What causes acne?
Acne forms when hair follicles become clogged with excess oil and dead skin cells. This allows acne-causing bacteria called Cutibacterium acnes (C. acnes) to grow and trigger inflammation. There are multiple factors that contribute to this process:
Increased sebum production – Androgens hormones stimulate oil glands during puberty, triggering more sebum output. This extra sebum can block follicles.
Follicular keratinization – Skin cells inside follicles stick together and block the pore rather than shedding normally.
Bacteria – C. acnes feeds on the trapped sebum and multiplies, causing swelling and redness.
Inflammation – The immune system responds to C. acnes bacteria, releasing inflammatory chemicals that damage follicles.
Genetics – Studies reveal acne susceptibility has a hereditary component in families. Genes regulating sebum production, immune responses and more play a role.
Stress – Stress hormones may exacerbate acne by increasing oil production and inflammation. The link between acne and stress/anxiety is debated.
Diet – Certain dietary factors like high glycemic index foods may worsen acne, but more evidence is needed.
In summary, acne arises when a combination of excess oil, abnormal skin cell shedding, bacteria and inflammation obstruct hair follicles and trigger pimples. Hormones, genetics and environmental factors interplay in complex ways to cause acne outbreaks.
How do dermatologists diagnose acne?
Dermatologists diagnose acne by examining the type of acne lesions and their distribution across the face/body. Based on this visual assessment, acne severity is categorized as:
Mild – Mostly whiteheads and blackheads with a few inflammatory papules/pustules. Less than 30 total lesions, concentrated in the “T-zone” of face.
Moderate – More extensive papules/pustules. 30 to 125 total lesions, spread more widely over the face.
Severe – Many inflamed cysts and nodules are present. Over 125 total lesions, often all over face/chest/back. Scarring risks increase.
Doctors also consider factors like a patient’s age, prior acne treatments tried, skin type, and medications. Lab tests are not routinely needed but may identify hormonal or other medical causes in some cases. Keeping a diary noting aggravating factors can help guide treatment.
What are the best acne face washes?
Look for acne face washes with these properties:
Non-comedogenic – Won’t clog pores and worsen breakouts
Gentle wash – Cleanses without irritation or over-drying
Salicylic acid – Keratolytic that exfoliates dead skin cells and unclogs pores
Benzoyl peroxide – Antibacterial agent that kills C. acnes bacteria
Some top over-the-counter acne face washes include:
CeraVe Acne Foaming Cream Cleanser – 4% benzoyl peroxide
La Roche-Posay Effaclar Medicated Gel Face Wash – 2% salicylic acid
Neutrogena Oil-Free Acne Fighting Face Wash – 2% salicylic acid
Clean & Clear Continuous Control Acne Cleanser – 5% benzoyl peroxide
Always rinse thoroughly after washing and avoid excessive scrubbing that can worsen irritation. Using a gentle face wash twice daily is recommended, even when using other acne medications.
What is the best acne spot treatment?
Spot treatments target individual pimples as they form to reduce inflammation and speed healing. Some OTC options:
Benzoyl peroxide gels/creams – Kills bacteria in pores and dries out blemishes. Can bleach fabrics.
Salicylic acid spot treatments – Penetrates pores to clear debris and reduce swelling.
Sulfur spot treatments – Absorbs excess oil and has mild antimicrobial effects.
Tea tree oil – Derived from the Melaleuca alternifolia plant. Has anti-inflammatory and antimicrobial properties.
Look for spot treatments with at least 5% benzoyl peroxide or 2% salicylic acid. Tea tree oil should be 5% concentration or less to avoid skin irritation. Always do a patch test before applying new products if you have very sensitive skin. Apply a thin layer only on the blemish 1-2 times daily as needed.
How does salicylic acid help acne?
Salicylic acid is a key ingredient in many over-the-counter acne medications. It treats acne in several ways:
Exfoliates – Loosens and sheds dead skin cells that clog pores. Prevents buildup inside follicles.
Unclogs pores – Dissolves excess sebum and allows debris in pores to wash away more easily.
Reduces inflammation – Has mild anti-inflammatory effects on early acne lesions.
Controls oil – Mildly reduces sebum production in oilier skin types.
Over-the-counter products use salicylic acid levels up to 2% which penetrates pores to clear blockages and prevent new blemishes from forming. It takes consistent daily use for optimal results. Using too much can cause dryness or peeling.
How does benzoyl peroxide help acne?
Benzoyl peroxide is a highly effective acne medication due to its antimicrobial properties. It attacks acne in several key ways:
Kills C. acnes bacteria – Benzoyl peroxide is antibacterial and reduces bacteria inside clogged pores.
Dries out oil – Absorbs excess sebum that contributes to blockages in follicles.
