Adult Acne: A Fact of Life for Many Women
Early Acne Often Predicts Severe Acne
Ways to Get Better Results from Acne Treatment
Acne Skin Care Guidelines
Acne Medications Not for Use During Pregnancy
Acne Treatment Revolutionized by 25 Years of Research
Adult Acne: Effective Treatment Available
Are laser and light treatments really light years ahead of conventional acne therapy?
Psst...Topical Acne Medication Can Clear Acne The secret lies in knowing how to use it
The Truth About Oral Contraceptives and Acne
Treating Acne in Skin of Color
Adult Acne: A Fact of Life for Many Women
Adult acne can be particularly frustrating. Treatment that worked so well during adolescence often is ineffective. Over-the-counter topical medications tend to irritate the skin, making acne worse. Some women try numerous treatments without success.
This lack of effectiveness can make one wonder if it really is acne. After all, do adults in midlife and older get acne?
Types of Adult Acne
The truth is that acne can persist well into one’s 30s, 40s, and even 50s. Dermatologists call acne that does not clear by one’s mid-20s persistent acne. Often causing deep-seated, tender, inflamed pimples and nodules, this type of acne is more common in women. Persistent acne tends to form on the lower face, predominately around the mouth, on the chin, and along the jawline.
Adults also develop late-onset acne. Again, women are more susceptible. People who have not had acne for years can suddenly see deep-seated, inflamed pimples and nodules. Even those who have never had acne get late-onset acne. For some women, acne becomes a problem during menopause. Adult-onset acne generally forms on the chin, jawline, and around the mouth. Lesions can appear on the chest and back.
Why Adults Get Acne
Regardless of age, acne develops when excess sebum (an oil that our bodies produce to naturally moisturize the skin), skin cells, and bacteria accumulate. Researchers have discovered that the following may trigger this in adults:
Fluctuating hormones. Acne is typically associated with the hormonal swings of puberty, but any time hormones fluctuate, acne can flare. Many women are familiar with the once-a-month breakout. Hormonal swings also occur during pregnancy and menopause, causing acne in some women
Discontinuing birth control pills. Some women get acne when they stop taking birth control pills. The pills may have been keeping their acne at bay
Taking certain medications. Birth control pills that contain estrogen and progestins often help control acne in women. When a birth control pill contains only progestins, it may make acne worse.
Acne is a possible side effect of other medications as well. These include anticonvulsants, corticosteroids, and sobriety drugs. Never stop taking a prescription medication because acne develops or worsens. Talk with the doctor who prescribed the medication. Ask if a different medication can be prescribed that will not cause acne to flare. If only one medication can be prescribed, talk with a dermatologist about ways to control the acne. Do not stop taking the medication
Family history of acne. In one study, researchers found that 50% of the adults with acne had a first-degree relative (parent, sibling, or child) who had acne. This suggests that some people may have a genetic predisposition to acne
Stress. Studies indicate that stress may trigger acne in women. Researchers have found a relationship between increased stress levels and higher levels of acne in women with fast-paced careers. In response to stress, the body produces more androgens (a type of hormone). These hormones stimulate the oil glands and hair follicles in the skin. When over-stimulated such as during times of stress, acne can flare
Products used on hair and skin. Some products such as oily sunscreens and hair greases promote a type of acne called acne cosmetica. When buying products to be used on the skin or hair, look for ones labeled “non-comedogenic” or “non-acnegenic.” This means that they are less likely to cause acne.
Acne Can Be Warning Sign
Acne also may be warning a woman of an underlying medical condition. When a woman’s acne is accompanied by excessive facial hair, thinning hair or bald patches on the scalp, and irregular periods, it may be a sign of polycystic ovaries (a condition that causes cysts to develop in the ovaries) or adrenal hyperplasia (a group of adrenal gland disorders). It also is possible that the woman has a hormone-secreting tumor located in her adrenal gland or an ovary. It is vital that women experiencing these signs and symptoms see a doctor. Testing can find the cause and allow the doctor to determine the best treatment. The acne will not clear until the medical condition is treated.
Barring an underlying medical condition, most cases of adult acne can be effectively controlled with acne therapy. Yet, researchers have found that many women do not seek treatment. Most believe treatment is not available. Dermatologists want women to know while adult acne can be stubborn, effective control is possible.
Early Acne Often Predicts Severe Acne
When acne begins early, between 8 and 11 years of age, it often means severe acne as a teenager. Treating the acne before it becomes severe can:
Studies Confirm Link Between
Early Acne and Severe Acne
Two large-scale U.S. studies looked at how acne develops during adolescence. One of these studies evaluated the severity of acne in 468 boys who ranged in age from 9 to 15 years. About half of the boys were African-American and half were Caucasian. The researchers found that acne becomes more common and more severe in adolescent boys as they mature. The researchers concluded that keeping an eye on acne in preadolescents and young adolescents can help determine when treatment, which can prevent severe acne from developing, should begin.
To expand upon these findings, the researchers evaluated acne in girls. This study followed 871 girls for 5 years. Again, about half of the participants were African-American and about half were Caucasian. At the beginning of this 5-year study, the girls were in 4th or 5th grade. Following the girls over a five-year period showed results similar to the previous study. The researchers found that the number of acne lesions and the severity increased as the girls matured. The girls who had significantly more acne lesions at age 10, when the study began, had the most severe acne at age 15. The researchers concluded that the best way to predict how severe acne will be at age 15 is to determine the severity at age 10.
Early Treatment Helps Prevent Physical and Emotional Scars
When acne is severe, large, red bumps called “cysts” form. Cysts can be painful and may cause permanent scarring. While not life threatening, these physical effects often cause extreme emotional distress that can last a lifetime.
Anxiety, loss of self-esteem, and depression are common in people who have acne. Even mild and moderate cases cause emotional distress. When asked to talk about how acne affects them, patients often mention feelings of inferiority, embarrassment, and depression. One teenager said, “I was more self-conscious about my skin, and at times very shy because I felt my acne made me very ugly.” A college student confessed that he avoided asking girls out because he thought, “She won’t be interested because of how I look.” Another patient confided, “I got severely depressed, and sometimes I wouldn’t go to school because I had a particularly large pimple, and I just didn’t want to be seen like that.”
Severe or long-lasting acne can cause feelings of insecurity that last a lifetime. One study found that people who had acne for a significant amount of time tend to feel “scarred for life.” Long after the acne clears, they may have low self-esteem and feelings of inferiority.
To avoid these physical and emotional scars, dermatologists recommend that early acne be properly treated and that treatment continue for as long as necessary to prevent the acne from recurring.
How Dermatologists Treat Early Acne
Today, there are a number of effective acne treatments and virtually every case of acne can be controlled. However, what clears one person’s acne may not work for another person. This is why appropriate treatment begins with an evaluation by a dermatologist.
During the evaluation, the dermatologist will determine the severity and types of acne lesions present. The doctor may ask questions to learn how the acne affects the patient. Sometimes the acne worries the parents; however, a young adolescent may not be concerned about appearance. The dermatologist also will want to learn if the patient is willing to follow an at-home treatment plan.
After the evaluation, the dermatologist will decide what, if any, treatment is appropriate. For ayoung adolescent who has mild acne, the dermatologist may prescribe a low-dose topical retinoid or benzoyl peroxide. It is important to realize that appropriate treatment may require more than one medication. Sometimes a topical antibiotic is part of the treatment plan. Severe acne may require an antibiotic in pill form as well as topical medication.
Proper skin care plays an important role in acne treatment. The dermatologist can provide tips for taking care of acne-prone skin as well as provide product recommendations for everything from cleansers to sunscreen.
Using Medication as Directed Gets Results
To get clearing, acne medication should be used as directed. Some medications must be taken daily; others may be used intermittently. Before leaving the dermatologist’s office, be sure that you understand how to use the medication and when to use it.
If using the medication as directed becomes a problem or the treatment plan does not seem to work, be sure to tell your dermatologist. There are many effective treatments available today.
It is important to realize that acne cannot be cured, but it can be effectively controlled. Keeping acne under control may require long-term treatment. Acne often returns when treatment is stopped, so continue to use your medication until your dermatologist tells you to stop. This helps prevent new acne lesions from forming.
A Lifelong Difference
Acne sometimes appears earlier than parents expect. If early acne develops, teaming up with a dermatologist can help keep acne from becoming severe as well as prevent physical and emotional scars. Preventing severe acne can make a difference that lasts a lifetime. 12 Ways to Get Better Results from Acne Treatment
Effective Acne Treatment Often Requires More Than Medication
Do you wish that your acne medication left you with clearer skin? Better results may not come from trying the latest acne treatment or a stronger acne-fighting cream — but from making some simple changes.
