Can dry skin cause acne and pimples?

Acne is usually linked with oily skin, so many people are surprised to have both dry, flaky skin and pimples at the same time. The two often go together. This guide explains how dry skin can lead to breakouts, why acne treatment makes it more likely, and how to treat acne when your skin is dry. For the causes of dryness in general, see what causes dry skin. To work out your overall skin type, see how to find your skin type.

How dry skin leads to breakouts

The American Academy of Dermatology (AAD) describes two ways.

Dry skin makes more oil. The AAD's page on moisturizer and acne says that when your skin becomes dry, your body makes more oil. The extra oil can clog your pores, which may lead to more breakouts. It adds that the right moisturizer can prevent your skin from becoming dry and irritated.

Dry skin is irritated skin. The AAD's page on habits that worsen acne says it plainly: "Dry skin is irritated skin. Anytime you irritate your skin, you risk getting more acne."

Acne itself starts in the pore. NIAMS, the NIH institute for skin diseases, explains that acne forms when skin oil, dead skin cells and hair stick together inside the pore, and bacteria then grow in the plugged pore and cause redness and swelling. Dry skin still has oil glands and pores, so it can still form these plugs.

Why people with acne end up with dry skin

Several parts of acne care dry the skin.

Acne treatments dry the skin. The AAD says benzoyl peroxide, salicylic acid, retinoids such as adapalene, tazarotene and tretinoin, and isotretinoin tend to dry and irritate the skin. The NHS lists dry or peeling skin as a common side effect of benzoyl peroxide.

Stronger is drier. The AAD's page on acne in darker skin tones says to start with a product that contains 2.5% benzoyl peroxide, because products that contain more can cause dryness and flaking, which can worsen acne. If the 2.5% product irritates your skin, it suggests using it every other day. The NHS gives the same idea for every strength: always start with the lowest one to see how well your skin tolerates it.

Trying to dry out oil. The AAD says it can be tempting to apply astringent and acne treatments until your face feels dry, and tells people not to do this. It also says to avoid astringents, rubbing alcohol and anything else that can dry out your skin.

Over-correcting with heavy products. A dermatologist in the AAD's moisturizer guide describes the cycle: people strip their face too much, then put on too much moisturizer, and end up with dry skin and pimples. The AAD also says to avoid putting petroleum jelly on your face if you are acne-prone, because it may cause breakouts in some people.

Signs your acne routine is drying you out

• Your face feels tight within minutes of washing.
• Skin peels or flakes where the acne treatment goes, often around the mouth and nose.
• Treatment stings or burns when you put it on.
• Your skin is shiny by midday even though it felt tight in the morning.
• New breakouts appear while the skin is red and flaky.

Some dryness in the first weeks of a treatment is expected. Skinli's plans say dry, red or peeling skin in weeks 2 to 4 is normal with the treatment gels. Dryness that keeps getting worse, or stinging that does not settle, means the routine needs adjusting. For retinoids, retinoid dryness and peeling explains what to change.

How to treat acne when your skin is dry

The aim is to keep treating the acne while stopping the dryness. These steps follow the AAD and NHS advice above.

Step	What to do	Source
Cleanser	A mild, non-comedogenic cleanser, applied with fingertips and rinsed with warm water	AAD habits page
Acne treatment	One product at a time, at its lowest strength. Benzoyl peroxide at 2.5%, every other day if it irritates	AAD, NHS
Moisturizer	Labeled non-comedogenic or won't clog pores, twice a day after washing, on damp skin	AAD moisturizer page
Skip	Astringents, rubbing alcohol, scrubs, heavy oils and petroleum jelly on the face	AAD
Sunscreen	Broad-spectrum, SPF 30 or higher, non-comedogenic	AAD

Moisturizer is a treatment step. The AAD says using a moisturizer every day can help your skin tolerate drying acne medicines. It also says that in studies, most patients see less acne 4 to 8 weeks after starting an acne-friendly moisturizer, as part of a plan that also used acne medicine and a cleanser.

A 2013 randomized trial in the Journal of Dermatological Treatment tested this on 30 volunteers. Everyone used adapalene gel 0.1% once a day on the whole face, and a moisturizing lotion on only one side. The side with moisturizer had better tolerance, meaning less redness, peeling, dryness, stinging and itch. The authors concluded that a moisturizer improves tolerance of adapalene and may help people keep using it.

Choose the right texture. For dry, acne-prone skin, a cream labeled non-comedogenic is a sensible middle point. The AAD says creams are more hydrating than gels and lotions. How to choose a moisturizer for acne-prone skin explains the labels.

Use acne washes with care. The AAD's page on pores says a salicylic acid cleanser may help unclog pores, and that if it dries or irritates your skin, you can use a mild cleanser in the morning and the salicylic acid cleanser at night.

Put moisturizer in the right order. Moisturizer goes on after the acne treatment has dried in Skinli's plans. What order to apply your acne products shows the full order morning and night.

A gentle start for dry, acne-prone skin

If your skin is already dry and you want to start an acne treatment, a slow start protects it. This sequence follows the NHS and AAD advice to start at the lowest strength and build up slowly, and the pace Skinli's own plans use.

Weeks	What to do
Week 1	Gentle cleanser twice a day and a non-comedogenic moisturizer on damp skin. No acne product yet. Let the dryness settle
Weeks 2 and 3	Add one acne product at its lowest strength, every other night, in a thin layer over the whole area that breaks out. Moisturizer after it dries
Weeks 4 and on	If the skin stays comfortable, move to every night. If it stings or peels, stay at every other night and add more moisturizer
Weeks 8 to 12	Judge the acne. Skinli's plans use 8 to 12 weeks for skin to change

Skinli's plans start the treatment gels every other night for two weeks, with a pea-sized amount of each in a thin layer on the whole area that gets pimples. Before you start any new product, patch test it on a small area.

Dry skin and acne in winter

Winter makes both problems harder. The AAD says it is common to develop dry skin when the air holds little moisture, and that indoor heating in winter removes moisture from the skin. A dermatologist in the AAD's moisturizer guide says a common winter mistake is exfoliating dry, peeling skin, which removes more moisture, and recommends moisturizing instead.

In cold months, you may need a richer non-comedogenic cream, a humidifier in the bedroom, and fewer nights of a drying acne product for a while. Keep the acne treatment going at a pace your skin can handle, because stopping and starting makes it harder to judge whether it works.

Other causes of bumps on dry skin

Not every bump on dry skin is a pimple.

• Hair products. The AAD says oils in shampoos, conditioners and styling products can cause whiteheads and tiny skin-colored bumps along the hairline, forehead and back of the neck, and that the acne can take 4 to 6 weeks to clear after you stop the product.
• A reaction to a product. The NHS says contact dermatitis makes skin itchy, blistered, dry and cracked, and most often affects the hands and face.
• Rough, dry skin. The AAD lists rough texture and flakes among the signs of dry skin.

When to see a doctor

See a doctor or dermatologist if your skin stays dry, red or stinging after two weeks of a gentler routine, or if your acne is deep, painful or leaving scars. If you use a prescribed acne medicine and it dries your skin, keep using it and ask the prescriber what to change. A doctor can adjust the strength or the type of treatment. Dry, cracked or itchy skin that does not improve can also be a condition such as eczema, which needs a diagnosis.