Exfoliating effect – Can help loosen and shed pore-clogging dead skin cells and debris.
Reduces inflammation – Has mild anti-inflammatory effect on inflamed pimples.
Most over-the-counter treatments use 2.5-10% benzoyl peroxide, with higher levels being more potent. It works best with consistent daily usage. Potential side effects are dryness, peeling, stinging and skin bleaching.
What are oral antibiotics for acne?
Moderate to severe inflammatory acne is often treated with oral antibiotics in addition to topical regimens. Some commonly prescribed options include:
Doxycycline – Taken twice daily, this tetracycline-class antibiotic reduces C. acnes bacteria in pores and also has anti-inflammatory activity.
Minocycline – Also a tetracycline taken twice daily. Prevents and treats inflammatory acne lesions by targeting bacteria.
Trimethoprim-sulfamethoxazole – This antimicrobial combination antibiotic is sometimes an alternative for those unable to take tetracyclines.
Azithromycin – Taken intermittently rather than daily, azithromycin also reduces C. acnes bacteria. May cause fewer side effects.
Oral antibiotics treat acne by lowering levels of inflammation-triggering C. acnes bacteria in skin pores and are usually taken for 6-12 weeks. Overuse can increase resistance, so they are rotated and combined with other acne treatments.
How do retinoids help acne?
Topical retinoids are vitamin A derivatives that treat acne in several unique ways:
Normalizing skin cell shedding – Prevents abnormal clumping and clogging inside follicles.
Unclogging pores – Loosens debris and oil plugs stuck deep inside pores.
Reducing inflammation – Lessens redness and swelling of inflammatory lesions.
Preventing comedones – Discourages closed comedones and microcomedones that lead to breakouts.
Brand names include adapalene (Differin), tretinoin (Retin-A), tazarotene (Tazorac) and others. Moderate-severe acne usually responds best to routine retinoid use combined with other topical/oral therapies for maximum results.
How does accutane treat acne?
Isotretinoin (Accutane) is a powerful oral retinoid drug for severe nodular/cystic acne unresponsive to other treatments. It works by:
Reducing oil gland size and output – Lowers sebum production by 70% or more.
Changing skin cell formation – Normalizes abnormal growth and shedding of cells inside follicles.
Reducing C. acnes bacteria – Lessens bacteria levels in pores through anti-inflammatory effects.
Anti-inflammatory effects – Blocks various inflammatory pathways that are overactive in acne.
Daily use for 4-6 months typically gives long term clearing or significant improvement in severe cases. Due to certain side effects, oral isotretinoin therapy requires tests and close monitoring by a prescribing dermatologist.
What natural ingredients help acne?
Some plant-based and natural agents have mild effects on acne:
Tea tree oil – Has antimicrobial and anti-inflammatory properties, especially in 5% concentration.
Aloe vera gel – Helps heal damaged skin from inflammatory lesions.
Witch hazel – Astringent that removes excess oil from skin.
Green tea extract – Polyphenols may reduce sebum production and inflammation.
Resveratrol – Antioxidant found in grapes, berries and peanuts that may inhibit C. acnes bacteria.
Zinc – Required for wound healing and immune cell function. Oral supplements may support severe acne treatment.
While natural ingredients alone cannot treat moderate to severe acne, they may provide complementary effects when combined with proven prescription therapies. Always consult your dermatologist first.
How can I avoid acne scarring?
Preventing the formation of permanent acne scars involves:
Avoid picking/squeezing pimples – Manipulating lesions worsens inflammation and pushes bacteria deeper into skin.
Treat acne early – Starting treatment when breakouts first appear prevents lesions from progressing to deep cysts.
Use correct acne products – Over-drying ingredients like alcohol or harsh scrubs damage skin and worsen scarring.
Don’t delay professional treatment – Seeing a dermatologist early-on for appropriate treatment minimizes formation of scars.
Incorporate gentle skincare – Using non-comedogenic moisturizer prevents dryness and irritation that impairs healing after breakouts.
While some superficial scarring can still occur with milder acne, these steps help limit the extent of permanent scars and pits by controlling inflammation and allowing lesions to heal properly.
Can hormonal acne be cured?
For women whose acne is clearly linked to shifts in hormones like during the menstrual cycle, hormonal therapies can help resolve the root cause:
Oral contraceptives (birth control pills) – Regulate hormone levels, including androgens that stimulate oil glands.
Anti-androgens like spironolactone – Block effects of hormones on oil glands.
Gonadotropin releasing hormone agonists – Medications that suppress ovarian hormone production. Requires injections.
For optimal improvement, hormonal therapy is paired with topical retinoids, antibiotics or both. While hormonal acne treatment cannot provide a permanent “cure”, it can allow women to remain clear while taking medications that balance hormone fluctuations.
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