For those seeing a dermatologist
Use your acne treatments exactly as prescribed
Acne only clears when the treatment targets everything that is causing the acne. Since most acne medications target only 1 or 2 causes, 2 or 3 products are often necessary. To see clearer skin, these products must be used as prescribed
Stop using acne treatments not prescribed by your dermatologist
Using acne products that are not part of the treatment plan prescribed by your dermatologist can irritate your skin. Irritated skin usually leads to more breakouts. For best results, dermatologists recommend using only the acne-fighting products and medications in your treatment plan
Dermatologists do not want patients to feel confused about acne treatment. If you do not understand something, ask about it. If an acne treatment option not prescribed by your dermatologist interests you, be sure to mention it. Asking questions is often the answer to effective acne treatment.
For everyone treating acne, including those seeing a dermatologist
Never pop, squeeze, or pick acne
Popping and squeezing pimples, whiteheads, blackheads, and cysts tends to make acne worse. All this does is make the acne last longer. This can make it difficult to see clearer skin no matter what treatment you are using. Trying to get rid of a pimple by popping or picking also can lead to scarring, which can be permanent
Avoid abrasive soap, facial scrub, toner, astringent, and masks
These can irritate the skin, and irritated skin is more likely to break out. Irritated skin also makes it more difficult to tolerate acne medication. A mild cleanser used twice a day to wash the skin is actually more effective for controlling acne and preventing breakouts
Do not scrub your skin clean
While scrubbing away oil and grime may seem like a good idea, scrubbing actually irritates acne-prone skin. Irritating the skin generally leads to breakouts.
When washing the skin, use lukewarm (not hot) water and gently apply a mild cleanser with your fingertips. Washcloths and puffs tend to be too abrasive. Limiting washing to twice a day can help reduce irritation and dryness
Wait 5 to 15 minutes to apply acne medication
Applying acne medication right after you shower or wash your face can irritate the skin and lead to breakouts. Wet skin is most absorbent. To avoid irritation, dermatologists recommend waiting 5 to 15 minutes before applying acne medication
Use only oil-free skincare and hair care products
Makeup, hair gel, and other products used by people with acne-prone skin should not contain oil. Oil tends to clog pores and lead to breakouts. Look for products that are labeled “oil free,” “nonacnegenic,” or “noncomedogenic.” This means the product does not clog pores
Apply acne medication before makeup
Wearing an oil-free makeup is fine, but make sure it does not prevent the acne medication from working. Makeup should always be applied after topical acne medication
Continue using the medication when skin clears
To keep skin blemish free, most people with acne need to continue using at least 1 acne medication. If you have been using an over-the-counter product, you may be able to taper your use to a few times a week
Gently cleanse skin after sweating
Sweating, especially under a hat or helmet, can aggravate acne-prone skin. Gently cleansing the skin as quickly as possible afterwards can help prevent breakouts. When cleansing the skin, avoid the temptation to rub or scrub sweat from the skin. This can irritate the skin and cause breakouts
Give acne-fighting products enough time to work
As a rule of thumb, it takes 6 to 8 weeks before you begin to see an improvement. Improvement does not mean blemish-free skin, but a noticeable difference. It generally takes about 6 months to see clear skin.
Effective Treatment Possible
Tremendous gains have been made in acne treatment. Today, virtually every case of acne can be resolved. If these tips do not help clear your skin, speak with a dermatologist.
Acne Medications Not for Use During Pregnancy
Some potent acne medications must not be used by women who are pregnant or who may become pregnant because of the potential harm to a fetus. These medications include:
Women in their child-bearing years need to avoid pregnancy while using these medications.
Here’s the lowdown on why these medications should not be used during pregnancy:
The “female” hormone, estrogen, and the anti-androgens, flutamide and spironolactone, are sometimes used to treat acne in women. None should be taken while a woman is pregnant. Flutamide and spironolactone can cause birth defects. It is not known if these medications can be passed along when a woman is breast feeding so the medications must also not be used if a woman chooses to breast feed.
Isotretinoin must not be used by a woman who is pregnant, trying to become pregnant or breast feeding.
This potent acne medication has revolutionized acne therapy due to its effectiveness in treating severe and therapy-resistant acne. However, isotretinoin also has the potential to cause some serious side effects. The most serious is the potential to cause severe birth defects in a developing fetus. For this reason, it is imperative that women taking isotretinoin follow the pregnancy-prevention program. This requires using 2 forms of birth control continuously beginning 1 month before therapy starts and not ending until 1 month after isotretinoin therapy is complete. A women taking isotretinoin must also be carefully monitored by her dermatologist during therapy. If pregnancy occurs, isotretinoin must be stopped immediately. Women planning a pregnancy should discontinue taking isotretinoin and maintain birth-control methods for at least 1 month before trying to become pregnant.
Oral tetracyclines. Tetracycline as well as doxycycline and minocycline—which are synthetically derived from tetracycline—must not be used by women who are pregnant or breast feeding because of potential side effects. These broad-spectrum oral antibiotics can inhibit bone growth and discolor permanent teeth in both a fetus and a child being breast fed.
The topical (applied to the skin) retinoids adapalene, tazarotene and tretinoin carry warnings stating that it is not known if these medications can adversely affect a developing fetus or child that is being breast fed.
Acne Treatment Revolutionized by 25 Years of Research
Acne is definitely not treated the same way it was 25 years ago — or even 10 years ago. Scientific research has greatly increased our knowledge of how acne develops, leading to many new acne therapies and changes in existing treatment options.
Newer products include acne treatments made for different skin types and less-irritating topical (applied to the skin) retinoids. Retinoids are medications derived from vitamin A. Newer topical retinoids have dramatically changed the way acne is treated. Twenty-five years ago, use of topical retinoids was commonly accompanied by side effects, such as redness, stinging, and peeling. With the advent of newer topical retinoids and patient-tailored dosing regimens, topical retinoids are now the first-line treatment for most patients with mild to moderately severe acne. Research shows that topical retinoids can effectively reduce blackheads, whiteheads, and the inflamed or red acne lesions. Early treatment with retinoids also can reduce scarring.
When a topical retinoid is prescribed along with a topical antimicrobial, such as benzoyl peroxide, or an oral antibiotic, such as doxycycline, most patients’ skin clears faster and the results last longer. This combination also allows patients to stop taking oral antibiotics sooner and eliminates the need for long-term use of oral antibiotics, which was common 25 years ago.
In recent years, combination treatments have become common. Most acne treatments work on only one cause of acne. Combining two or more medications allows the different factors causing the acne to be attacked simultaneously. Today, dermatologists often combine medications to give patients faster clearing and better resolution.
Another significant change made during the past 25 years has been the acceptance of oral contraceptives as an effective form of acne therapy for women. Today’s low-dose oral contraceptives are generally a well-tolerated and effective way to treat acne.
Research continues to produce new acne therapies. Recently, several light and laser therapies have been introduced. While much is still unknown about using these therapies to treat acne, such as long-term effects, lasers and lights are being used as an alternative treatment when traditional methods fail.
Today, there are a number of very effective acne therapies, and virtually every case of acne can be resolved. Sometimes the help of a dermatologist is needed. If over-the-counter treatments have not worked for you, be sure to see a dermatologist. Acne treatments are definitely not what they were 25 years ago.
Adult Acne: Effective Treatment Available
While it may seem that nothing will clear a case of adult acne, the fact is that treatment can be effective. Often combination therapy (the use of two or more treatments), a dermatologist’s help, and a bit of patience are required.
The following describes treatment that can be effective for adult acne.
Topical treatment for acne includes creams, lotions, gels, and solutions. A topical medication that combines benzoyl peroxide and a topical antimicrobial such as clindamycin or erythromycin can be effective for adults with mild to moderate acne. Combining topical clindamycin with a retinoid also can be effective. These products require a prescription. An over-the-counter product that contains sodium sulfacetamide and sulfur helps some adults.
A topical retinoid is often used to treat the small bumps under the skin and blackheads. Some are available over-the-counter. The more effective ones require a prescription. Retinoids are the only medication believed effective for battling the microcomedone — the lesion that precedes acne.
While some patients shy away from using a topical retinoid because of the product’s reputation for irritating the skin, newer formulations are available that cause significantly less irritation. When using a retinoid, dermatologists recommend that patients apply sunscreen daily before going outdoors. A topical retinoid increases the risk of sunburn. An added benefit of using a topical retinoid is the product’s ability to reduce fine lines and wrinkles
Acne-fighting cosmetics. Over-the-counter acne treatment for women is one of the fastest growing areas of skin care product development. Tried-and-true acne-fighting ingredients such as salicylic acid are finding their way into facial moisturizers and foundations. While the active ingredients are the same as those available in products tailored for teens, the products formulated for women are less drying. Many of these products include anti-aging ingredients.
