Acne usually starts shortly after puberty and begins because of hormonal changes and increased oil secretion. However, it is common to see patients (particularly women) in their 30s, 40s, and 50s with adult onset acne. Internal hormonal changes and starting/stopping/switching birth control pills may play a role. Acne develops when hair follicles, the site of acne, get plugged with dead skin cells. Then sebum (oil) and bacteria accumulate and lead to inflammation. Stress may aggravate acne. Studies do not show any relationship between food and acne.
Types of Acne Lesions:
Blackhead (open comedone): Oil and dead cells leave a black plug on the skin surface.
Whitehead (closed comedone): Oil and dead skin cells leave a plug below the skin surface.
Papules (red pimples) and white pustules: The material in the plugged hair follicle seeps through the walls of the follicle and causes redness and tenderness.
Cyst: A very deep, ruptured, inflamed follicle.
Acne Treatment:
Therapy should help lessen the severity and reduce the amount of scarring, which could result from acne if left untreated. Different combinations of medications may need to be tried to determine which combination is best for you. It will take 8 to 12 weeks to see results in most people. Medications only suppress acne. If you stop your therapy, your acne is likely to recur.
Topical antibiotics: (clindamycin, erythromycin) These help decrease or kill skin bacteria.
Oral antibiotics: (tetracycline, doxycycline, minocycline, erythromycin, and others) Help decrease redness and kill bacteria. These are most helpful for red papules and cysts.
Retinoids: (Retin A, Differin, Avita, Tazorac). These unclog pores to eliminate blackheads and whiteheads.
Benzoyl peroxides: (Triaz, Brevoxyl) These unclog pores and prevent bacteria growth. They help prevent antibiotic resistance.
Finacea, Azelex: These unclogs pores and may help decrease bacteria.
Oral contraceptives: (Ortho tri-cyclen, Orthocept, others): These are sometimes helpful in women.
Accutane: This is our most potent acne medication. It has many possible side effects and is usually reserved for severe acne or for when other medications are not working well.
Skin Care:
Wash your face two times per day with a mild soap of soap-free cleanser. (Dove, Oil of Olay foaming face wash, Cetaphil cleanser, Neutrogena or Purpose cleansers for sensitive skin.) DO NOT use harsh soaps and do not scrub vigorously.
If we place you on topical retinoids, please stop any over the counter acne cleansers or creams. Medications for acne are applied to all involved areas; topical not just individual blemishes.
Use a noncomedogenic moisturizer on any dry or irritated areas on your face (Purpose facial, Neutrogena facial, DML facial, Oil of Olay Complete).
All cosmetics, moisturizers, and sunscreens should be noncomedogenic, meaning that they will not clog your pores. Look for this word in print on the label or packaging.
FOR WOMEN ONLY:
Oral antibiotics may decrease the effectiveness of oral contraceptives. A second method of contraception is advised if this concerns you.
All prescribed acne medications should be discontinued if you decide to attempt pregnancy or when you become pregnant unless okay with your obstetrician.
Accutane is absolutely contraindicated in pregnancy.
Washing:
Wash gently but thoroughly twice daily with the recommended cleanser. Avoid harsh scrubs, masks, and other non-prescription products.
Glycolic acid products aid in reduction of comedones (whiteheads and blackheads). These may be used as an after-cleansing step, before benzoyl peroxide, Differin or Retin-A, or topical antibiotics once or twice daily.
Recommended cleansers:
Sensitive, less oily skin: Cetaphil Gentle Skin Cleanser, Cetaphil Gentle Cleansing Bar or Antibacterial Bar, Dove unscented soap, Salac Wash)
Oily or Combination skin: Cetaphil Oily Skin Cleanser, Purpose, Neutrogena’s oil-free acne wash.)
Diet:
A balanced diet is good for everyone. There are no absolute food restrictions; however, chocolate, caffeine, excess milk and milk products, nuts and soft drinks may cause problems for some people, and if they seem to bother you, then avoid them. Drink eight glasses of water daily. Three glasses of skim milk daily is recommended for optimum calcium needs.
Hair:
Keep your hair clean and off your face. Avoid hats and bands that rub the forehead. Wash daily, if needed. Avoid hairspray. Change pillow case nightly if hair spray is used, or wash hair before sleeping.
Cosmetics:
Make-up should be non-comedogenic or non-acnegenic only. Examples of make-ups include: Neutrogena, Clinique Pore Minimizer, Clinique Stay – True, and Almay Oil Free.
Moisturizers include: Cetaphil Moisturizing Lotion or Creme, and Almay Oil-Free Cream. Some products say oil-free but can worsen acne with other ingredients. Read the labels of products and avoid:
Acetylated lanolins
Isocetyl stearate
Myristyl lactate
Peanut
Aloe
Isopropyl isotstearate
Myristyl myristate
PPG-2 myristyl palmitate
Butyl Stearate
Isopropyl myristate
Nalauryl sulfate
Propylene glycol monostearate
Cocoa butter
Isopropyl palmitate
Oleyl alcohol
Red dye
Coconut linseed
Isotearyl neopentanoate
Octyl palmitate
Sesame
D&C Red #9 & 27
Laureth-4
Octyl stearate
Vegetable oils
Decyl Oleate
Other questionable ingredients are lanolin, petrolatum, and mineral oil, especially greater than 15%. True oil-free products contain no animal, mineral or vegetable oil.
Skin Care:
Don’t squeeze or pick at blemishes. It causes more inflammation and larger involvement, which may lead to permanent discoloration or scarring. Don’t prop the phone on your chin or hold your hand to your face.
Use only the medications prescribed for you and only as ordered. Doubling up won’t double the effect and is usually harmful. Always tell us if you change your routine.
Skin:
Some dryness to your skin is desirable in this treatment. Avoid over-moisturizing. You do not need to be red and flaky, however.
Topicals:
Apply topical medicine in a thin layer to the entire involved area, not just individual blemishes. Do not stop your medicines when your skin clears! Acne medicines are primarily preventive, and are used to prevent breakouts. If you stop using them, your blemishes will return.
If problems or questions arise before your next visit, come in sooner or call the office and we’ll be glad to help you. If you can’t make your appointment, please remember to call and cancel.
What is acne ?
