Acne

Acne is a skin disorder that can occur at any age but is common in teenagers during puberty. It is caused by the blockage of pores (or hair follicles) in the skin and mostly occurs on the face, chest, and back. Preadolescent acne can often first occur in the ear. The blocked pores can become inflamed or infected with bacteria.  

Acne is the most common skin condition in the United States and can be frustrating to manage. It cannot be cured but it can be controlled by using medications. As everyone’s skin is different, successful management depends on an optimized regimen that works best for you.

There are different types of acne. You may have one or both of these depending on your skin:

  • Comedonal acne – Comedones are clogged hair follicles (pores) in the skin. The pores are blocked with dead skin cells and oil. A whitehead is when the follicle is still closed off by skin.  Blackheads are when the follicle is open and the oil darkens. The oil becomes darker when exposed to air. Blackheads are not full of dirt.
  • Inflammatory acne – Pimples, or “zits,” are often red, nodular, or cystic bumps on the skin. These are blocked pores that become inflamed or infected with bacteria. Nodular acne is a more severe form of pustular acne, where the lesions become larger, more inflamed and painful. Nodular acne can often lead to scarring.

Over-the-counter treatments for acne

Acne is treated to prevent scarring and to decrease any impact on self-esteem, psychological state, or social interactions. There are many effective treatments available:

  • Start with skin hygiene. Wash your face (or other affected area) twice a day with a gentle cleanser. Soaps or cleansers labeled for sensitive skin are milder and better for acne-prone skin.
  • Use makeup or sunscreen products that are labeled non-comedogenic. This means it won’t clog pores.
  • Facial toners can decrease oiliness and remove makeup and traces of dirt. Many prepackaged acne treatments contain toners. You should be careful not to overuse toners because they can irritate the skin. 
  • Benzoyl peroxide is the most effective over-the-counter active ingredient. It comes in a wash (like Clean and Clear Continuous Control Acne Cleanser or Panoxyl), cream (like Clearasil Ultra Rapid Action Vanishing Treatment Cream), gel or lotion (like Clean and Clear Persa-gel 10). While these treatments are over the counter, your doctor can help determine which formulation may be best for you. Be careful as benzoyl peroxide can increase the risk of sunburn as well as bleach linens like towels and sheets
    • Apply the cream, gel, or lotion to clean and dry skin. This medication can work by preventing new breakouts.
    • When applying on the face, use the “5-dot” method: Take a pea-sized amount and place dots in each of these five locations on your face: mid-forehead, chin, each cheek, and nose (be sure to avoid the skin around your eyes). Then rub in. You should not see a film of the medication on your skin; if you do, you’re probably using too much.

Prescription treatments for acne

If over-the-counter treatments aren’t effective, there are some prescription treatments available:

  • Benzoyl Peroxide. While many formulations are over the counter, there are prescription options as well.
  • Topical retinoids. A prescription medication used to prevent the formation of inflamed acne lesions and help unplug pores. It can be drying and cause irritation or redness but this is usually temporary. Sometimes you have to gradually increase how often you use it. Your doctor will determine if this medication is useful for you.
  • Antibiotics. Blocked pores can become infected and antibiotics help to reduce bacteria on the skin and in the pores. They are often used together with other treatments, such as benzoyl peroxide or topical retinoids. There are topical (applied to skin) and oral (take by mouth) options.
  • Hormonal therapy. Sometimes treatment with oral contraceptives (birth control) can block the production of hormones and decrease the amount of oil production leading to improvement in acne.
  • Isotretinoin. An oral medication used for treatment of severe acne. It is the strongest and most effective medication we have to treat acne but it has side many effects. This can only be prescribed by certain physicians who have had special training (usually dermatologists).

Remember to be patient. Improvement in acne may take 2–3 months. Follow-up visits are usually planned for three months. Sometimes treatment may be required for several years.

What can make acne worse?

While many people think acne is caused by the foods you eat or the makeup you wear, that is not true. There are no specific “acne diets” and using oil-free, non-comedogenic makeup does not worsen the severity of acne or interfere with treatment. Makeup may help some people feel more comfortable in their own skin. The following factors, however, can make acne worse:

  • Repeated pressure, leaning, touching, or scrubbing acne-prone areas. This can occur from headbands and helmets
  • Over-washing or over-scrubbing your face. This will not improve acne and can create dryness and irritation. This includes scrubbing with a loofa or washcloth.
  • Oils and grease in moisturizers, face creams, or makeup. Look for “non-comedogenic” options.
  • Squeezing pimples and digging at the skin with fingernails may result in scarring.
  • Certain medications taken for other problems. Your doctor should be informed of all medications that you are taking
  • Not showering after strenuous activities, as oil and sweat on your skin can lead to breakouts.
  • Emotional stress may aggravate acne due to hormonal changes.

Quick tips for handling acne:

  1. Choose the right products. When applying anything to areas prone to break out (such as face, back, or chest), look for products that are oil-free and/or “non-comedogenic” (won’t clog pores).
  2. Avoid picking, squeezing, scrubbing, or scratching acne lesions. This can lead to longer healing times, skin infections, discoloration, and scarring.
  3. Be Patient. It can sometimes take 2–3 months before you can tell if a treatment is “working” for your acne. It is best to give your regimen at least this long, using treatments as directed by your doctor, before trying something else.

Additional resources:

 

Updated by Jennifer White, MD. Reviewed by Sara Laule, MD

Updated September 2018