While this may sound very promising, the active ingredients approved for over-the-counter products may not effectively control adult acne.
As adult acne often involves hormonal swings, an oral medication may be necessary to minimize these fluctuations and control the acne. Medications that can minimize hormonal fluctuations in women include some oral contraceptive pills, spironolactone, and hormone replacement therapy. These therapies are not appropriate for every woman and should never be taken during pregnancy. Hormone replacement therapy is typically reserved for treating women when acne develops around or after menopause. This therapy is more likely to be prescribed when the acne is accompanied by mood swings, insomnia, anxiety, thinning hair, and decreased verbal skills.
An oral antibiotic also may be part of an adult’s acne treatment plan and can be used to help get the acne under control. Recent studies show that taking an oral antibiotic and using a topical retinoid for a few months and then stopping the antibiotic can be effective. The topical retinoid alone often can maintain the results over time.
If acne is severe or very resistant to treatment, oral isotretinoin may be prescribed. In some cases, intermittent therapy with isotretinoin can help adults maintain clear skin. Patients in their 50s and 60s who develop sporadic acne have been successfully treated with low-dose oral isotretinoin.
When oral medications are prescribed for acne, it is important that the patient consult a specialist trained in acne therapy, such as a dermatologist.
To treat the occasional persistent nodule or cyst, a dermatologist may inject a corticosteroid into the lesion. This treatment quickly reduces pain and swelling as well as lessens the potential for scarring.
While chemical peels and other physical treatments available in spa-like settings claim to effectively treat acne, their role in treating adult acne has not been determined.
Proper Skin Care Essential
When it comes to skin care for their patients with acne, dermatologists generally recommend gently washing the face with a mild facial cleanser. Avoid vigorous scrubbing, as it can irritate the skin and make acne worse. Daily sun protection is essential because some acne medications increase the skin’s sensitivity to sunlight. It is equally important to use only skin and hair care products labeled “non-comedogenic” or “non-acnegenic.” Above all, do not pick, squeeze, or pop the lesions. This tends to make acne worse and cause scarring.
Benefits of a Dermatologist’s Help
If over-the-counter acne treatments and good skin care fail to clear the acne, do not get discouraged. Seeing a dermatologist can give you peace of mind. The lesions may not be acne. Other skin conditions resemble acne. A dermatologist can tell. If acne is the problem, different medication may be required.
Getting the acne under control has benefits. It reduces the risk of scarring. The longer the acne persists, the more likely it is to cause scarring. Gaining control over acne also can improve one’s quality of life. Research shows that older adults report more negative effects on their quality of life from acne than do younger people.
Are laser and light treatments really light years ahead of conventional acne therapy?
Tired of applying messy lotions and remembering to take medications as prescribed? If so, you may be wondering if a laser or light therapy is right for you. To shed some light on these therapies, this article explains what research studies show and why lasers and light therapies still are not routinely prescribed to treat acne.
What Research Shows
Data from clinical trials is limited. The U.S. Food and Drug Administration (FDA) classifies laser and light therapies as procedure-oriented, so the stringent, long-term studies necessary for approval of drugs is not required. As such, more comparative studies are needed to determine long-term effects and to perfect these technologies. However, data from recent studies indicates that laser and light therapies show much promise in treating acne. Here’s what is known:
Blue-light therapy. The FDA approved narrow-band, high-intensity blue-light therapy for treating acne. Now widely advertised, this is probably the best-known light therapy for acne treatment. Blue light works by killing the acne-causing bacteria, P. acnes, and is being used to treat inflammatory acne vulgaris that has not responded to other acne therapies. The blue-light products of today do not contain ultraviolet (UV) light, which was a staple of former light therapy used to treat acne. UV light can damage skin and is no longer used to treat acne.
Patients receive blue-light therapy in increments. Generally, eight sessions are given over a four-week period, and each session lasts about 15 minutes. Side effects tend to be mild and include temporary pigment changes, swelling of the treated areas, and dryness. As the results from the following studies show, many patients — but not all — see noticeable improvement with about 55% clearance:
31 patients with symmetrical (same on both sides) facial acne received blue-light treatment on 1 side of their faces. Blue-light therapy was given twice a week for four consecutive weeks. The other side of each patient’s face did not receive any treatment so that researchers could judge the effectiveness of the blue-light therapy. The researchers concluded that blue-light therapy is an effective acne treatment unless the patient has nodulocystic acne lesions, which tend to worsen when treated with blue light. (Taiwan)1
25 patients with inflammatory acne on their faces had half of their face treated with blue-light therapy (8 sessions over 4 weeks) and the other half with clindamycin (a topical antimicrobial shown successful in treating acne). Patients were instructed to apply the clindamycin twice a day for four weeks. After four weeks, the clindamycin side showed a 22.25% improvement, and the side treated with blue light improved by 39%. However, after eight weeks and without further treatment, the side treated with clindamycin was better able to maintain results. (United States)2
10, 13, and 25 patients were enrolled in three separate studies designed to learn more about the effects of blue-light therapy on papulo-pustular (inflammatory) acne. In all three studies, more than 80% of the patients treated with blue-light therapy responded to the treatment. The patients who responded saw a 59% to 67% reduction in inflammatory acne lesions. (Israel)3
30 patients with mild to moderate acne were treated twice a week with blue-light therapy for up to five weeks. After five weeks, acne lesions decreased by 64%. However, not all patients saw improvement; 20% remained unchanged or experienced a worsening of their acne. (Japan)4
As you can see, the number of patients involved in these studies is small. Clinical trials conducted to test new drugs generally must enroll hundreds to thousands of participants before submitting the data to the FDA for consideration. With such small numbers, statistically valid conclusions cannot be drawn. Research also is needed to learn the long-term effects. At present, blue-light therapy appears to improve acne vulgaris in some individuals. This therapy appears most effective for inflammatory acne lesions and may not be suitable for patients with nodulocystic acne.
Pulsed light and heat energy (LHE) therapy
This treatment combines pulses of light and heat, which researchers believe target two causes of acne
It is known that LHE destroys P. acnes, the acne-causing bacteria. LHE also may decrease sebum (oily substance) production by shrinking the sebaceous glands. A system that combines pulses of green light and heat has been approved by the FDA for treating mild to moderate acne. Here’s what a recent study showed:
19 patients with mild to moderate acne received two LHE treatments per week for four weeks. At the end of eight treatments, researchers saw significant clearance in both inflammatory and non-inflammatory lesions. Further improvement was seen one month after the last treatment. The most significant reduction in lesions was observed two months after the last treatment was given. Researchers concluded that LHE technology is effective and safe for treating acne vulgaris. (Israel)5
ALA + light therapy
Studies are investigating the effectiveness of this therapy in treating acne. Patients receiving this treatment undergo a two-step process. First, a solution of 5-aminolevulinic acid (ALA) is applied to the skin to be treated. ALA is a medication that increases sensitivity to light. When used to treat acne, the ALA is kept on the skin for a period of time ranging from 15 to 60 minutes. The length of time depends on the severity of the acne. Step two involves removing the ALA and treating the skin with light therapy. Since ALA makes the skin more light sensitive, patients are instructed to use sun protection for 48 hours after treatment.
Findings from research studies indicate that treatment with blue or red light after the application of ALA is effective. However, as the following shows, red light may produce some undesirable side effects:
10 patients who received multiple treatments of ALA + red-light therapy on their backs had a statistically significant reduction in inflammatory acne lesions. However, the side effects, such as temporary darkening of the skin and development of folliculitis (an inflammation of hair follicles that resembles acne), limit recommendation of this treatment. (United States)6
A recent study that looked at using ALA followed by blue light concludes that this therapy may be suitable for acne treatment. (Israel)7
A few studies have looked at the possibility of treating acne with the 1450-nm diode laser. One study found that the 1450-nm diode laser effectively treats inflammatory acne on the back. Recently, a study looked at using this laser to treat facial acne:
19 patients with inflammatory acne on their face were treated with the 1450-nm diode laser to evaluate the safety and effectiveness of using this laser to treat facial acne. Every patient saw a significant reduction in acne lesions. After one treatment, lesion counts decreased 37%. A 58% decrease was seen after two treatments, and lesion counts decreased by 83% with three treatments. The researchers found that the pain associated with diode-laser treatment is well tolerated with a topical anesthetic. Side effects in this study were limited to temporary redness and swelling at the treatment sites. (United States)8
Pulsed dye laser
Two studies looked at treating facial acne with the pulsed dye laser. Results were inconsistent.
