Acne

Certain things may trigger or worsen acne:

• Hormonal changes: During puberty, the increase in hormones called androgens can cause the sebaceous glands to enlarge and produce more sebum, leading to acne. Hormone changes during midlife, especially in women, can also contribute to breakouts.
• Certain medications: Drugs containing corticosteroids, testosterone, or lithium can trigger or worsen acne.
• Diet: Some studies suggest that consuming certain foods, such as carbohydrate-rich foods like bread, bagels, and chips, may worsen acne. However, further research is needed to determine if following specific dietary restrictions can benefit individuals with acne.
• Stress: While stress does not directly cause acne, it can exacerbate existing acne conditions.
• Acne myths: The following factors have little to no effect on acne:
• Chocolate and greasy foods: Consuming chocolate or greasy food does not significantly impact acne.
• Hygiene: Acne is not caused by dirty skin. In fact, excessive scrubbing or using harsh soaps and chemicals can irritate the skin and worsen acne.
• Cosmetics: Using noncomedogenic, oil-free makeup and regularly removing makeup does not necessarily worsen acne. Nonoily cosmetics do not interfere with the effectiveness of acne medications.
• Complications: People with darker skin types are more prone to experiencing the following acne complications:
• Scars: Acne scars, including pitted skin and keloids, can persist long-term after acne has healed.
• Skin changes: After acne clears, the affected skin may appear darker (hyperpigmented) or lighter (hypopigmented) than before the condition occurred.

Treatment

If over-the-counter acne products have not been effective after several weeks, it is advisable to consult a doctor for prescription-strength medications.

A dermatologist can assist in:

• Controlling acne
• Preventing scarring or other skin damage
• Reducing the visibility of scars
• Prescription acne medications work by reducing oil production, reducing swelling, or treating bacterial infection.

Results from prescription acne drugs may not be visible for four to eight weeks, and complete clearance of acne may take months or even years.

Treatment regimen

The recommended treatment regimen depends on factors such as age, type and severity of acne, and patient commitment.

For instance, it may be necessary to wash and apply medications to the affected skin twice a day for several weeks.

• Topical medications and oral medication are often used in combination.
• Pregnant women have limited treatment options due to potential side effects.
• Risks and benefits: It is important to discuss the risks and benefits of medications and other treatments with the doctor.
• Follow-up appointments: Follow-up appointments with the doctor should be scheduled every three to six months until the skin improves.

Topical medications for acne include:

1. Retinoids and retinoid-like drugs:

• Examples: tretinoin (Avita, Retin-A, others), adapalene (Differin), tazarotene (Tazorac, Avage, others)
• These medications come in the form of creams, gels, and lotions.
• Apply in the evening, starting with three times a week and gradually increasing to daily use.
• They prevent hair follicle plugging.
• Do not use tretinoin at the same time as benzoyl peroxide.
• Side effects may include increased sun sensitivity, dry skin, and redness, especially in individuals with brown or Black skin.
• Adapalene may be better tolerated.

2. Antibiotics:

• These medications kill excess skin bacteria, reduce redness, and inflammation.
• For the first few months of treatment, use both a retinoid and an antibiotic.
• Apply the antibiotic in the morning and the retinoid in the evening.
• Antibiotics are often combined with benzoyl peroxide to prevent antibiotic resistance.
• Examples: clindamycin with benzoyl peroxide (Benzaclin, Duac, others), erythromycin with benzoyl peroxide (Benzamycin).
• Topical antibiotics alone are not recommended.

3. Azelaic acid and salicylic acid:

Azelaic acid:

• Azelaic acid is a naturally occurring acid with antibacterial properties.
• A 20% azelaic acid cream or gel used twice a day is as effective as conventional acne treatments.
• Prescription azelaic acid (Azelex, Finacea) is safe during pregnancy and breastfeeding.
• It can also manage discoloration associated with acne.
• Side effects may include skin redness and minor irritation.

Salicylic acid:

• Salicylic acid helps prevent hair follicle plugging.
• Available as wash-off and leave-on products.
• Limited evidence supports its effectiveness.
• Side effects may include skin discoloration and minor irritation.

4. Dapsone:

• Dapsone (Aczone) 5% gel twice daily is recommended for inflammatory acne, especially in women.
• Side effects may include redness and dryness.

The use of zinc, sulfur, nicotinamide, resorcinol, sulfacetamide sodium, or aluminum chloride in topical treatments for acne is not strongly supported by evidence.

