Acne is a common skincare concern for many people. In fact, it’s the most common skin condition in the U.S and affects around 50 million Americans each year.
Acne is how the skin reacts to dirt, debris, sebum (oil), and dead skin cells clogged in the hair follicles. Under the surface of the skin, we have sebaceous glands that produce sebum. Sebum is responsible for pushing dead skin cells and debris out of the follicle and up to the surface of the skin. Hair also grows out of these follicles.
When the follicle becomes clogged with a mixture of debris, sebum, and hair, it becomes inflamed and swollen in response to bacteria buildup. This is when those red, under-the-skin, painful pimples appear. As the follicle continues to shed the bacteria cluster and push it to the surface of the skin, pimples, blackheads or whiteheads arise.
Different Types of Acne
There are two main subcategories of acne—inflammatory and non-inflammatory.
Inflammatory acne appears red, inflamed, and swollen and is the immune system’s response to an infection trapped under the skin. Examples of inflammatory acne include:
Non-inflammatory acne typically doesn’t appear swollen or red, because these types of acne are caused solely by clogged pores and aren’t due to a bacterial infection under the skin. Examples of non-inflammatory acne include:
Inflammatory acne is generally considered moderate to severe acne, while non-inflammatory acne is considered a mild type of acne. The swelling, redness, and tenderness caused by inflammatory acne can be rather unpleasant and more apparent than non-inflammatory acne.
Causes of Acne
Pimples and breakouts appear when a hair follicle is clogged with sebum, dead skin cells, dirt, or debris. This clogging can result from a number of common triggers, including:
- Hormones: Acne is common in young adolescents and women. During the adolescent years, the brain is releasing sex hormones, growth hormones, and stress hormones in overdrive, causing increased sebum production, which is known to worsen acne. For women, the menstrual period, pregnancy, and regular use of hormonal birth control can also increase sebum production and exacerbate breakouts.
- Stress: When a person experiences stress, the stress hormone CRH (corticotropin-releasing hormone) binds to receptors in the skin’s sebaceous glands, which increases oil production and causes pimples.
- Bacteria: When the hair, sebum, and dead skin cells block the pores and prevent oil from reaching the surface, it creates a breeding ground for bacteria to grow in the clogged pores. The body perceives the invading bacteria as an infection, so it reacts with inflammation and swelling. Touching your face regularly throughout the day can cause clogged pores and bacteria buildup.
- Heredity: Acne can be a hereditary condition, as some genetics may trigger dead skin cells to produce in excess, which leads to more clogged pores. Excessive production of sebum can also run in families, and oily skin increases the chances of bacteria blocking the pores.
- Cosmetics and irritating ingredients: Cosmetics that are naturally greasy or oily can contribute to the formation of acne and breakouts. Greasy ingredients can cause the bacteria plug to form in the hair follicle. Especially if you have oily skin or acne-prone skin, opt for ingredients that are non-comedogenic. (Non-comedogenic products are specially designed to not block pores.)
Depending on the severity of a person’s acne condition, lifestyle changes, skincare routine changes, topical medications, oral medications, therapies (or a mixture of treatments) may be the best treatment option.
Lifestyle Changes for Acne Treatment
Eat a balanced diet. Your diet can have a significant impact on the condition of your skin. The foods you choose to fuel your body with can help to regulate oil production or increase oil production.
Specifically, foods that increase your blood sugar, like high-carb rice and bread, refined sugars, dairy products, and fast food, should be consumed in moderation or given up all together to prevent spikes in insulin. (Excess insulin in the blood can cause the sebaceous glands to produce more sebum, which contributes to oily skin and breakouts.)
Avoid touching your face. To prevent acne, avoid touching your face at all costs. Think of the number of bacteria you accumulate on your hands throughout the day. Studies by the University of Colorado Boulder determined that any given hand can harbor about 150 different species of bacteria at once!