41 patients with mild to moderate inflammatory acne on their faces were recruited. These patients were randomly selected to receive either one treatment with a pulsed dye laser or a treatment that they thought was the investigational therapy (placebo). After 12 weeks, the patients treated with the pulsed dye laser had a statistically significant reduction in acne lesions — 53% for total lesions and 49% for inflammatory lesions. A significant reduction in lesions was not observed in the patients treated with the placebo. Researchers concluded that the pulsed dye laser improves inflammatory facial acne after just one treatment without serious side effects and that future study is needed. (United Kingdom)9
40 patients aged 13 and older who had facial acne received either one or two pulsed dye laser treatments to one-half of the face. The other half of the face was left untreated. After 12 weeks, researchers found no significant difference between the treated and untreated sides. This study concluded that treatment with the pulsed dye laser did not significantly improve facial acne and more research should be conducted before this laser therapy is recommended for acne. (United States)10
Still Not Routinely Prescribed
While the results from these studies are promising, the use of lasers and light therapies to treat acne is still in the investigational stage and may not be the first choice for treating acne. If you are considering a laser or light therapy to treat acne, you should know the following:
More research is needed
Controlled studies with large number of patients are needed to:
Know which therapy is best for which patient. To date, it appears that laser and light therapies are more effective on adults. However, the profile of a good candidate for each type of treatment still needs to be developed.
Evaluate the effectiveness of each therapy. To date, consistent results have not been obtained in the research studies.
Studies that can provide long-term data are in the planning stages.
Many patients require multi-targeted approach. Acne develops when one or more of the following occurs: excess sebum production, rapid production of P. acnes, skin cells shed too quickly, and release of inflammatory substances. For treatment to work it must interfere with what is causing the acne. This is why the acne treatment prescribed by a dermatologist often requires patients to use more than one medication.
Since some of the laser and light therapies target only one cause, a patient’s acne may not resolve. For example, blue-light therapy targets only P. acnes, so acne will resolve only when this is the sole cause. If other factors are present, blue-light therapy will not clear the acne.
Psst . . . Topical Acne Medication Can Clear Acne The secret lies in knowing how to use it
Did you know the way that you apply topical acne medication and even your skin care routine can affect how well the acne treatment works? To help you get the best results from topical acne medication, here are some inside tips from dermatologists.
Use as directed
The next time you are tempted to use more medication in order to get faster results or apply your acne medications once a day instead of using some in the morning and others at night as directed, remember this:
The directions you see printed on a label or that you get from your dermatologist are based on numerous research studies that have been conducted to determine how to get the best results
Using medication as directed increases effectiveness and decreases the risk of possible side effects.
Place all acne medication so that you see it everyday
Do you sometimes forget to use your acne medication? Placing the medication in plain view, next to your toothbrush or with your makeup, can help you remember to use it
Wash and wait
Be sure to wait 10 to 15 minutes after washing your face or showering before you apply topical acne medication. This helps reduce the chance that a medication will irritate your skin
Apply these medications — benzoyl peroxide, topical antibiotics, and topical retinoids — to the entire acne-prone area, not just the blemishes
Clearing generally does not occur when these medications are only applied to the blemishes
Dab on several smaller amounts instead of one larger amount
Applying several smaller amounts delivers a stronger concentration of medication to several areas. This increases effectiveness
Do you see redness, drying, or peeling after applying a topical acne medication?
These indicate that your skin is irritated. People using topical retinoids (adapalene, tretinoin, and tazarotene) to clear acne may experience these side effects. Following this action plan can help:
Check your cleanser. You should use a mild cleanser on your face and other acne-prone areas. A mild cleanser feels non-abrasive and does not contain alcohol
If your cleanser does not fit this description, switch cleansers
Stop using over-the-counter medications that contain alpha-hydroxy acids or salicylic acids. While your skin is irritated, stop using over-the-counter products that contain these ingredients, which can irritate the skin causing redness, dryness, and peeling
Avoid rubbing alcohol and all astringents, exfoliators, masks, and toners. These can irritate acne-prone skin
Read the directions to make sure you are using the medication properly. Using more than directed can cause irritation as can using the medication more frequently than recommended. If you have questions about a prescription medication, be sure to contact your dermatologist.
If you are using the medication as directed, try these tips:
Wait a bit longer. Try waiting 20 to 30 minutes after washing before applying the medication
Use a smaller amount than directed, or use the medication every other day until the irritation clears
Apply a moisturizer. Using a noncomedogenic (won’t clog pores) moisturizer immediately after applying the medication can reduce the redness, drying, and peeling.
Do you experience itching or stinging after applying a topical acne medication?
These indicate that your skin is dry or irritated. Following this action plan can help:
Check your cleanser. You should use a mild cleanser on your face and other acne-prone areas. A mild cleanser feels non-abrasive and does not contain alcohol
If your cleanser does not fit this description, switch cleansers
Wait a bit longer. Try waiting 20 to 30 minutes instead of 10 to 15 minutes after washing the skin to apply the medication
Moisturize first. Apply a noncomedogenic (won’t clog pores) moisturizer first and then the medication. This can reduce dryness.
Give acne medication enough time to do its job. Acne does not clear overnight. Do not stop using a medication if you do not see results in a few weeks. After 6 – 8 weeks, you can expect to see about a 40% improvement. It takes 4 to 6 months to see significant improvement
Follow the skin care guidelines for acne-prone skin
Your skin care routine also affects the results. Be sure to follow the dermatologist-recommended acne skin care guidelines.
The Truth About Oral Contraceptives and Acne
Yes, it’s true. An oral contraceptive, what many people call “the Pill,” can effectively clear acne in women. If you are using — or considering — an oral contraceptive to treat acne, here are a few other truths about oral contraceptives and acne that you should know:
Several Brands Effective
Several brands of oral contraceptives can effectively control acne. A few brands have received approval from the U.S. Food and Drug Administration (FDA) for treating acne in women.
For Best Results: Use with Other Acne Treatment
Oral contraceptives are effective because they target one of the four key causes of acne — excess sebum. Sebum, a natural oil that protects the skin against moisture loss, can clog pores when the body produces too much.
Since an oral contraceptive targets only one cause, it is generally not the only treatment used to clear acne. Here’s another key fact. Dermatologists generally do not prescribe an oral contraceptive until other acne medications have proven ineffective. Acne treatment usually begins with benzoyl peroxide and topical retinoids. Depending on the type and severity of the acne, an oral antibiotic also may be part of the treatment plan. If a woman’s acne does not respond to these treatments, an oral contraceptive may be considered.
Taking Other Medication? Tell Your Dermatologist
If an oral contraceptive is a potential treatment option, be sure to tell your dermatologist about other medication that you are taking. Medications can interact with each other — in some case producing undesirable side effects. Sometimes one medication can reduce the effectiveness of another medication. The anti-epilepsy drug, lamotrigine, can reduce the effectiveness of an oral contraceptive. A second form of birth control may be necessary to prevent pregnancy
Not for Every Woman
While oral contraceptives can safely and effectively treat acne long term, this medication is not appropriate for every woman. Due to potential side effects, oral contraceptives are usually prescribed to women who:
- Are 35 years of age or younger
- Do not smoke
- Do not have a history of migraines
- Have normal blood pressure
Dermatologists recommend that their patients who take oral contraceptives examine their breasts regularly and see a gynecologist for regular examinations.
Clearing Takes Time
The truth is clearing takes time. Patients can expect to see results about three months after beginning to take an oral contraceptive. Before then, some women’s acne worsens. If acne flares, continue to take the oral contraceptive as prescribed. Repeatedly missing doses decreases the medication’s effectiveness.
While taking an oral contraceptive for acne treatment, it is important to follow your dermatologist’s entire acne treatment plan. An oral contraceptive targets only one cause of acne — excess sebum.
Now that you know the truth about oral contraceptives and acne, you may wonder if this treatment may be right for you. A dermatologist can help a woman decide if this is an appropriate treatment option.
Treating Acne in Skin of Color
Whether it’s a few pimples or severe acne, there are five key factors that people with skin of color, especially those of African descent, should know before they begin acne treatment. Considering these factors can help individuals with skin of color make informed decisions about their treatment options and obtain better results.
Five Key Factors
Dark skin prone to developing “dark spots.”
These darkened spots on the skin, which dermatologists call “post-inflammatory hyperpigmentation,” can occur at the site of a healed or healing inflamed acne lesion. Caused by excessive melanin production, this darkening of the skin is a normal reaction when dark skin becomes inflamed, such as after a rash, scratch or pimple. While these spots tend to gradually disappear over time, they are the number one complaint among dark-skinned patients with acne vulgaris. Like acne, “dark spots” can diminish one’s self-esteem and affect a person’s ability to function confidently in society.
How to treat “dark spots.”
When these spots appear, they can be treated with a topical skin-lightening product. Some skin-lightening agents are available over-the-counter, and stronger forms can be obtained from a dermatologist. Dermatologists can also recommend cosmetic tips that will make the spots less apparent. Additionally, some topical acne treatments used by dermatologists may help fade the discoloration.
