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FAQ on Acne
ACNE is a common condition that affects both men and women at almos t any age. It is most commonly associated with adolescence; however, it is present in over 40 million people in the United States between the ages of 12 and
40. The appearance and involvement can vary from individual to individual. It can present as small to large tender pimples or cysts, or as small skin-colored “bumps” or blackheads.
Cause: The cause of acne involves many factors, with genetics playing a key role. Acne develops in the pores and oil glands (pilosebaceous units) in the
skin. The cells in the pores form keratin (cellular debris) that accumulates and blocks the openings. The oil glands continue to produce oil (sebum).
Microbacteria is common and lives in the pores. This bacterium is called Propionibacterium acnes. The bacteria in the pore flourishes in the
environment of blockage and increased presence of sebum. The result is a cascade effect causing the skin to become inflamed and swollen, forming a pimple or cyst.
Other causes of acne vary in each individual. In females, it is not uncommon to have pre-menstrual flares secondary to hormones called androgens. Many
medications are also associated with acne. Examples include testosterone, barbiturates, lithium, anticonvulsants and topical, inhaled or systemic
corticosteroids. Finally, mechanical irritation such as vigorous brushing of the upper hairline or friction from a bra strap, football helmet or headband may cause acne.
Ethnicity: In general, people with darker skin tend to have less severe acne compared to lighter skinned individuals. Darker skin is more compact with
larger oil glands and more structurally defined pores. These characteristics are usually protective against severe acne. When acne is present, the causes are
identical to lighter skinned individuals. Darker skin, however, tends to hyperpigment after the pimple has resolved. When treating this condition, be
careful not to irritate the skin, as this may worsen the darkening.
Diet: For years, people have thought that greasy foods, soda, milk, chocolate or iodine products may cause acne. This approach is controversial but not
without some merit. Some people are exquisitely sensitive to food and medications. Food, for the most part, is not a major cause of acne.
Cosmetics: Each individual’s skin is uniquely sensitive to various cosmetics or products. Always use “oil-free makeup". The term non-comedogenic is used
in lieu of “oil-free” on many products.
Water based products are not necessarily oil free. Many of these products contain oil. If your skin is sensitive to cosmetics, use name brand lotions, gels or creams and check the label.
When applying cosmetics, minimize finger contact with the jar or bottle; this may contaminate the product with bacteria. Use sable brushes and make sure
your brushes and sponges are clean. A sable brush may be cleaned through the gentle dishwasher cycle.
Pink and red cosmetic shades draw attention to irritated skin. Keep cosmetic color tones neutral with skin tones or warm browns. Makeup artists mix a green
-tinted makeup with regular foundation to help conceal red areas. Use this sparingly. Another hint is to try to dab concealer on top of your foundation.
Blend the edges out and then set this with pressed powder.
Powders can be used when applied with a sable brush. This reduces skin irritation. Powders are important as they can camouflage the red to purple
areas and absorb excess oil in oily-skin individuals. Avoid iridescence in the powder. Iridescence is achieved by ground-up mica that can clog the pores
and cause acne. It is advisable to choose a powder of matte finish.
Examine the contents of the makeup and avoid the following compounds: acetylated lanolin, algae extract, algin, butyl stearate, carrageenan, cocoa
butter, hexadecyl alcohol, laurel alcohol, laureth 4, isocetyl stearate, isopropyl esters, isopropyl isosterate, isopropyl myristate, isopropyl palmitate, isostearyl
isostearate, myristyl lactate, myristyl myristate, octyl stearates, oleyl alcohol, potassium chloride, PPG 2 myristyl propionate, red algae, sodium chloride,
sodium lauryl sulfate, solulan 16, steareth 10 and wheatgerm oil.
Keep in mind that hair products may aggravate acne. Watch the use of styling gel, mousse, pomades and hairspray.
Acne Tips:
- Drinking lots of water is good for your overall health; however, it does not treat or cure acne.
- Scrubbing may aggravate acne and slow down the healing time of current acne. You can’t scrub away acne. Acne is not caused by dirt, but rather
a plugging of the pores combined with bacteria, oil production and skin inflammation.
- Over-drying the skin may make acne worse. The body responds by increasing oil production.
- Stress may aggravate acne, but it does not cause it.
- Sun tanning and sunburn will aggravate acne in the long run. The skin responds by exfoliating and clogging the pores.
- Sweating and exercise may aggravate facial, chest and back acne. This varies from individual to individual and usually can be treated by topical washes and creams. (Don’t stop exercising!)
- Be aware that climate may affect the oil production in your skin. Hot humid weather may increase oil production and subsequently aggravate
acne. Dry hot climate may over-dry skin and also aggravate acne.
Recommendations:
Keep in mind that acne treatment is designed to prevent outbreaks. Treatment is individualized from person to person. Treat the entire acne involved area on
a daily basis with maintenance and not episodically when an outbreak is bad. Remember, it doesn’t help to treat individual lesions separately; treat the whole
face, chest, or back area to get good results.
When cleaning your face, use your hands only. Do not scrub with a washcloth or use abrasive granular products. This damages your skin and can actually
make the acne worse. Try not to pop, pinch or over-medicate your face. This also may make the acne worse and possibly cause scarring.
 The dark, hyperpigmented, areas on the face usually are from previous
acne and inflammation. It generally does not represent scarring. These areas almost always resolve after many months. In the early
stages, a topical bleaching agent (lightening gel) may help decrease skin darkening. This is especially important in darker skinned individuals.
The treatment of acne should be a combination approach. Single agents usually do not work well. The treatment should be designed
with the goals of controlling the microbacteria and opening the pores.
 Benzoyl peroxide products are excellent for oily skin, exfoliation
and their antibacterial properties. Benzoyl peroxide washes may be used two to three times a day. Benzoyl peroxide creams may
be used in the morning or at night. This provides excellent antibacterial coverage, as bacteria have no resistance to benzoyl peroxide. Initially, choose a mild benzoyl peroxide strength. The
strength can be increased as tolerated.
 Benzoyl peroxides, as mentioned above, and retinoic acids open the skin pores. Over-the-counter retinoic acid is called retinol. Retinol is a form of Vitamin A that is very effective in opening pores. The appropriate benzoyl
peroxide wash or mild acidic wash is used two to three times daily. The benzoyl peroxide cream or lotion is applied in the morning and retinol in the evening. An oil free moisturizer may be used over the benzoyl peroxide or
retinol.
 Finally, if the acne is primarily skin colored bumps or blackheads (comedonal), home glycolic acid peels and
blackhead extraction can be done once or twice a week to clear the pores. Facial masks are also very effective at clearing the pores while toning the skin.
Although over-the-counter preparations are excellent, some individuals may need prescription medication. Your dermatologist may prescribe antibiotics,
birth control pills, prescription benzoyl peroxides or retinoic acid. If the acne is severe, a high-dose prescription Vitamin A oral medication, Accutane, is an
option. This must be prescribed and closely monitored by your dermatologist.
FAQ on Acne
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