Acne is one of the most common skin conditions in the world, affecting almost 10% of the population. It affects all races, genders, and ages. Even though it is not life threatening, it causes significant emotional distress and morbidity for some. The good news is there are many treatment options available to help acne sufferers. There is no cure for acne, but it can be controlled well. The sooner you treat acne, the less likely you are to get permanent scarring and discoloration of your skin.
What causes clogged pores and acne?
Pores are tiny holes in our skin that connect sebaceous glands (oil glands) to the skin's surface. These pores are lined with skin cells called keratinocytes. Oil is expelled through the pores onto the skin's surface to lubricate, moisturize, and protect the skin. Also, hairs grow out of the pores.
Acne occurs when oil and dead skin cells (keratinocytes) get trapped inside the pores. This type of acne is called comedonal acne and includes blackheads and whiteheads.
If bacteria, such as P. acnes, get trapped in the pores along with oil and dead skin cells, this causes inflammation around the acne lesions. Inflammatory acne includes papules, pustules, nodules, and cysts. These are more severe forms of acne, which are more challenging to treat.
What treatment options are available for acne?
Combination treatment – including proper hygiene, over-the-counter medications, and prescription medications – works best to keep acne under control.
Most of these treatments are not appropriate for pregnant women, women planning on becoming pregnant, and women who are nursing. Also, some of these treatments may not be appropriate for patients with certain medical conditions.
It is best to discuss your acne and treatment options with your doctor before starting an acne regimen.
- Wash twice daily with an acne wash or non-comedogenic gentle cleanser. Massage the cleanser into your skin with clean fingertips. Use lukewarm water because hot water can damage your skin. Do not scrub with a brush or washcloth because that can irritate and damage your skin. Pat dry with a clean towel.
- Moisturize twice daily with a non-comedogenic moisturizer. This keeps your skin from overproducing oil. Also, many acne products can dry out your skin and require moisturizer use.
- It is vital to apply non-comedogenic sunscreen daily to prevent premature aging and skin cancers. Also, many acne medications make you sensitive to the sun.
- No picking. Picking inflames the skin and makes acne last longer. It can also lead to infection and scarring.
- Wash towels, linens, cell phones, masks, athletic gear, hats, headbands, and anything else that comes in contact with your skin daily. These items can harbor dirt, bacteria, and oil, which can be implanted into our pores and worsen acne.
- Use only non-comedogenic products. All products (cleanser, moisturizer, sunscreen, makeup, and concealers) must be non-comedogenic. This means they do not contain oils that can clog your pores.
- Avoid friction. Friction can irritate the skin and implant bacteria and dirt into your pores.
- Avoid touching your face. It is best to keep your hands away from your face. The more you touch your skin, the more likely you are to implant dirt and bacteria from your fingers into your pores.
- Shower after sports or sweating. It is critical to wash immediately after sports or sweating to get rid of the dirt, oil, and bacteria on your skin before it gets into your pores and clogs them.
- Shampoo your hair daily to remove oils that can clog your pores. Also, keep your hair off your face so the oils from your hair do not get on your skin and clog the pores.
- Drink plenty of water every day.
- Stick to a low-carb diet rich in antioxidants, fiber, and omega-3 and 6. Avoid dairy and sugars.
- Lower stress. Try to lower stress by exercising or meditating.
- Probiotics may help reduce acne breakouts. They are also beneficial if you are taking oral antibiotics for your acne.
Oral acne treatments are available only by prescription, and include:
- Antibiotics. The tetracycline antibiotics (tetracycline, doxycycline, and minocycline) are commonly used to treat acne. They kill the bacteria causing inflammatory acne. Minocycline also helps reduce inflammation. BP is often added to the regimen to decrease bacterial resistance. Macrolide antibiotics (erythromycin and azithromycin) can be used in patients who cannot tolerate tetracyclines.
- Oral contraceptive pills can help regulate a woman's hormones and decrease androgens that stimulate oil production. These pills carry the risk of the development of blood clots and cancers.
- Accutane (isotretinoin) is usually reserved for severe cases of cystic acne. It is an excellent acne treatment. It works by decreasing oil production by shrinking the oil glands. It also reduces inflammation and kills bacteria. Accutane carries serious risks, such as birth defects, inflammatory bowel disease, problems with the liver, and depression leading to suicide.
- Spironolactone can help women’s acne by blocking androgens, which will decrease oil production. Some women have reported painful periods or breast tenderness while taking this medication.
Steroid injections can help decrease the inflammation in acne nodules and cysts. It works very quickly to reduce the size of the lesions. Sometimes skin atrophy or discoloration can occur from steroid injections.
Light therapies. Blue light can help kill bacteria and decrease oil production. Photodynamic therapy (PDT) combines blue light with a topical photosensitizer to increase efficacy. Red light can reduce inflammation.
Some lasers, such as 1450nm diode, 585 or 595nm pulsed dye laser, and 1540nm erbium glass laser, can help acne by decreasing inflammation, reducing oil production, and killing bacteria.
Chemical peels can help exfoliate dead skin cells and decrease oil production to unclog pores. Some can also kill bacteria leading to inflammatory acne. Ingredients include SA, retinoids, or glycolic acid.
Incision and drainage can help all forms of acne. Doctors use special tools to lance the lesion and remove the contents to help the acne lesion resolve quicker. It can lead to scarring.
Acne is one of the most common skin problems in the world.
Severe cases can cause a significant negative impact on patients' lives.
Many good treatment options are available for acne that are used alone or in combination. Combination therapy works best for moderate and severe cases of acne.
Do not delay treatment of acne because it can lead to permanent scarring.
American Academy of Dermatology. Acne.
Bolognia, J., Jorizzo, J.L., Schaffer, J.V. (2012). Dermatology. Philadelphia: Elsevier Saunders.
National Institute of Arthritis and Musculoskeletal and Skin Diseases. Acne.
Heng, A.H.S., Say, Y.H., Sio, Y.Y., Ng, Y.T., Chew, F.T. (2021). Gene variants associated with acne vulgaris presentation and severity: a systematic review and meta-analysis. BMC Med Genomics.
Krutmann, J., Moyal, D., Liu, W., Kandahari, S., Lee, G.S., Nopadon, N., Xian, L.F., Seité, S. (2017). Pollution and acne: is there a link? Clinical Cosmetic Investigative Dermatology.
Leyden, J., Stein-Gold, L., Weiss, J. (2017). Why Topical Retinoids Are A Mainstay of Therapy for Acne. Dermatology Therapy (Heidelb).
Jih, M.H., Kimyai-Asadi, A. (2007). Laser treatment of acne vulgaris. Semin Plastic Surgery.