Oral medications

• Oral medications for acne treatment include antibiotics, combined oral contraceptives, anti-androgen agents, and isotretinoin.
• Antibiotics are recommended for moderate to severe acne to reduce bacteria. Tetracycline (minocycline, doxycycline) or macrolide (erythromycin, azithromycin) are commonly prescribed options. Macrolides are suitable for individuals who cannot take tetracyclines, such as pregnant women and children under 8 years old.
• Oral antibiotics should be used for the shortest duration possible to prevent antibiotic resistance. Combining them with other drugs like benzoyl peroxide can help reduce the risk of developing antibiotic resistance.
• Severe side effects from antibiotics for acne treatment are rare, but they can increase skin sensitivity to the sun.
• Combined oral contraceptives, which combine progestin and estrogen, are FDA-approved for acne therapy in women who also desire contraception. It may take a few months to see the benefits, so using other acne medications initially can be beneficial.
• Common side effects of combined oral contraceptives include weight gain, breast tenderness, and nausea. They are also associated with an increased risk of cardiovascular problems, breast cancer, and cervical cancer.
• Anti-androgen agents like spironolactone (Aldactone) may be considered for women and adolescent girls if oral antibiotics are ineffective. Spironolactone works by blocking the effect of androgen hormones on oil-producing glands. Possible side effects include breast tenderness and painful periods.
• Isotretinoin (Amnesteem, Claravis, others), a derivative of vitamin A, may be prescribed for individuals with moderate or severe acne that hasn’t responded to other treatments.
• Potential side effects of oral isotretinoin include inflammatory bowel disease, depression, and severe birth defects. All individuals receiving isotretinoin must participate in an FDA-approved risk management program and have regular doctor visits to monitor for side effects.

Therapies

• Light therapy: Various light-based therapies have shown some success in treating certain individuals. Multiple visits to a doctor’s office are typically required for these therapies. However, further research is necessary to determine the most effective method, light source, and dosage.
• Chemical peel: This procedure involves the repeated application of a chemical solution, such as salicylic acid, glycolic acid, or retinoic acid. It is primarily used for mild acne and may temporarily enhance the skin’s appearance. However, the effects are not long-lasting, and additional treatments are often required.
• Drainage and extraction: In cases where topical medications have not resolved whiteheads, blackheads, or cysts, a doctor may utilize specialized tools to gently remove them. While this technique can temporarily improve the skin’s appearance, it also carries the risk of scarring.
• Steroid injection: Nodular and cystic lesions can be treated by injecting a steroid drug directly into them. This therapy has shown rapid improvement and reduced pain. However, potential side effects include skin thinning and discoloration in the treated area.

Treating children

• Consult a pediatric dermatologist if your child has acne.
• Inquire about drugs that should be avoided in children.
• Ask about appropriate doses of medication for children.
• Discuss potential drug interactions and side effects.
• Seek information on how acne treatment may impact a child’s growth and development.

Alternative medicine

• Tea tree oil: Gels containing at least 5% tea tree oil have shown potential in reducing acne. They may be as effective as lotions containing 5% benzoyl peroxide, although the effects of tea tree oil may be slower. However, it is important to note that tea tree oil may cause minor itching, burning, redness, and dryness. Therefore, individuals with rosacea should avoid using it as it may exacerbate their condition.
• Brewer’s yeast: A specific strain of brewer’s yeast called Hansen CBS has been found to have a positive impact on decreasing acne when taken orally. However, it is worth mentioning that this supplement may cause gas (flatulence).
• Further research: It is crucial to conduct more research to establish the potential effectiveness and long-term safety of alternative and integrative approaches, including biofeedback and ayurvedic compounds, in treating acne.
• Consultation with a healthcare professional: Before trying any specific treatments, it is highly recommended to consult with a doctor. They can provide valuable insights into the pros and cons of different approaches, helping individuals make informed decisions about their acne treatment.

Lifestyle and home remedies

• Wash problem areas with a gentle cleanser: Use your hands to wash your face with mild soap or a gentle cleanser (Cetaphil, Vanicream, others) and warm water twice a day. Be gentle if you’re shaving affected skin.
• Avoid certain products: Facial scrubs, astringents, and masks can irritate the skin and worsen acne. Avoid using them. Excessive washing and scrubbing can also irritate the skin.
• Try over-the-counter acne products: Look for products containing benzoyl peroxide and adapalene as active ingredients. These products help dry excess oil and promote peeling. You can also try products with salicylic acid, glycolic acid, or alpha hydroxy acids.
• It may take a few weeks to see improvement.
• Choose creams over gels or ointments: Nonprescription acne medications may cause initial side effects like redness, dryness, and scaling. These side effects often improve after the first month of use. Creams are generally less irritating than gels or ointments.
• Avoid irritants: Oily or greasy cosmetics, sunscreens, hairstyling products, or acne concealers can worsen acne. Use water-based or noncomedogenic products labeled as such, as they are less likely to cause acne.
• Protect your skin from the sun: Sun exposure can worsen discoloration after acne has cleared. Some acne medications also increase sunburn susceptibility. Check with your doctor to see if your medication falls into this category. If it does, minimize sun exposure and regularly use a nonoily (noncomedogenic) moisturizer with sunscreen.
• Avoid friction or pressure on your skin: Protect acne-prone skin from contact with items like phones, helmets, tight collars or straps, and backpacks.
• Avoid touching or picking acne-prone areas: Touching or picking at acne can trigger more breakouts, lead to infection, or cause scarring.
• Shower after strenuous activities: Oil and sweat on the skin can contribute to breakouts. Showering after strenuous activities helps remove these substances.