When you touch your face with an unwashed hand, you’re likely exposing your skin to millions of bacteria at once. Dirt, debris, and bacteria can block the pores, stunting the sebum production process, and leading to acne, inflammation, and swelling.
Protect your skin from the sun. The sun’s UV rays can do considerable damage to your skin, in the form of dry skin, hyperpigmentation, acne, and most importantly—skin cancer. For numerous reasons, it is critical that you apply sunscreen before exposing your skin to the sun. If you do get diagnosed with skin cancer, there are treatment options available that have been proven to be very effective, most notably – Mohs surgery.
When the sun dries the skin out, the sebaceous glands try to compensate for the lack of moisture in the skin by ramping up sebum (oil) production. As we know, an increase in sebum production means an increased chance of pores becoming clogged when transferring the oil from the glands to the surface of the skin, and clogged pores create acne.
Sun exposure also causes hyperpigmentation (as our melanocytes rush to the surface to protect the skin) and intensifies existing acne scars and blemishes. Sunscreen (SPF 30 or more) gives your skin the protective barrier it needs to stay hydrated and shielded from harmful UVA and UVB rays.
Skincare Routine Changes for Acne Treatment
Wash your face twice a day. The goal is to keep your skin clean without overwashing it. It’s a good idea to wash your face twice a day, once in the morning and once at night, and any time after you sweat.
When we sleep, our body temperature naturally rises, which often causes us to sweat. We may also touch our faces in our sleep without realizing it. Both sweating and touching the face can increase the chances of clogged pores and breakouts. Washing your face first thing in the morning is ideal for cleansing any residual bacteria from the pores.
After exercising and at the end of the day, washing your face again will prevent bacteria from building up in the pores and irritating the hair follicles.
Although, be wary of overwashing. Washing your face too often can cause an imbalance in your skin’s pH level, increase oil production, and clog the pores. Your skin needs to maintain an ideal pH level to prevent excessive oiliness.
Use gentle ingredients in face wash. Your daily face wash should be relatively gentle. Don’t use a face wash with irritating ingredients, like alcohol. Alcohol dries out the skin, which forces the sebaceous glands to produce more sebum, leading to breakouts. Choose an alcohol-free, non-comedogenic (non-pore-clogging) face wash for daily use. If you have naturally oily skin, it may be best to try an oil-free face wash.
A gentle face cleanser with an acne-fighting, active ingredient (like salicylic acid) can help to regulate sebum production and maintain clean pores.
Topical Medications for Acne Treatment
Salicylic acid: Salicylic acid is a staple ingredient in an effective skincare routine. Salicylic acid is a BHA (beta hydroxy acid), which means it’s a chemical exfoliant that triggers the skin to shed dead skin cells and generate new skin cells.
This ingredient penetrates the surface of the skin, entering the pores and follicles to cleanse and dissolve debris and bacteria. You can use a gentle face wash, a topical medication, or a spot acne treatment with salicylic acid to keep your pores debris-free.
Retinoid: Retinoid medications use the active ingredient, retinol, to accelerate cellular turnover, which aids the skin in shedding dead skin cells and clearing the pores. Some retinoids can be purchased over-the-counter, while others are considerably potent and require a prescription to purchase.
Retinoids often come as topical creams and have proven to be highly effective for treating different types of acne, from moderate to severe cases. These medications keep the pores clean by preventing the accumulation of bacteria and dead skin cells in the hair follicles.
Benzoyl peroxide: Benzoyl peroxide is a common ingredient in a variety of acne medications, from over-the-counter gels and spot treatments to daily-use face washes. As a microbial agent, benzoyl peroxide penetrates the pores and hair follicles to kill bacteria, which dissolves the clumps of sebum, hair, and debris that create inflammatory acne.
Though benzoyl peroxide can be an effective treatment for all types of acne, it’s especially effective for treating inflammatory acne.
