies with 671 participants found too few well-performed studies to make reliable recommendations about washing and cleansers at all.
How to wash
Water temperature is simple. The AAD says to wet your face with lukewarm water, apply cleanser with your fingertips, then rinse with lukewarm water and pat dry with a soft towel. Fingertips matter: a washcloth, mesh sponge or anything else can irritate your skin. So does scrubbing. Both the AAD and the NHS say not to scrub, and the NHS adds that it can make acne worse.
For the cleanser itself, the AAD suggests a gentle, non-abrasive one that doesn't contain alcohol. Its acne tips also suggest avoiding astringents, toners and exfoliants, which can dry your skin and make acne appear worse. For dry skin, the AAD advises using enough cleanser to remove dirt and oil, but not so much that you see a thick lather.
You can send a general question through this contact form. For advice matched to your own skin type, though, a pharmacist or a dermatologist is the person to ask, since they can look at your skin rather than guess from a shelf of options.
Is all-natural the best type of acne therapy?
Washing is routine care, not treatment. For a natural treatment tested against a placebo, take tea tree oil. In a randomised, double-blind study from Iran, 60 patients with mild to moderate acne used either a 5% tea tree oil gel (30 patients) or a placebo (30 patients) and were followed for 45 days. Tea tree oil did significantly better than placebo: 3.55 times more effective on total lesion count and 5.75 times on the acne severity index. Side effects were relatively similar in both groups and tolerable.
That's a real result, but a narrow one. It compares tea tree oil with a placebo, not with the treatments a pharmacist would normally suggest, so it can't tell you natural is best. The NHS lists treatments such as salicylic acid or benzoyl peroxide, with a pharmacist's advice, as things you can try yourself. It says to see a GP if you've tried treating acne yourself and it isn't getting better, or if spots are deep, painful or causing scars. The AAD also notes that acne treatments can take several weeks to a few months to show a difference, so switching treatments too often works against you.
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This article is general information, not medical advice. If acne is severe, scarring or not improving, speak to a pharmacist, GP or dermatologist.
References
- American Academy of Dermatology. Face washing 101. aad.org
- American Academy of Dermatology. 10 skin care habits that can worsen acne. aad.org
- American Academy of Dermatology. Acne: Tips for managing. aad.org
- American Academy of Dermatology. Dermatologists' top tips for relieving dry skin. aad.org
- NHS. Acne. nhs.uk/conditions/acne
- Choi JM, Lew VK, Kimball AB. A single-blinded, randomized, controlled clinical trial evaluating the effect of face washing on acne vulgaris. Pediatr Dermatol. 2006;23(5):421-7. PMID 17014635
- Stringer T, Nagler A, Orlow SJ, Oza VS. Clinical evidence for washing and cleansers in acne vulgaris: a systematic review. J Dermatolog Treat. 2018;29(7):688-693. PMID 29460655
- Enshaieh S, Jooya A, Siadat AH, Iraji F. The efficacy of 5% topical tea tree oil gel in mild to moderate acne vulgaris: a randomized, double-blind placebo-controlled study. Indian J Dermatol Venereol Leprol. 2007;73(1):22-5. PMID 17314442