Sunscreen may help. Although there are no clinical studies to confirm this, some dermatologists find that repeated sun exposure leads to longer treatment time and that daily use of sunscreen (SPF of 15 or higher) helps resolve the spots more quickly. Only sunscreen labeled “noncomedogenic” should be used. “Noncomedogenic” means the product will not clog pores.
Acne treatments designed to dry the skin should be use with caution. Acne medications that can have a drying effect on the skin, such as benzoyl peroxide, should only be used under the supervision of a dermatologist as these medications may irritate the skin and prolong post-inflammatory hyperpigmentation in some cases. Benzoyl peroxide can also decolorize skin.
Topical acne medications for skin of color
Clinical studies show that some topical medications, such as retinoids, safely and effectively treat acne in skin of color without the drying effects when used properly. Topical retinoids, which are only available by prescription, include adapalene, tazarotene and tretinoin.
Pomade may be the culprit.
A recent survey of acne patients with skin of color revealed that almost half, 46.2%, use pomade (oil or ointment for hair) to style or improve the manageability of their hair and that 70.3% of the patients using pomade developed forehead acne. The acne that develops from using pomade is called “acne cosmetica” or “pomade acne.” It occurs when pomade blocks pores and acne develops on the scalp, forehead and/or temples—places where pomade comes into contact with the skin. Pomade acne usually consists of blackheads and whiteheads, with perhaps a few papules and pustules.
Treatment. For pomade acne, treatment consists of these options:
If using pomade to decrease scalp dryness, try applying pomade one inch behind the hairline.
If using pomade to style or make hair more manageable, try applying pomade to the ends of the hair only to avoid contact with the scalp and hairline.
Stop using pomade.
Once use of pomade stops, pomade acne should clear. If it persists, be sure to see a dermatologist.
Pomade can also contribute to a bacterial infection of the scalp called “folliculitis,” in which pus bumps and redness develop around the hair. Folliculitis can cause hair loss and the spread of infection. If folliculitis is suspected, discontinue using pomade and see a dermatologist.
Moisturizers can worsen acne
Moisturizers relieve the dry or “ashy skin” that is common among dark-skinned people. When using moisturizer, make sure the label includes the word “noncomedogenic.” This means the product will not clog pores. If acne gets worse after moisturizing with a product labeled “noncomedogenic,” discontinue moisturizing and seek the advice of a dermatologist
Keloid may form after acne outbreak.
When scarring occurs in a person with skin of color, there is a greater tendency for a keloid (large raised scar that spreads beyond the size of the original wound) to form. While uncommon in acne patients with skin of color, keloids have been seen on the chest, back and jaw line. Early and aggressive acne treatment is needed to prevent scarring because keloids, unfortunately, tend to return even when treated.
Treatment. Scar treatment should be discussed with a dermatologist or dermatologic surgeon before it is undertaken. Depending on the location, treatment may involve pressure, silicone gels, surgery, laser treatment or radiation therapy.
Before beginning any acne treatment, be sure to consider these key factors and direct your questions to a dermatologist. But, don’t delay treatment as dermatologists recommend early and aggressive acne treatment in skin of color to prevent scarring and darkened spots from developing. Acne Skin Care Guidelines
Good skin care plays an important role in treating acne. Following these skin care guidelines — unless your dermatologist instructs otherwise — can help improve your results:
Gently Cleanse Acne-prone Skin
Avoid Acne Skin Care Taboos
Limit washing to twice a day – and after perspiring. Once in the morning and once at night as well as after perspiring heavily should be the limit. Perspiration, especially when wearing a hat or helmet, can make acne worse, so the skin should be gently cleansed as quickly as possible after perspiring
Use a gentle, non-abrasive cleanser. Wash the face and other acne-prone areas with a gentle, non-abrasive cleanser that does not contain alcohol
Use your fingertips. Apply the cleanser and wash with your fingertips. This reduces skin irritation. Using a washcloth, mesh sponge, or anything else can irritate the skin and lead to breakouts
Never scrub the skin. Scrubbing the skin clean does not clear acne. In fact, scrubbing irritates the skin and can make acne worse
Rinse with lukewarm water. Be sure to thoroughly rinse away the cleanser with lukewarm, not hot, water
Shampoo regularly. If you have oily hair, shampoo daily.
Astringents, rubbing alcohol, and tanning do not help clear acne nor keep acne-prone skin free from blemishes. Dermatologists recommend that their patients with acne and acne-prone skin avoid the following:
Astringents, exfoliators, masks, and toners. These products do not help clear acne. In fact, these can aggravate the skin and make acne worse. These products also may make it more difficult to tolerate prescription acne medications, so it is best not to use these when treating acne
Greasy hair-care products. Oily hair-care products, such as oil-containing gels and pomades, can drip onto the skin and clog pores. This can cause acne
Picking, popping, and squeezing pimples. People pick and pop pimples to get rid of them quickly. The truth is this prolongs healing time and increases the risk of scarring
Rubbing alcohol. Some people apply rubbing alcohol in order to dry out the oily skin. This will not help clear acne nor prevent breakouts. It can irritate the skin and cause breakouts
Tanning. Some people claim that their acne clears with sun exposure. The truth is that tanning does not clear acne. Tanning, however, does increase one’s risk of developing melanoma and other skin cancers.
Touching the skin throughout the day. Dermatologists advise their patients with acne and acne-prone skin not touch their skin frequently. This can cause flare-ups.
Select “Noncomedogenic” Cosmetics and Skin Care Products
Many acne patients are surprised to learn that makeup, moisturizers, and sunscreen are okay to use while treating acne. The key is to select products labeled “noncomedogenic.” This means the product does not clog pores. Just because a product says “noncomedogenic” does not mean that it works for everyone. You may have to experiment with different noncomedogenic products before you find one that works for you.
The truth is makeup can be worn when treating acne — even when using topical medications. Just be sure to follow these guidelines:
Choose oil-free cosmetics that are labeled “noncomedogenic” (won’t clog pores)
Apply makeup after applying acne medication
If you have trouble finding makeup that can be used with acne medication, consult a dermatologist.
Did you know that moisturizer can help calm irritated acne-prone skin? If your skin feels dry and you want to moisturize, follow these guidelines:
Practice Sun Protection
Use a moisturizer that is oil-free and says “noncomedogenic” (won’t clog pores)
If you use a topical acne medication, apply the moisturizer after applying the acne medication. If your skin still feels dry or stings, try applying the moisturizer before applying the acne medication.
Dermatologists recommend sun protection, which includes but is not limited to regular use of sunscreen, for all their patients, including those with acne. Research shows that most cases of skin cancer can be prevented with sun protection. Sun protection also can help prevent sunburn in patients using topical retinoids, which increase the skin’s sensitivity to the sun.
The American Academy of Dermatology recommends that everyone protect their skin by following these sun-protection practices:
Shave with Care
Generously apply sunscreen to all exposed skin. Use a sunscreen that has a Sun Protection Factor (SPF) of at least 15 and provides broad-spectrum protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays. Re-apply every two hours, even on cloudy days, and after swimming or perspiring.
People with acne or acne-prone skin should use a sunscreen labeled “noncomedogenic” (does not clog pores) and apply it after applying topical acne medication
Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat, and sunglasses, where possible
Seek shade when appropriate, remembering that the sun’s rays are strongest between 10 a.m. and 4 p.m
Use extra caution near water, snow, and sand as they reflect the damaging rays of the sun, which can increase your chance of sunburn
Get vitamin D safely through a healthy diet that includes vitamin supplements. Don’t seek the sun
Avoid tanning beds. Ultraviolet light from the sun and tanning beds causes skin cancer and wrinkling. If you want to look like you’ve been in the sun, consider using a sunless self-tanning product, but continue to use sunscreen with it
Check your birthday suit on your birthday. If you notice anything changing, growing, or bleeding on your skin, see a dermatologist. Skin cancer is very treatable when caught early.
Men know that shaving when you have acne can be a challenge. Here are some dermatologists’ tips that can help give you a clean shave.
Before shaving, soften the hairs. Wetting the face thoroughly with lukewarm water can help soften the hairs
Experiment. Try shaving with electric and safety razors to see which works best for you
Make sure the blade is sharp. This helps prevents nicks from a safety razor, which can irritate the skin and lead to breakouts
Shave lightly. This can help avoid nicking acne lesions, which can make acne worse
Never try to shave off the acne. This aggravates the condition and makes the acne worse.
