Acne 101


Acne 101:

Today we know more about the causes of acne than ever before.  Blemishes can be leading cause of embarrassment and lack of self-esteem, especially among the teenage population.   Acne patients often shy away from social situations, avoid meeting new people and miss opportunities.  In addition to the above, many acne sufferers harbor feelings of guilt.  It is not unusual for them to wonder “what am I doing wrong to cause my skin to break out?”

The good news is that acne is NOT your fault!

The better news is there are many options available to control and prevent acne.

Common Myths

  • Acne is caused by not washing enough
  • Over-washing your face or stripping it with alcohol in an effort to “clean” your skin can make blemishes worse.
  • Chocolate, pizza, French fries, etc. can cause acne.  (Though a healthy diet is recommended, these foods rarely affect acne)


Acne is caused by your hormones and your skin’s inability to slough off old dead cells.

Avoid excessive sun exposure as it can increase plugging of pores resulting in comedones.

Open comedone is commonly referred to as a blackhead. 

Closed comedone is commonly referred to as a whitehead, papule or pustule.

The number one step anyone can take in treating acne is to visit a board-certified dermatologist.  Your dermatologist will be able to properly diagnose your acne and customize a treatment plan for your specific needs.

Patients should limit washing to 2-3 times/day.  More than that often irritates the skin, offers no benefit and may lead to increased oil production.  Products such as harsh facial scrubs with almond or apricot shell fragments, or with high levels of isopropyl alcohol are not recommended because they tend to tear or irritate fragile skin, which can aggravate acne.

Squeezing or picking blemishes can force bacteria deeper into the skin causing even greater inflammation and infection.  This can also lead to scarring.

Simply starting a few healthy habits will enable your face to be free from grime and bacteria.  Patients should use cosmetics that are oil free and non-comedogenic (will not clog pores).

Stress can raise levels of the hormones cortisone, which causes increased secretion of oil in skin.

Types of Acne:

Approximately 90% of all teenagers will develop acne.  It is important to treat acne as soon as the first signs appear to prevent breakouts from becoming larger problems.

Most mild to moderate conditions can be treated with safe, effective topicals containing benzoyl peroxide and salicylic acid while more severe conditions may require prescription topical and/or oral medications.

Though all pimples start out the same way, they may appear different on your skin.  If the plug stays below the surface of the skin it is called a “closed” comedone or whitehead.  If it enlarges and pops out of the duct it is called an “open” comedone or blackhead.  This is not dirt and will not wash away.  The color is due to a buildup of melanin.

Acne develops in the hair follicles, the lining of the skin duct surrounding the hair follicles, and the sebaceous glands that produce oil.

The skin cells are in a continuous state of renewal.  As the old cells die, they mix with the skin’s natural oil and are sloughed off.  Some individuals do not shed dead cells evenly.  When this happens, the cells become “over sticky.”  These sticky cells and oil form a plug, called comedone, in the hair follicle.  The comedone is similar to cork in a bottle.  The comedone holds the oil and bacteria (p.acnes) in the follicle, which begins to swell as the skin produces more oil.  Next, the white blood cells swarm around the follicle and kill the bacteria.  The result is a pimple – ACNE

Inflammatory Acne:

With inflammatory acne, the whiteheads become infected with bacteria (Propionibacterium acnes or p. acnes) and swell producing pimples.  Physicians may refer to them as papules and pustules.  This condition is known as acne vulgaris.

Non-Inflammatory Acne:

Most people have non-inflammatory acne, this is a relatively mild form with a few whiteheads (closed comedones) and blackheads (open comedones).

Acne Treatments:

The secret of controlling acne is prevention, stopping the formation of acne before it becomes a visible pimple.  This can often be accomplished by using a combination of topical medications.  For more severe cystic acne, physicians often prescribe oral antibiotics or Accutane.

Accutane:  The strongest oral medication available for acne.  Accutane usually makes a dramatic difference.  Unfortunately it may have severe side effects including liver damage and birth defects if a woman becomes pregnant while taking it.  Patients must be closely monitored by a dermatologist during the 5 month course of treatment.

Oral Antibiotics:  Includes tetracycline, doxycycline, ertythromycin, minocycline.  Effective against p. acnes.  Often causes stomach problems.  There is a concern of developing antibiotic resistance.

Topical Antibiotics:  Less side effects than oral.  Most common are erythromycin and clindamycin. There is a concern of developing antibiotic resistance.  Sometimes these topical antibiotics are combined with Benzoyl Peroxide as well.

Retinoids – Topical retinoic acid and retinol assist in normalizing keratinizaiton and desquamation (cell turnover).  Promotes the detachment and shedding of cells from the follicle.  Excellent comedolytic agent.

Benzoyl Peroxide Products:

Benzoyl peroxide is an oxidizing agent that possesses antibacterial properties and is classified as a keratolytic (promotes cell turn over).  Also kills p. acnes on the skin and in the follicular canal.

Glycolic and Salicylic Acid Products –

Glycolic Acid helps exfoliate and accelerate the removal of dead skin cells that can interfere with proper oil drainage while Salicylic acid products offers superior comedolytic results .

Dermatologists will work with your specific skin type to determine the combination of therapies to control your acne and prevent breakouts.  There is no need to let acne take over your life, clear skin can be achieved with the proper treatments.

Cosmetic Dermatology of Orange County provides personalized acne protocols, with specialized acne products, prescription therapy, as well as acne laser therapy and acne scar tissue treatment.

0 replies

Leave a Reply

Want to join the discussion?
Feel free to contribute!

Leave a Reply

Your email address will not be published. Required fields are marked *