Therapies for Acne Treatment
For people who experience severe acne or recurring breakouts, a therapy treatment method (laser therapy, chemical peels, and microdermabrasion) may be a more effective treatment method than topical medications or lifestyle changes alone.
Laser therapy: Laser therapies are an option for people who have severe cases of acne. Therapy using intense pulsed light (IPL) with a gentle vacuum device that pulls dead skin cells out of the pores has been known to treat anti-inflammatory acne.
Photodynamic therapy is a similar treatment that uses a skin-sensitizing solution and a laser or light device to treat severe acne. Photodynamic therapy has proven effective in preventing acne for years after treatment.
Chemical peels: During a chemical peel, your dermatologist applies a potent chemical solution that causes the top layer of skin to shed. Because these top layers are where pimples and blemishes are located, shedding these surface layers of skin can effectively treat acne and reduce acne scars and associated hyperpigmentation.
Chemical peels increase the skin’s pH level, loosening the dead skin cells and shedding the skin that’s clogged with debris and excess oil.
Microdermabrasion: Similar to chemical peels, microdermabrasion treatments are performed in a dermatologist’s office to treat the outermost layers of skin.
Microdermabrasion uses tiny, high-quality crystals that physically exfoliate the skin to cleanse pores, remove dead skin cells, and promote skin rejuvenation as new skin cells are generated. These treatments are most effective for treating residual acne scars and hyperpigmentation on acne-prone skin, but can also treat the source of pimples and blemishes by gently scrubbing bacteria out of the pores.
Oral Medications for Acne Treatment
If other treatment methods, specifically lifestyle changes and skincare routine changes don’t effectively treat acne, various oral medications, including antibiotics, birth control pills, and Isotretinoin, can be prescribed to treat this condition.
Antibiotics: Antibiotics, namely tetracycline medications, are sometimes prescribed to treat acne. These antibiotics treat the source of acne by killing the bacteria that grow in the hair follicles and reducing the inflammatory effects of the underlying infection.
Antibiotics should be used for the shortest amount of time possible to prevent the bacteria from becoming resistant to the antibiotic. These oral medications are often used alongside topical medications for maximum effectiveness.
Birth control: Acne breakouts are commonly caused by hormonal fluctuations—especially in women with menstrual cycles. Hormonal birth control medication, specifically combination birth control pills, are effective for inhibiting androgen spikes in the body. (High androgen levels are associated with increased oil production and acne.)
A birth control pill that includes both estrogen and progestin may be prescribed to manage recurring acne.
Isotretinoin: Isotretinoin, otherwise known as Accutane, is a powerful acne treatment. Similar to retinol, Isotretinoin is a derivative of vitamin A. This ingredient works on a cellular level to shrink the sebaceous glands in the skin, which curbs oil production to regulate skin oiliness.
Isotretinoin inhibits bacterial growth in the hair follicles and reduces inflammation to treat moderate to severe acne conditions.
Choosing the Right Acne Treatment for You
Knowing what your skin needs can be fairly challenging. Everyone’s skin type is different, so to effectively treat your skin, you need a personalized treatment approach.
We are a leading Orlando dermatologist here to help you understand your skin! Our exceptional dermatologists will take your lifestyle, preferences, and goals into consideration to help you decide on the best treatment route for your condition.
When you visit us for your first appointment, we will assess the severity of your condition, and discuss your symptoms and treatment preferences (whether you prefer an oral medication, topical medication, or therapy treatment) to design a personalized treatment plan that meets your needs and accommodates your lifestyle.
We will discuss the side effects, pros, and cons of each treatment option and provide you with the knowledge and resources you need to make an informed decision.
Your treatment plan should be affordable for you and your family! We accept most major insurance plans and are more than happy to discuss your insurance coverage with you. (If you want to know more about your insurance coverage, please give one of our specialists a call at 407-266-3627.)
After your appointment, you can view your test results and prescriptions by logging into our convenient patient portal.