Acne and the quest for a clear complexion
- doctalk101
- Aug 21, 2023
- 3 min read
Updated: Sep 15, 2023
Acne is the most common skin disorder affecting 40 to 50 million people of different ages in the United states. It can have negative psychological impact on a person especially when severe. Although many people outgrow this after their teenage years a good 30% to 40% have problems into adulthood. There are a number of things one can do to help control acne, which include washing the face twice daily, eating a good diet that has fruits and vegetables, and cutting down on processed/fatty foods. Drink plenty of water, get enough rest, exercise, and make sure to change your sheets as least every 2 weeks. Careful about products you use on your face. Use cosmetics that are water based and non- comedogenic (non-pore clogging), use loose powder which can reduce oils, masks are also great at absorbing oils (clay masks are especially good). Once you have optimized your routine then you can discuss with your physician and what treatment would be best for you if you are still having problems. Sometimes this comes down to genetics. Some people are lucky and have beautiful skin without much effort and others have to get help.
There are four factors that can cause acne and one or all may affect an individual. This is primarily an inflammatory disorder of the pilosebaceous gland.
There can be increased sebum production in the skin which leads to oiliness. This is hormonally related. This is why teenagers tend to have break outs as they start puberty and produce more hormones, especially androgens. Another is hyperkeratinization of the skin, which can lead to epithelial cells sticking together and can cause the pores to clog. This leads to comedone formation which is what white and black heads are. Third is a bacteria called propionobacterium acnes which can colonize a follicle. Fourth, one can develop an inflammatory reaction to the previously listed problems.
Treatment depends on the predominating form of acne. One can have noninflammatory acne in which there are comedones, blackheads and whiteheads. One can develop an inflammatory form which has pustules or nodules. This can effect the face, neck, chest, and back to various degrees. For some people it can be so severe that it is psychologically damaging.
First thing is to wash the face and effected area twice daily to reduce the amount of oil on the skin, there are many products such as Neutrogena or other brands that you may prefer. Then over the counter medications with benzoyl peroxides and salayilc acid can be tried. These tend to be less effective then prescription medication. Your case needs to be discussed with a physician. For noninflammatory to mild inflammation the treatment includes topical retinoids, such as Retin-A or Differin, or their generic brands. It can be combined with benzoyl peroxide.
Moderate to severe acne.
If there is mild to moderate inflammation then topical antibiotics may be beneficial and tend to be clindamycin or erythromycin based. You would need a prescription from your doctor. Usually this can be combined with higher strength benzyl peroxide. Oral antibiotics are used for moderate to severe acne in combinations with some other topical agent. Once under control patients can continue on maintenance therapy such as a topical retinoid.
For those people that have severe nodular acne that is resistant to treatment, oral isotretinoin may be recommended, this is commonly known as Accutane. This drug can cause some serious side effects and can even cause severe birth defects so caution has to be used in females. A pregnancy test is required and have to ensure birth control methods are used while on this medication.
Other treatment is estrogen containing oral contraceptives for women that notice worsening acne around the menstrual cycle and in females with heavy oil production. Tea tree oil has also been shown to be effective in reducing inflammation.
Other things that can help are laser therapy. Microdermabrasion or chemical peels help to reduce scarring and pigmentation changes. Masks are wonderful with absorbing excess oil. Of course a good diet, drinking plenty of water, and exercising can also be beneficial for a good complexion as mention before. A few products that I use and like are Hydra Zen by Lancombe.
Clarity Rx also has some great products like their detoxifying charcoal mask. There are plenty of brands but dermatologist recommended CeraVE is another good product line for face washes and creams. I also like Kiehl's Calendula deep cleansing face wash.
1. S. Titus MD, J. hodge MD, AAFP Oct 2012; 86(8):734-740
2. Health.com
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