A Primer on Pimples…

Acne 101

Acne is a common skin condition that affects greater than 90% of people at some point in their lives. The great majority of teens experience acne, and men and women in their 30’s and 40’s may continue to have acne as well.

Washing face

With so many people afflicted by acne, it’s no wonder that the U.S. has spent over $2.5 billion dollars trying to correct it.

So what causes acne? It’s a complex mixture that can be broken down more easily into four main causes:

1. Extra oil production. This is caused by hormones and driven by genetic makeup. Oil contributes to clogging of pores, which leads to acne. While washing the skin 2-3 times per day will remove this oil, washing more often can dry the skin out and cause more oil production. Often, washing with a gentle cleanser is enough. Ingredients like Salicylic Acid and Benzoyl Peroxide help to “dry up” the skin and remove the oil. Occasionally, oral prescription medications (birth control pills, anti-hormone agents, and oral vitamin A agents) are required.


2. Dead skin cell build up. This can lead to clogged pores (called “comedones”). Exfoliating the skin helps remove the built up dead skin cells that clog pores. Exfoliation can be done in 2 basic ways — Mechanically (with a wash cloth, scrub, or Clarisonic brush) or Chemically (with ingredients such as glycolic acid, benzoyl peroxide, and retinoids).


3. Bacteria called P. Acnes. This bacteria loves to live on our skin (we all have it), and it feeds on the oil and dead skin. P. Acnes is responsible for red pus bumps and tender pimples on the skin. We can minimize the number of P. Acnes with antibiotics and antibacterials (topical and/or oral).


4. Inflammation. We can decrease the active redness and inflamed pimples with prescription medication such as topical dapsone or one of the oral antibiotics listed above. As red blemishes resolve, they may leave a purple or dark pink mark behind. These dark marks are usually not permanent but can take 6-12 months (on average) to fade. If you are developing pock or icepick marks on the skin, please seek a Dermatology provider as soon as you can (to start treatment to prevent more from occurring).


So what’s the best way to treat my acne? It depends on which type you have.

Clogged pores (tiny bumps, blackheads, and small whiteheads) are best treated with agents that exfoliate the skin (like topical retinoids — i.e., Retin-A and its cousins).

Inflammatory lesions (pus bumps and tender pimples) are best treated with antibiotics, either topical or oral.

Hormonal acne (commonly seen in adult women) may be improved with the use of birth control pills or anti-hormone agents.


Let’s talk about diet!!

While there are many opinions on the topic of diet and acne, there is not enough research evidence to suggest an association between acne and dietary habits. There is no proof that chocolate, caffeine, greasy foods, or other foods cause acne. Does this mean that we should eat whatever we want?  No, it means we should be eating a balanced and nutritious diet, as well as drinking adequate amounts of water daily. Maintaining good health and weight is an integral part to achieving good skin.


General tips:
1. Wash the affected area twice daily.
2. Use non pore clogging products (washes, makeup, moisturizer, sunscreen).  Look for “noncomedogenic” on the label.
3. Try not to touch affected areas (don’t touch your face!).
4. Give new medications time to work — it can take two to three months to see a 60-80% change after starting a new regimen.
5. Seek medical help if you are experiencing severe acne or scarring — remember, acne is a medical condition!
6. All acne can be treated no matter the age of the patient.


No matter which type of acne you have, if you have tried treating it and are frustrated or are developing scars, please seek the help of a Dermatology provider. Dermatology providers are experienced in developing a plan that can help you.


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