If after following these guidelines, you are not satisfied with the results, be sure to see a dermatologist. Today, virtually every case of acne can be effectively treated. Frequently Asked Questions About Acne
Acne is a very common disease. People who have it tend to have similar kinds of questions about it and its treatment. This section addresses some of the common questions asked by people with acne. Please remember that your dermatologist is always the best source of specific information about your individual health issues, including acne.
Click on a specific question to go directly to the answer to that question, or you can read through all the questions.
What causes acne?
Is acne just a cosmetic condition?
Can acne be cured?
Will sun exposure help acne?
Is acne caused by dirt?
Does makeup cause acne?
Does chocolate or junk food cause acne?
Is acne triggered by stress?
Is acne just for teenagers? Will you grow out of it?
Can scrubbing and toning stop acne?
Do spot treatments work?
I wash my face several times a day. Why do I still get acne?
Does stress cause acne?
I never had acne as a teenager. Why am I now getting acne as an adult?
What role does diet play in acne?
Does the sun help acne?
What is the best way to treat acne?
What kind of cosmetics can an acne patient use?
Is it harmful to squeeze my blemishes?
Can anything be done about scarring caused by acne?
How long before I see a visible result from using my acne medications?
Would using my medications more frequently than prescribed speed up the clearing of my acne?
My topical treatment seems to work on the spots I treat, but I keep getting new acne blemishes. What should I do?
My face is clear! Can I stop taking my medication now?
Does it matter what time I use my medications?
I have trouble remembering to take my oral medication every day. What's a good way to remember? What should I do if I forget a dose?
More Frequently Asked Questions
Q: What causes acne?
A: The causes of acne are linked to the changes that take place as young people mature from childhood to adolescence (puberty). The hormones that cause physical maturation also cause the sebaceous (oil) glands of the skin to produce more sebum (oil). The hormones with the greatest effect on sebaceous glands are androgens (male hormones), which are present in females as well as males, but in higher amounts in males.
Sebaceous glands are found together with a hair shaft in a unit called a sebaceous follicle. During puberty, the cells of the skin that line the follicle begin to shed more rapidly. In people who develop acne, cells shed and stick together more so than in people who do not develop acne. When cells mix with the increased amount of sebum being produced, they can plug the opening of the follicle. Meanwhile, the sebaceous glands continue to produce sebum, and the follicle swells up with sebum.
In addition, a normal skin bacteria called P. acnes, begins to multiply rapidly in the clogged hair follicle. In the process, these bacteria produce irritating substances that can cause inflammation. Sometimes, the wall of the follicle bursts, spreading inflammation to the surrounding skin. This is the process by which acne lesions, from blackheads to pimples to nodules, are formed.
Q: Is acne just a cosmetic condition?
A: Acne is a cosmetic condition as it affects the person’s appearance although it does not pose a serious threat to one’s physical health. However, it affects how a person feels about himself, which causes low self-esteem and at times even depression. Even after the acne is gone, it can leave behind permanent physical and emotional scars. It is encouraged that one seeks treatment for acne and to take it seriously. It is better to consult a professional as soon as possible.
Q: Can acne be cured?
A: As of now, acne cannot be cured but is highly treatable. The best treatment is prevention. As soon breakouts occur, consult a dermatologist right away in order to prevent blemishes from happening. A lot of treatments for this condition are available now. It is a matter of finding the appropriate one for you. However, keep in mind that although the blemishes are gone, it does not mean that your acne is cured. It is vital that you continue to be diligent with your treatment plan even after your skin has cleared up.
Q: Will sun exposure help acne?
A: Sun exposure will not help your acne. At first, a little amount of sun exposure may improve the appearance of acne. The blemish may appear less noticeable as the skin darkens. On the other hand, prolonged sun exposure results in clogged pores because of the rapid exfoliation of the dead skin cells. Also, spending too much time under the sun darkens acne’s post-inflammatory hyperpigmentation and macules. The chances of damaging the skin and having acne scars are increased with prolonged exposure. More seriously, sun exposure may increase your chances of having some form of skin cancer. So it is vital that one uses a sunblock that is oil free and has a “sun protection factor” or SPF of at least 15 for UVA and UVB rays.
Q: Is acne caused by dirt?
A: This is one of the most common mistaken beliefs about acne. A combination of factors that cannot be controlled such as hormonal imbalance and the natural pace of a person’s skin’s renewal system can cause acne. The good thing about this is that you are not helpless. There are a number of things that can be done in order to keep your acne at bay.
Q: Does makeup cause acne?
A: Not necessarily. Most of the cosmetics in the market are non-comedogenic, meaning they would not clog your pores. So, when buying cosmetics, make sure that you look for products that are non-comedogenic, oil-free or water-based and hypoallergenic (no fragrance added). However, even the right kind of cosmetics, when used during a strenuous activity such as exercise, can travel across the skin and into the pores. So it is better to do without cosmetics during these activities.
Q: Does chocolate or junk food cause acne?
A: Scientists have not been able to prove or find any significant link between diet and acne. Foods you have always associated with acne do not really cause it and are actually fine. However, it is still important to have a healthy diet to aid your body in fighting against acne.
Q: Is acne triggered by stress?
A: Acne is not caused by stress but stress can generate flare-ups. Cortisol, which causes the sebaceous glands to produce more oil, steps up its production when the body encounters stress. It is not easy to determine the usual effects of stress on the skin since individual stress response varies from each person. One should know that even the good kind of stress (i.e. when planning a wedding) can still generate a trigger response. The best way to handle this is to make sure that you are able to make time for things that will make you feel relaxed and happy.
Q: Is acne just for teenagers? Will you grow out of it?
A: This is actually a myth which can be harmful since teenagers would tend to “wait it out” instead of actually seeking help for their acne. This may result in a severe case of acne and scarring which can eventually lead to low self-esteem. This myth also affects adults who are suffering from acne as they may be too embarrassed to seek treatment wondering why they still have acne at this stage and if they are doing something wrong in handling it. Fact is, acne can hit you at any age and although it is treatable, the course and duration of the treatment varies for each person.
Q: Can scrubbing and toning stop acne?
A: Since we have established that acne is not necessarily caused by dirt, excessive washing with scrubbing and toning will not make it go away. Over-the-counter exfoliants that are harsh, such as apricot pits or walnut shells, can irritate or tear the skin and lead to an increased chance of infection and more breakouts. Similarly, the use of alcohol-based toners can strip the skin of needed oils and leave it dry and irritated, making the skin produce more oil. It is recommended that one uses a gentle medicated scrub and a mild alcohol-free toner in order to achieve best results. A good and gentle alternative is witch hazel.
Q: Do spot treatments work?
A: For the longest time, over-the-counter products claim that a touch of medicine placed directly on the pimple will clear it up. Unfortunately, this is not true. Blemishes take 2 to 3 weeks to develop. So what is happening is that you are treating an old symptom of the problem rather than treating the problem itself. Taking care of the whole face area everyday even before the development of blemishes is the best way to treat acne.
Q: I wash my face several times a day. Why do I still get acne?
A: Many people still believe that acne is caused by dirty skin. The truth is, washing alone will not clear up or prevent acne. Washing does, however, help remove excess surface oils and dead skin cells. Many people use all kinds of products, including alcohol-based cleansers, and scrub vigorously, only to irritate the skin further and worsen their acne. Washing the skin twice a day gently with water and a mild soap is usually all that is required. However, acne is actually caused by a variety of biologic factors that are beyond the control of washing. For that reason, you should use appropriate acne treatments for the acne
Q: Does stress cause acne?
A: Stress is commonly blamed for the development of acne. Stress can have many physiologic effects on the body, including changes in hormones that may theoretically lead to acne. In some cases the stress may actually be caused by the acne lesions, not the other way around! If the acne is being treated effectively, stress is not likely to have much impact on the majority of people
Q: I never had acne as a teenager. Why am I now getting acne as an adult?
A: Usually, acne begins at puberty and is gone by the early 20s. In some cases, acne may persist into adulthood. Such types of acne include severe forms that affect the body as well as the face (which afflict males more than females) and acne associated with the menstrual cycle in women. In other cases, acne may not present itself until adulthood. Such acne is more likely to affect females than males.
There are several reasons for this. As females get older, the pattern of changes in hormones may itself change, disposing sebaceous glands to develop acne. Ovarian cysts and pregnancy may also cause hormonal changes that lead to acne. Some women get acne when they discontinue birth control pills that have been keeping acne at bay. Sometimes young women may wear cosmetics that are comedogenic-that is, they can set up conditions that cause comedones to form
Q: What role does diet play in acne?
A: Acne is not caused by food. Following a strict diet will not, clear your skin. While some people feel that their acne is aggravated by certain foods, particularly chocolate, colas, peanuts, shellfish and some fatty foods, there is no scientific evidence that suggests food causes or influences acne. Avoid any foods which seem to worsen your acne and, for your overall health, eat a balanced diet--but diet shouldn't really matter if the acne is being appropriately treated
Q: Does the sun help acne?
