Acne
Acne occurs due to the following
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Overproduction of oil (sebum)
Irregular shedding of dead skin cells resulting in irritation of the hair follicles of your skin
Buildup of bacteria
Factors that may worsen acne
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Hormones. Androgens are hormones that increase in boys and girls during puberty and cause
sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy
and use of oral contraceptives can also affect sebum production.
Certain medications. Drugs containing corticosteroids, androgens or lithium are known to cause
acne.
Diet. Studies indicate that certain dietary factors, including dairy products and carbohydrate-rich
foods—such as bread, bagels, and chips, which increase blood sugar may trigger acne
Acne myths
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Greasy foods and chocolate have proved to have little to no effect on the development of acne
Dirty skin. Acne isn’t caused by dirt. In fact scrubbing the skin too hard or cleansing with harsh
soaps or chemicals can irritate the skin and make the acne worse.
Stress doesn’t cause acne, but if you have acne already, stress may make it worse
Treatment
Acne treatments work by reducing oil production, speeding up skin cell turnover, fighting bacterial
infection, reducing inflammation or doing all four. With most prescription acne treatments, you may not
see results for 4-8 weeks, and your skin may get worse before it gets better.
Topical treatments available by prescription
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Retinoids (tretinoin, Retin-A, differin, and tazorac) are derived from vitamin A. They work by
promoting cell turnover and preventing plugging of follicles. Over time this improves acne,
softens skin, lifts dark spots, and reduces appearance of wrinkles.
Isotretinoin (Acutane) is an oral form of retinoid that is used to treat the most severe cases of
acne. Monthly lab work is required.
Tips for tolerance
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Start out using retinoid at night 2-3 days a week. After a few weeks, increase as tolerated. Goal
would be to apply a pea size amount to entire face once daily, but if unable to tolerate due to
dryness, then decrease to frequency that works for you. Remember it is very important to apply
after retinoid application.
Your skin will be more sun sensitive, so wear moisturizer with SPF of 30 if out in the sun.
Benzoyl peroxide and antibiotic (clindamycin, erythromycin, and sulfa) topicals are effective in killing
excess skin bacteria. Often a combination of such products is required to achieve optimal results.
Oral Treatments
Oral antibioitics—for moderate to severe acne
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May need a short course (usually 3-4 months) of prescription oral antibiotics to reduce bacteria
and fight inflammation.
Oral contraceptives
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Combination of norgestimate and ethinyl estradiol (Ortho Tri-Cyclen, Yaz, Yasmin, and others)
can improve acne in women
Spirolactone
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Not currently FDA approved for treatment of acne
Androgen blocker and anti-inflammatory that is typically used as a diuretic for management of
blood pressure. Low dose of this can be prescribed that works well for hormonal acne (typically
along jaw line). Periodic lab work is required for this. Must be on some form of contraceptives.
Not recommended if patient has first degree relative with history of breast cancer.
Isotretinoin (Acutane) is an oral form of retinoid that is used to treat the most severe cases of acne.
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Monthly lab work is required
Laser and light therapy
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Laser therapy is thought to damage the oil (sebaceous) glands, causing them to produce less oil
Light therapy targets the bacteria that causes acne inflammation
These therapies can also improve skin texture and lessen appearance of scars
Recommended that these approaches for treatment of acne are reserved to those that can’t
tolerate approved acne medications.
Cosmetic procedures
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Chemical peels and microdermabrasion may be helpful in controlling acne. These are most
effective when used in combination with other acne treatments. They may cause temporary
redness and peeling.
Lifestyle and home remedies
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Wash face with gentle cleanser
Ovoid irritants. You may want to avoid oily or greasy cosmetics, sunscreens, and hairstyling
products or acne concealers. Use products labeled “water-based” or “noncomedogenic.”
Watch what touches your face. Keep your hair clean and off your face. Avoid resting your hands
or objects, such as telephones on your face. Tight clothing or hats can also pose a problem,
especially if you’ll be sweating. Sweat, dirt, and oils can contribute to acne.
Don’t pick or squeeze blemishes. Picking or squeezing can cause infection or scarring.