Acne is the most common skin condition in the United States. Most people experience acne at some point during his/her life. Although frequently seen in teenagers, acne occurs in adults as well. Sometimes, people who had no acne during high school develop acne in their 20s and 30s and approximately 10% of 40-year-old women have acne. Even newborns can develop acne.
Unfortunately, accurate information about acne treatment can be scarce. Dr. Craig Singer is an acne expert, and has treated thousands of patients with mild, moderate and severe acne. Dr. Singer, himself, suffered from acne when he was in college and also treated his oldest child who had severe teenage acne. Dr. Singer understands the emotional impact that acne can have on a person’s self-esteem, and he enjoys helping others suffering from this common condition.
This schematic diagram shows how acne develops: (1) oil and skin cells clog the pores (i.e. blackheads and whiteheads), (2) bacteria overgrow within the oil glands, and (3) the immune system attacks the bacteria causing inflammation and swelling (pustules and cysts). The most current thinking however is that inflammation occurs at the start of an acne lesion.
Wash your face every morning, evening, and after exercise.
Glycolic acid is a gentle facial cleanser used for the treatment of acne. Alpha-hydroxy acids provide exfoliation and their low pH helps reduce P. acnes levels on the skin. Glycolic acid is well-suited for use by individuals with dry skin because the hydroxy acids act as humectants (i.e. draw water into the skin). In addition, the exfoliating activity of glycolic acid improves the penetration of other acne medications into the skin. Glycolic acid wash is available for purchase at Craig Singer MD Dermatology.
It is always a good idea to apply a moisturizer to the skin after you wash your face. This preserves the normal skin barrier and minimizes irritation. The more irritated your skin becomes, the worse the acne becomes. Even if you have oily skin, it is still wise to moisturize.
A number of moisturizers are available for purchase over-the-counter. (The label may say “won’t clog pores” or “non-comedogenic”). Some people prefer one over another. Some people find that certain moisturizers sting or irritate their skin. It may take some trial and error to figure out what you like best. Dr. Singer’s personal preference is for a moisturizer called Theraplex. However many other over-the-counter moisturizers are more than adequate. These include Neutrogena Hydro boost, Cetaphil moisturizer and Cerave moisturizing cream.
Dermatologists know that letting acne runs its course is not always the best advice. Here’s why:
There are multiple different types of acne lesions. The earliest lesion is known as a comodone (more commonly referred to as “blackheads and whiteheads”). These are the basic form of acne in which oil and skin cells clog the pores. Papules and pustules (i.e “zits”)represent the body’s inflammation towards the overgrowth of C. Acnes bacteria within the pores. Cysts and nodules refer to inflammation associated with ruptured pores and carry a higher risk of potential scarring. In general, it is easier to calm down the inflammatory lesions quicker than it is to unclog the pores.- It takes months to unclog the pores.
Acne is caused by two main influences:
When you pick acne lesions, you are creating an injury to your skin.- This leads to persistence of the acne lesion for weeks. Also, you will likely end up with temporary redness or a dark spot on your skin lasting even longer. And finally, a permanent mark (i.e. scar) may develop from picking.
Our recommendation: When you develop a large acne cyst, it is best to perform a hot compress with a wet washcloth for five minutes and spot treat with a topical acne medication. Also, Dr. Singer can inject the acne cyst with cortisone which usually shrinks the lesion within 48 hours. We welcome patients on a walk-in basis for acne injections.
Those people who have a darker skin complexion (i.e. skin of color) tend to develop dark spots in previous areas of acne. This is known as post inflammatory hyperpigmentation. When someone with a darker skin complexion sustained an injury to the skin, a bug bites or a pimple, the pigment cells in the skin are stimulated to release excessive amount of pigmentation. This leads to an uneven complexion and can be more bothersome than the acne itself.
The first step in addressing the discoloration is to aggressively treat the acne to prevent new pimples from forming. If the acne is not adequately controlled, then any treatment of dark spots will be ineffective.
Use of sunscreen is mandatory, bleaching creams (such as Triple therapy), and chemical peels are effective. Additional treatments include kojic acid, Tranexamic acid (e.g. Lytera), etc.
Dark Spots from Acne often require a “Triple Therapy” bleaching cream
Benzoyl peroxide is considered first-line treatment for acne. Benzoyl peroxide kills the bacteria on the skin that cause acne, thus reducing pimples, pustules and cysts. It also helps unclog pores.
It is found in washes, gels, creams, and combination products such as Benzaclin™, Onexton™, and EpiDuo.™ Benzoyl peroxide is also found in over the counter preparations such as Neutrogena Rapid Clear™ or Panoxyl. ™
Lower strengths (i.e. 2.5%) produce less skin irritation than higher strengths. Also, benzoyl peroxide bleaches dark fibers of clothing and towels. If benzoyl peroxide is applied at night, we often recommend that the person sleep with a white pillowcase. If applied in the morning, be careful not to accidentally apply it to the neck as you may bleach your shirts.
If benzoyl peroxide is used in a wash form, it is important to get a five minute contact time with the skin before washing off. Otherwise it may not be effective.
Approximately 1% of people are allergic to benzoyl peroxide.
What are retinoids?
Retinoids, the cornerstone of acne treatment, are derived from Vitamin A. This class of medication is available in creams, gels and foams.
Retinoids slowly unclog the pores, getting rid of blackheads and whiteheads. They also provide an anti-inflammatory effect hoping to reduce pimples and cysts. Unfortunately, retinoids do not work overnight. – It takes at least three months to see their full benefit.
When a person applies a retinoid to the face, it causes a slow peeling of the skin.
However, if someone were to apply too much retinoid cream, too quickly, it can cause a fast peeling of the skin with significant redness, irritation, and burning. Therefore, proper understanding of how to apply these medications is essential.
Here are some general guidelines to help:
Use a gentle skin cleanser.- see above accordion
Apply retinoids to a dry face. This means that you should wait at least 15 minutes after washing your face to let your skin thoroughly dry. If you apply retinoid immediately after you wash your face, your skin is still damp and the retinoid may penetrate your skin more deeply, leading to irritation.
Only use a pea-sized or chocolate chip sized amount of retinoid for the entire face.
Always use a moisturizer after you apply a retinoid
For the first month of treatment, only use the retinoid three nights a week. If you can tolerate it after month, you can slowly increase the frequency.
If you are still unable to tolerate the retinoid, then try applying a moisturizer BEFORE you apply the retinoid.
Note that retinoids are contraindicated during pregnancy.
There are times when traditional therapies, hormonal therapies, and cosmetic treatments fail to control cystic acne.
Fortunately, there is a miracle cure for acne – Accutane.