A: Many patients feel that sunlight improves their acne lesions and go to great lengths to find sources of ultraviolet light. There is no proven effect of sunlight on acne. In addition, ultraviolet light in sunlight increases the risk of skin cancer and early aging of the skin. It is, therefore, not a recommended technique of acne management, especially since there are many other proven forms of treatment for acne. Moreover, many acne treatments increase the skin's sensitivity to ultraviolet light, making the risk of ultraviolet light exposure all the worse
Q: What is the best way to treat acne?
A: Everyone's acne must be treated individually. If you have not gotten good results from the acne products you have tried, consider seeing a dermatologist. Your dermatologist will decide which treatments are best for you. For more information about the types of acne treatments that are available, and for basic acne treatment guidelines, please see Acne Treatments.
Q: What kind of cosmetics and cleansers can an acne patient use?
A: Look for "noncomedogenic" cosmetics and toiletries. These products have been formulated so that they will not cause acne.
Some acne medications cause irritation or pronounced dryness particularly during the early weeks of therapy, and some cosmetics and cleansers can actually worsen this effect. The choice of cosmetics and cleansers should be made with your dermatologist or pharmacist.
Heavy foundation makeup should be avoided. Most acne patients should select powder blushes and eye shadow over cream products because they are less irritating and noncomedogenic. Camouflaging techniques can be used effectively by applying a green undercover cosmetic over red acne lesions to promote color blending
Q: Is it harmful to squeeze my blemishes?
A: Yes. In general, acne lesions should not be picked or squeezed by the patient. In particular, inflammatory acne lesions should never be squeezed. Squeezing forces infected material deeper into the skin, causing additional inflammation and possible scarring
Q: Can anything be done about scarring caused by acne?
A: Scarring is best prevented by getting rid of the acne. Dermatologists can use various methods to improve the scarring caused by acne. The treatment must always be individualized for the specific patient. Chemical peels may be used in some patients, while dermabrasion or laser abrasion may benefit others. It is important that the acne be well controlled before any procedure is used to alleviate scarring
Q: How long before I see a visible result from using my acne medication?
A. The time for improvement depends upon the product being used, but in almost all cases it is more a matter of weeks or months instead of days. Most dermatologists would recommend the use of a medication or combination of medications daily for 4 to 8 weeks before they would change the treatment. It is very important for patients to be aware of this time frameso they do not become discouraged and discontinue their medications. Conversely, if you see no change whatsoever, you might want to check with your dermatologist regarding the need to change treatments
Q: Would using my medication more frequently than prescribed speed up the clearing of my acne?
A: No--always use your medication exactly as your dermatologist instructed. Using topical medications more often than prescribed may actually induce more irritation of the skin, redness and follicular plugging, which can delay clearing time. If oral medications are taken more frequently than prescribed, they won't work any better, but there is a greater chance of side effects
Q: My topical treatment seems to work on the spots I treat, but I keep getting new acne blemishes. What should I do?
A: Topical acne medications are made to be used on all acne-prone areas, not just individual lesions. Part of the goal is to treat the skin before lesions can form and to prevent formation, not just to treat existing lesions. Patients are generally advised to treat all of the areas (forehead, cheeks, chin and nose) that tend to break out rather than just individual lesions
Q: My face is clear! Can I stop taking my medication now?
A: If your dermatologist says you can stop, then stop--but follow your dermatologist's instructions. Many times patients will stop their medication suddenly only to have their acne flare up several weeks later. If you are using multiple products, it may be advisable to discontinue one medication at a time and judge results before discontinuing them all at once. Ask your dermatologist before you stop using any of your medications
Q: Does it matter what time I use my medication?
A: Check with your dermatologist or pharmacist. If you were taking one dose a day of an antibiotic, you could probably take it in the morning, at midday or in the evening, although you should pick one time of day and stay with it throughout your treatment. With oral medications prescribed twice a day or three times a day, you should try your best to spread out the doses evenly. Some antibiotics should be taken on an empty or nearly empty stomach. For optimal results with topical treatments, you should strictly follow your dermatologist's recommendations. For example, if instructed to apply benzoyl peroxide in the morning and a topical retinoid at bedtime, it is important to follow these directions strictly. If the two were applied together at bedtime, for example, you could decrease the efficacy of the treatment because of chemical reactions that make them less effective
Q: I have trouble remembering to take my oral medication every day. What's a good way to remember? What should I do if I forget a dose?
A: This is a common problem. Many patients try to associate taking their medication with a routine daily event such as brushing teeth or applying makeup. It also helps to keep the medication close to the area where the reminder activity is carried out.
In most cases, if you miss a day of your oral treatment, do not double up the next day; rather, get back to your daily regimen as soon as possible--but there may be different instructions for different oral medications. Ask your dermatologist or pharmacist about what to do if you miss a dose of your particular medication.
More Frequently Asked Questions About Acne
Q: Ihave been using topical benzoyl peroxide and an oral antibiotic for my acne and have noticed blue-black and brown marks developing on my face and some discoloration on my body. The marks are especially noticeable around acne scars and recently healed lesions. Is this a side effect of medication and is it permanent?
A: It is not possible to make general statements about side effects of medications that apply to individual cases. A dermatologist should be consulted. The facial marks and body discoloration described by the patient in this case do fall within the range of side effects of some antibiotics.
Unique patterns of pigmentation are sometimes seen in acne patients treated with certain oral antibiotics—particularly minocycline. The pigmentation patterns that appear may include:
Localized blue-black or brown marks in and around acne scars and in areas of previous acne inflammation
A "muddy skin" appearance that may cover much of the body
Diffuse brownish pigmentation of the feet and lower legs.
The pigmentation side effect gradually disappears after the therapy is discontinued.
Any side effect of a medication should be noted by the patient and brought to the attention of the physician. While most side effects are temporary they should be discussed with the physician and monitored.
Q: My doctor is prescribing a topical retinoid for my acne. He said a retinoid is a substance related to vitamin A. If the drug is related to vitamin A, shouldn’t vitamin A dietary supplements be helpful in getting rid of acne?
A: Dietary vitamin A is essential to good health, especially vision. It has healthful effects in the skin. Large doses of vitamin A for the treatment of acne is not recommended on grounds of safety. The retinoids and retinoid-like substances used as topical treatments for acne are prepared especially for their potent effect on the shedding of cell lining in the sebaceous follicle. Their use should be monitored by a dermatologist.
Dietary vitamin A has multiple health effects in the human body. Vitamin A is essential for good vision. Extreme vitamin A deficiency can result in blindness, usually accompanied by dry, scaly skin. Vitamin A overdose that far exceeds the Recommended Dietary Allowance (RDA) of 5,000 IU can have effects nearly as catastrophic. Extreme vitamin A overdose can cause the skin to blister and peel—an effect first seen in early North Pole explorers who nearly died after eating polar bear liver that has an extraordinarily high vitamin A content.
Topical retinoids are usually prescribed as a treatment for moderate to severe acne. Side effects are chiefly dermatologic, including redness, scaling and dryness of the skin, itching and burning. These side effects can usually be managed by adjustment of the amount and timing of retinoid applied to the skin. Dose adjustment must be discussed with the dermatologist who prescribed the treatment.
Q: Are there any acne treatments specifically for people with dark skin? Are there any treatments specifically harmful to dark skin?
A: There are no acne treatments specifically for use on dark skin. Acne treatments are generally as safe and effective on dark skin as on light skin. Some treatments for acne scars may cause temporary lightening of dark skin.
Acne is a common skin disease that has the same causes and follows the same course in all colors of skin.
Very dark or black skin may be less well-moisturized than lighter skin. Topical anti-acne agents such as benzoyl peroxide that have a drying effect on the skin should be used under the supervision of a dermatologist. Benzoyl peroxide also is a strong bleach and therefore must be applied carefully to avoid inadvertent decolorization of a patch of hair, towels or clothing.
Darker skin has a tendency to develop post-inflammatory hyperpigmentation (excessive skin darkening at places where the skin was inflamed). Severe inflammatory acne may result in dark spots. The spots resolve over time; a dermatologist may be able to recommend cosmetic measures to make the spots less apparent until they resolve. Some acne treatments, such as topical retinoids and azelaic acid, may also help fade the discoloration.
Removal of acne scars by dermabrasion or chemical peeling may cause temporary lightening or darkening of dark skin in the areas of treatment. Scar treatment should be discussed with a dermatologist or dermatologic surgeon before it is undertaken.
Alterations of melanin (dark pigments that give the skin its color) pigmentation such as vitiligo and melasma are not related to acne, but they may be present simultaneously with acne. The diagnosis and treatment of melanin pigmentation disorders such as vitiligo requires a dermatologist with knowledge and experience in treating these conditions.
