Acne Recommendations

Causes

Most people have a few pimples during their teenage years; some have severe or long-lasting disease. Acne is predestined in certain individuals and will occur regardless of their physical, social or cultural upbringing. The sensitivity of the oil glands to plugging (to form blackheads and whiteheads) and to rupture (to form pimples) is inherited.
Oil glands are inactive in childhood, and develop at puberty. This explains why the face then becomes oily, pores become visible (pore size is related to oil gland size), and acne may develop. Pore size is unchangeable, and is not affected by astringents, massage, saunas, facial packs, or cosmetics.
Blackheads or pore plugs, the basic culprit in acne, are composed of dead skin produced by the cells lining the pore. The plug is not made of dirt or hardened oil. It is deep and cannot be scrubbed out. Its formation cannot be prevented by washing or the use of astringents. A pimple is an inflamed area of tissue reacting to the rupture of an oil gland and/or hair root. The hair root ruptures at least partially because it is plugged. A pimple may contain a few bacteria, but it is not a true infection, and is not the result of touching the face with dirty fingers.

The occurrence of acne in some people may be influenced by:

  1. Stress, illness, or exhaustion.
  2. Sunlight: Sun exposure often improves acne, but may worsen it in some individuals (especially those who sunburn easily).
  3. Hormonal changes: There are often slight flares of acne related to the menstrual cycle. Pregnancy usually improves acne. Birth control pills may or may not improve acne depending on the estrogen content.
  4. Cosmetics: Certain cosmetics irritate the cells lining the oil gland pores so that they make dead skin plugs. The thickness of the cosmetic, or whether it is 'hypoallergenic' is not related to this effect.
The occurrence of acne is NOT influenced by:
  1. Diet: Chocolate, junk food, greasy food, vitamins and minerals do not affect acne.
  2. Cleanliness.
  3. Sexual activity.
Scarring is the natural result of significant skin inflammation. It is not caused by picking. However, picking may worsen the inflammation of a pimple so that it is more likely to scar. The type of pimple especially sensitive to manipulation is the deep red bump not surmounted by a pus head. This type has nowhere to drain and is fragile, so manipulation of it is likely to cause more rupture and inflammation in the tissues.

Treatment

There is no 'cure' for acne, but modern treatments help keep acne under control until it clears with time. Your doctor will select the treatments which work best and have the fewest side effects, and will follow you and change treatments if your response to treatment changes. Below are general rules about acne treatments; your doctor will tell you specifically how to use various medications.
Except for cortisone treatments given by doctors, all treatments for acne primarily work by preventing the formation of new pimples, and do little to hasten the healing of existing pimples. As a result, at least two to four weeks of constant treatment are necessary before improvement begins. Things will continue to improve even more for up to 12 weeks before leveling off. Also, treatment must be given constantly to all acne-prone areas, and not just to individual existing pimples.
Washing excessively with regular soap, special acne soaps, or with abrasives has little impact on acne. More often they dry out, chap, and irritate the skin. Then when effective anti-acne creams or lotions are used they are likely to burn and irritate more. Just washing once or twice a day with a mild soap is best. If parts of the face feel oily during the day, they can be wiped with a mild alcohol-and-water astringent.

Acne treatment with topical antibiotic, benzoyl peroxide and/or tretinoin

These are external anti-acne medications. All are applied regularly to the areas likely to break out with acne. They work slowly to stop the appearance of new pimples. No benefit may be seen for a month or more, and the benefit may increase over two to three months. About two-thirds of patients get a good response.
Benzoyl peroxide and tretinoin, especially, may be irritating. To minimize irritation they should be applied thinly, with care taken to avoid puddling in folds around the eyes, nose and mouth. They are more irritating to moist skin, so they should not be applied within 15 minutes of washing. Washing should be infrequent (twice a day) and with mild soap. Strong acne soaps tend to increase irritation. Your doctor may prescribe a soothing medication if irritation cannot be avoided.

Benzoyl peroxide

This helps reduce inflamed pimples and will also reduce blackheads. It should be applied twice a day - to the point that the skin feels slightly dry and tight, but not to the point of redness or irritation. Some people can use it only once a day, and some can tolerate it more often than twice a day. Find the schedule that suits your skin. Occasionally an allergy to it will develop, so if an itchy red rash occurs, stop treatment. Also, benzoyl peroxides have a mild bleaching action on dark clothing.

Topical antibiotic

Like benzoyl peroxide, topical antibiotics help prevent new pimples. They have no effect on blackheads. Most are in alcohol solutions and may be slightly drying, but usually do not irritate as benzoyl peroxides might. They do not bleach clothing. They are applied twice daily to acne-prone areas.