Acne is a problem with blockage down inside the pores. The blockage is from skin cells that line the inside of the pore not shedding normally. It is not from dirt or surface oil. These blockages range from microscopic to pinhead sized bumps called comedones. If the pore remains blocked, oil and bacteria build up in the follicle. When this build up is excessive the follicle breaks open under the skin and a red sore bump or pus bump (papule or pustule) develops which then gradually resolves. Occasionally, a very large deep-seated sore nodule or cyst can develop.
Gentle washing is best. Dirt and surface oil do not cause acne, and frequent washing does not improve it significantly. Wash with a mild soap (Dove, Purpose, Basis or others for dry skin) or acne wash once or twice a day. Excessive washing, harsh soaps (Ivory, Zest, Dial, Irish Spring, etc.), buff puffs and scrubs can dry and irritate the skin and may make acne worse. Bothersome oiliness can also be removed with toners containing salicylic or glycolic acid.
Diet: Studies have not been conclusive on if certain foods cause acne. In general we recommend eating a balanced diet, drinking plenty of water and incorporating exercise into your regimen to help eliminate toxins from your body. Some patients, feel that a certain foods high in fat or caffeine predictably makes their acne worse. If this is the case, avoid those foods. Supplements with DHEA and Androstenedione will flare acne.
Moisturizers and Cosmetics
These do not usually cause or flare acne. Many times a moisturizer may be necessary if medications are excessively drying. When using cosmetics, try to use those labeled as “noncomedogenic” or non-acne causing (most are). Obviously avoid any that still seem to flare your acne. We often recommend mineral based cosmetics which actually have some anti-inflammatory effects against acne.
These are very helpful but may take several weeks to show their full benefit. They work to unplug pores and to prevent new lesions from forming rather than to treat large inflammatory papules and pustules that have already developed. Therefore, they must be used regularly for prevention. Also, you should apply them to the entire area where you get acne. The topical medicine may contain retinoid, prescription-strength benzoyl peroxide, antibiotic, salicylic acid, azeleic acid and or anti-inflammatory medications. Sometimes we use combination treatments to maximize the results and depending on your skin type and your type of acne.
These type of treatment is usually necessary to treat acne cyst and nodules. Oral Antibiotics, help to kill bacteria and reduce inflammation. Birth Control Pills and spironolactone that work on hormones, can be helpful for women. Isotretinoin, is the only treatment that works on all that causes acne; therefore it is the only medication that can cure acne.
Inflamed lesions (papules, pustules, especially large/deep cysts) can cause scarring. Changes in color (darker, lighter or red spots) will eventually return to normal over a number of months. Persistent pitting or bumps can occur which only partially improve with time. The best treatment is to control the acne and avoid new scars. Also, scarring can be reduced by not picking at acne lesions. Other options include chemical peels, Laser treatment and PRP.