What causes acne?
There are many contributors in the formation of this annoying problem, which affects both adolescents and adults. 80-90% of teens, and 10% of adults, must deal with acne. You are not alone; in fact, not having acne is unusual. Here are the major contributors to the development of acne:
- Hormones: At the start of puberty, there is an increase in the amount of hormones circulating in the body. The hormones that affect acne are the androgens. Both males and females have these, although often males have higher levels. These hormones trigger an increase in the oil production (sebum) in sebaceous glands on the face, back, and upper chest. Acne does not necessarily relate to how high a level of androgens you have, but how sensitive you are to them.
- Bacteria: There are bacteria called Proprionibacterium acnes (P. acnes) that thrive and multiply in hair follicle cells that contain excess sebum.
- Skin: Changes in the skin lead to an increase in the dead skin cells, which then combine with sebum to plug the ducts and it is these plugged ducts that we call acne pimples.
- Immune system: In its efforts to do its job, the immune system contributes to acne. The plugged oil ducts and bacteria upset the surrounding tissue, which triggers a response from the immune system causing swelling, inflammation, and redness.
- Heredity: If your parents had a lot trouble with acne, you may be more likely to have trouble, too.
What makes acne worse?
It is easy to aggravate acne. Here are the most common culprits:
- Pinching, popping, scrubbing, or otherwise fidgeting with the pimples. This can damage the skin around the pimple and either cause one very large one, or cause more pimples in the same area.
- Mechanical irritation (rubbing) from clothing, hats, headbands, athletic pads, etc
- Oily cosmetics: this includes many make-ups, moisturizers, and hair products
- Oily air – i.e. not the fried food, but the air in the fast food restaurant, mechanic garages, etc
- Sweat – can clog pores
- Stress, anxiety, emotional tension
- Menses: during menstrual cycles there are hormone level fluctuations, which can cause acne
- Medications: certain drugs used for seizures and depression, excessive B12, and in some people, iodine. If you are sensitive to iodine, avoid foods that contain it in large quantities (seaweed, kelp, some fast foods)
- Body building steroids – they are not only illegal and very hard on the rest of your body, but they cause severe acne because they are androgens, the hormones that started this whole problem
What doesn’t cause acne?
There is no proof that any food causes acne (unless there is an iodine sensitivity). However, if you feel there is a strong correlation between a certain food and your skin, you may want to avoid it.
Acne is not caused by actual dirt. A blackhead is due to the reflection of light on skin pigment, it is not a plug of dirt. Also, acne is not contagious; it cannot be “caught” or “given”.
What are the treatments for acne?
There is no cure for acne, but there are many ways to improve and control it. Be patient during treatment. It takes 4-6 weeks for acne plugs to reach the surface and clear. Therefore, treatment trials should be at least 6-8 weeks long before they are changed. That is one of the biggest challenges in treating acne. Most teenagers get frustrated early in the course and don’t follow through during that 6 week treatment period.
The most important first step in treating acne is having what we call good skin hygiene. No treatment will be successful without the basics of washing your face and taking care of your skin. Follow these tips:
- Wash your face twice a day, extra if needed (sweating, greasy environment). Do not scrub, gently pat dry.
- Use lukewarm water; very hot water on your face will cause it to become red, irritated, raw and very dry.
- Use only an oil-free moisturizer, usually daily.
- Use only water-based cosmetics. Any products on your face that contain oils should be avoided.
- Take care of yourself! Eat a balanced diet, drink lots of water and get enough rest. Find ways to relax and lower stress. Remember that your worth as a person is not based on your skin.
- Sunscreen is very important because acne treatments make your skin more sensitive to the sun, and more easily burnt. The problem is, many sunscreens are oily and will make your skin worse! Use a sunscreen gel, or oil-free lotion, that is SPF 30 or higher. Oral antibiotics make all of your skin very sensitive, so avoid the sun and use plenty of sunscreen.
When it comes to medications, there are various options for treatment. These include:
- Benzoyl Peroxide: One of the best medications for most acne, benzoyl peroxide kills the skin bacteria and breaks up the plugs in the oil ducts. It is available without a prescription, and can be found in many forms (creams, lotions, cleansers, and pads).
- Generally it is used in 5% or 10% concentrations.
- Apply the cream or gel in a thin layer over all acne prone areas; avoid sensitive skin near eyes, mouth, and corners of nose.
- Use once a day initially. If insufficient, you may increase to twice a day if your skin tolerates it (not too red or peeling). Allow skin to dry completely before applying. For sensitive skin, you may want to start with 5% and increase to 10% if needed and tolerated.
- Benzoyl peroxide acts like bleach, therefore be careful with your clothing, especially silk! Also, it is not a good idea for people with dark pigmented skin to use benzoyl peroxide because it may bleach the skin.
- Salicylic acid: This common ingredient in skin care products (usually 2% concentration) has been used for acne for over 100 years. It breaks apart the sebum plugs and sheds the dead skin cells. Benzoyl peroxide and salicylic acid are found in many over the counter skin care products. Look for them in the list of ingredients, but be careful not to overdo it! Your skin will let you know when it has had too much by becoming red, painful, and by peeling. Be sensible! Slowly increase the amount you use instead of overdoing it all at once and ruining your skin.
- Retin-A/Differin Gel (tretinoin & derivatives): These medications reduce the excessive skin around the sebaceous glands, break up the plugs, and make an environment difficult for the bacteria to survive. Differin Gel is most popular in our office because it is as effective, but less irritating, than Retin-A. A prescription is required however.
- Use once each day, or every other day if that is too much for your skin. Because it may cause peeling and burning, it is helpful to use at night.
- Use at a different time than other face medications when possible.
- Use on all acne-prone areas, just like the benzoyl peroxide.
- Topical: One of these may be added after a sufficient trial of the tretinoin creams. The addition of an antibiotic should prevent, even further, the infection of the pores with P.acnes, reducing the plugs and inflammation. Some examples include: erythromycin and clindamycin. A prescription is required. Use once a day. Use at a different time than other face medications. And use on all acne-prone areas.
- Oral: Systemic antibiotics may be beneficial for severe, widespread acne. It usually takes a few months to see results. This long-term use can have side effects, including vaginal yeast infections.
- Oral contraceptives: Many oral contraceptives (birth control pills) will improve acne by suppressing hormone levels. They seem to be especially helpful in women who have other signs of hormone excess, such as facial hair. It does take a few months to see results, and the pills need to be continued for 1-2 years. Like all medications, these should be carefully considered before use.
- Accutane: Often thought of as the “miracle drug” for acne, Accutane is very effective but has many potential, very serious, side effects. Accutane is taken orally, and is considered a last resort for severe acne. Its use must be carefully monitored by a dermatologist, and your blood must be drawn regularly to monitor for evidence of damage to the blood or the liver. However, for certain people it is an excellent treatment because it permanently changes the pore so that it doesn’t get blocked as easily
This is just a general guide with some suggestions. We are unable to include every possible product on the market, and if one is not mentioned it does not mean it is not good. It is your responsibility to read labels, including the contents, and decide whether or not to try a product
Everyone is different, and that includes our skin. A product that is good for one person may not be good for another. If you are just starting to consider acne treatments or are unsuccessful with previous treatment attempts, please schedule an appointment so we can discuss this further with you.