Q: Is acne that appears for the first time in adulthood different from acne that appears in adolescence?
A: Acne has a specific definition as a disease of sebaceous follicles. This definition applies to acne that occurs at any age. However, it may be important to look for an underlying cause of acne that occurs for the first time in adulthood.
Current understanding of the causes of acne vulgaris is described in the Main Text section Why and how acne happens. In brief summary, acne vulgaris develops when excessive sebum production and abnormal growth and death of cells in the sebaceous follicle result in plugging of follicles with a mixture of sebum and cellular debris and formation of comedones (blackheads and whiteheads). Bacteria in the follicles—chiefly Propionibacterium acnes, the most common bacterial colonist of sebaceous follicles—may contribute to the inflammation of acne by release of metabolic products that cause inflammatory reaction. The pathogenic events, which cause disease, in the sebaceous follicle are believed to be due in large degree to changes in levels of androgenic (male) hormones in the body—a circumstance usually associated with growth and development between ages 12 and 21.
Some acne investigators believe that although this understanding is generally correct, there is more yet to be learned about the causes of acne vulgaris.
Acne that appears after the age of 25-30 years is (1) a recurrence of acne that cleared up after adolescence, (2) a flare-up of acne after a period of relative quiet—for example, during pregnancy, or (3) acne that occurs for the first time in a person who had never previously had acne.
Acne that occurs in adulthood may be difficult to treat if there are multiple recurrences. Some patients with severe recurrent acne have undergone repeated courses of treatment with the potent systemic drug isotretinoin.
Acne flares in association with pregnancy or menstruation are due to changes in hormonal patterns.
Acne that appears for the first time in adulthood should be investigated for any underlying cause. Drugs that can induce acne include anabolic steroids (sometimes used illegally by athletes to “bulk up”), some anti-epileptic drugs, the anti-tuberculosis drugs isoniazid and rifampin, lithium, and iodine-containing drugs. Chlorinated industrial chemicals may induce the occupational skin disorder known as chloracne. Chronic physical pressure on the skin—for example, by a backpack and its straps, or a violin tucked against the angle of the jaw and chin—may induce so-called acne mechanica. Some metabolic conditions may cause changes in hormonal balance that can induce acne.
Some lesions that appear to be acne may be another skin disorder such as folliculitis—infection and inflammation of hair follicles—that require different treatment than acne. Acne that appears for the first time in adulthood should be examined and treated by a dermatologist.
Q: My 15-year-old daughter has what I would describe as a very mild case of acne. She has made it much worse by constant picking and squeezing. She looks in the mirror for hours, looking for some blackhead or blemish she can pick or squeeze. Does she need psychological counseling?
A: Excessive picking and squeezing of otherwise mild acne is a condition called excoriated acne, seen most often in young women. A dermatologist may provide effective counseling.
The typical person with excoriated acne is a person—often a young women—who is so distressed with her appearance due to acne that she literally tries to "squeeze the acne out of existence." The acne is often very mild, but the person’s face may constantly be covered with red marks from squeezing, and open sores where lesions have been picked open.
The word excoriate means to scratch or abrade the skin. Excoriated acne is a medically recognized condition that should be discussed with a dermatologist. Occasionally giving in to a temptation to squeeze a blackhead is not defined as excoriated acne. Hours in front of a mirror, squeezing and picking every blemish, is a definition of excoriated acne. A dermatologist may be able to counsel the patient regarding a course of treatment in which the patient can participate, but keep "hands off."
Q: Can the rate of secretion or the composition of sebum be altered by diet? If it can, shouldn’t alteration of diet be considered a treatment for acne?
A: Diet has never been proven to have a role in the cause or treatment of acne. Dietary manipulation may have a role in the treatment of some scaling diseases of the skin, but not in the treatment of acne.
Dietary cause is one of the most persistent myths about acne. Foods, such as chocolate or greasy foods, do not cause acne, but certain foods seem to make some people’s acne worse. The following can bring on or worsen it:
An increase in male hormones found in both males and females
Oil and grease from cosmetics, work environment
No food has been shown to be effective in preventing or treating acne. A healthy diet is, of course, necessary for good general health.
Acne conglobata: A very severe type of acne in which nodules are connected beneath the skin surface to other nodules or acne lesions.
Acne mechanica: Form of acne that develops in response to heat, covered skin, constant pressure, and/or repetitive friction against the skin.
Acne vulgaris: The medical term for common acne, which is characterized by the presence of one or more of the following: blackheads, whiteheads, papules and pustules.
Androgenic: Referring to the hormones that stimulate the sebaceous glands to create sebum.
Androgens: Hormones that stimulate sebaceous glands in addition to other effects on the body. Present in both males and females, androgens are responsible for physical maturation in males and therefore occur in much higher levels in males. Males tend to have more severe acne than females.
Antimicrobial: Agent, such as a medication, that kills or eliminates microorganisms.
Blackhead: A non-inflammatory acne lesion that is filled with excess oil and dead skin cells. Blackheads are also called “open comedomes” because the surface of the skin remains open.
Chloracne: Rash characterized by many comedones that develops from exposure to chlorinated chemicals or herbicides.
Closed comedo: A whitehead; a non-inflammatory comedo with white center.
Comedo (plural: comedones): An acne lesion.
Comedogenic: Likely to cause comedones.
Dermatologic surgery: Deals with the diagnosis and treatment of medically necessary and cosmetic conditions of the skin, hair, nails, veins, mucous membranes and adjacent tissues by various surgical, reconstructive, cosmetic and non-surgical methods. This includes laser surgery, cryosurgery, chemical surgery, aspirational surgery and excisional surgery. The purpose of dermatologic surgery is to repair and/or improve the function and cosmetic appearance of skin tissue
Follicle: The tiny shaft in the skin through which a hair grows, and sebum is excreted from sebaceous glands to the surface of the skin.
Hormones: Chemical substances produced by the body that, depending on the hormone, govern many body processes. Certain hormones cause physical maturation during puberty. These are the ones implicated in acne.
Inflammatory: A word that means "causing inflammation." In acne, "inflammatory" is usually used to describe lesions that are inflamed by chemical reactions or bacteria in clogged follicles.
Isotretinoin: Potent systemic medication used to treat severe forms of acne. Due to potential birth defects, a woman must not take this medication while pregnant or breast feeding and must not become pregnant while taking isotretinoin.
Keloid: Large raised scar that spreads beyond the size of the original wound.
Lipids: Oily substances that include things like fats, oils and waxes. Sebum is made up of lipids. A particular kind of lipid, free fatty acids, are irritating to the skin.
Macule: A flat spot or patch of skin that is not the same color as the surrounding skin.
Melanin: Substance that gives hair and skin its color.
Microcomedo: The first stage of comedo formation; a comedo so small that it can be seen only with a microscope.
Nodulocystic acne: A severe form of acne that is characterized by numerous deep, inflamed bumps (nodules) and large, pus-filled lesions that resemble boils (cysts). The nodules tend to be tender when touched and feel firm. The severe inflammation can cause the acne to become very red or even purple. Scarring often results when the acne heals.
Noncomedogenic: Not likely to cause comedones.
Noninflammatory: In acne, comedones that are not associated with redness in the skin.
Open comedo: A blackhead) a noninflammatory comedo with a dark top and firmly packed contents.
Papule: An inflammatory comedo that resembles a small, red bump on the skin.
Papulopustular: A type of acne characterized by the presence of papules and pustules.
Post-inflammatory hyperpigmentation: Excessive skin darkening at places where the skin was inflamed.
Propionibacterium acnes (P. acnes): A normal resident on the skin,
P. acnes will multiply rapidly in clogged hair follicles where sebum is trapped.
Puberty: The time of life when a child begins the physical maturation process toward adulthood. Onset is usually in the early teens and is accompanied by a large increase in hormone production.
Pustule: An inflammatory comedo that resembles a whitehead with a ring of redness around it.
Retinoid: A natural or synthetic substance derived from vitamin A.
Sebaceous glands: Glands in the skin that produce an oily substance called sebum--these glands are the sites of acne lesions. Sebaceous glands are attached to hair follicles and are found mostly on the face, neck, back and chest.
Sebum: The oily substance produced by sebaceous glands.
Steroid acne: Acne that develops from long-term use of corticosteroid medications. Since this condition can develop, corticosteroid medications are prescribed for a limited time.
Systemic therapy: Treatment that consists of taking medication internally, such as in pill form or by injection or infusion.
White blood cells: Components of the blood that help fight off infections.
Whitehead: An acne lesion that forms when oil and skin cells block the opening of a hair follicle. For this reason, whiteheads are called “closed comedomes.”