A Single‐Blinded, Randomized, Controlled Clinical Trial Evaluating the Effect of Face Washing on Acne Vulgaris

Abstract

Despite the common recommendation to wash the face twice daily with a mild cleanser, there is little published evidence to support the practice. Indeed, while the general public believes that cleaner skin will result in fewer blemishes, dermatologists often warn that overwashing and scrubbing can exacerbate the condition. To clarify the effect of frequency of face washing on acne vulgaris, we designed a single-blinded, randomized, controlled clinical trial to be conducted on males with mild to moderate acne vulgaris. Subjects washed their faces twice daily for 2 weeks with a standard mild cleanser before being randomized to one of three study arms, in which face washing was to be done once, twice, or four times a day for 6 weeks. At the end of the study no statistically significant differences were noted between groups. However, significant improvements in both open comedones and total noninflammatory lesions were observed in the group washing twice a day. Worsening of acne condition was observed in the study group washing once a day, with significant increases in erythema, papules, and total inflammatory lesions. We concluded that slight support exists, both in terms of efficacy and convenience, for the recommendation to wash the face twice daily with a mild cleanser. However, excessive face washing may not be as culpable as previously thought.

South‐East Asia study alliance guidelines on the management of acne vulgaris in South‐East Asian patients

“…Skin care is important in the management of acne and involves cleansing, moisturizing and sun protection (protection against UV radiation). Studies have shown that washing the face twice daily with a mild cleanser produced significant improvements in the skin of patients with acne, and cleansers reduced both the inflammatory and non‐inflammatory lesion counts . The ideal cleanser should be non‐comedogenic, non‐acnegenic, non‐irritating and non‐allergenic.…”

A multicenter epidemiological study of acne vulgaris in Korea

“…In the present study, 48.4% of patients felt that acne was aggravated and 10% felt that acne improved when they did not wash their faces thoroughly. In a study undertaken to investigate the effect of face washing on acne, 27 acne was observed to worsen in those who washed once per day but to improve significantly in those who washed twice per day. Curiously, some patients experienced improvements when they did not wash well; this observation may be associated with the fact that excessive washing can reduce skin hydration and cause skin irritation.…”

Evaluation of the Postoperative Cutaneous Findings in Rhinoplasty Patients

“…The inability to wash the face in the early postoperative periods may cause pilosebaceous occlusion that triggers acne vulgaris (10). However, in the following visits at months 3 and 6 after the removal of this prohibition (15). Although, the exact pathogenesis of acne vulgaris remains unknown, the presence of excessive reactive oxygen species has been implicated in acne vulgaris previously (16).…”

“…Psychological stress of open technique rhinoplasty, not being able to wash the face due to pain, and plaster casts are some of the factors that have been mentioned (5,14,15).…”

“…We think that as the time passes and the patients' postoperative fear is reduced, acne severity probably decreases due to decreased stress hormones at postoperative months 3 and 6. Facial cleaning twice a day is commonly recommended for patients with acne vulgaris (15). The inability to wash the face in the early postoperative periods may cause pilosebaceous occlusion that triggers acne vulgaris (10).…”