Acne (part 1)

© Dr. Michael D. Jacobson, D.O. Do not reproduce this article without permission.

From the May 2018 issue of Heartfelt Magazine

Acne vulgaris is a chronic skin condition characterized by blackheads and whiteheads (comedones), as well as inflammatory lesions (pimples, pustules, nodules). Acne affects over eight in 10 American teenagers and more than half of women in their 20s, but some countries enjoy a much lower incidence rate.

Factors that may contribute to acne include numerous medications; hormonal changes (e.g. polycystic ovary syndrome [PCOS]; adrenal problems; menstrual cycles; pregnancy); picking at the skin; emotional stress; or using greasy skin products that clog pores. A few foods are suspicious (but not yet proven to cause or flare acne). These include milk (especially skim), whey protein supplements, and B vitamins. Studies have not found that sun exposure, skin hygiene or chocolate consumption (welcome news for many people) have much effect.

Acne begins when a hair follicle gland becomes blocked with skin cells. This enables a greasy substance (sebum) to accumulate in the blocked follicle, forming either an open blackhead or a closed whitehead. Inside, a particular type of bacteria that thrives in a low-oxygen environment begins to multiply. This leads to inflammation, resulting in pimples, pustules, or larger nodules or cysts.

Though the diagnosis is usually pretty easy to make, it’s sometimes prudent to consult a healthcare professional. There are other factors that can cause conditions similar to acne—and these conditions should be treated differently.

Treatment is implemented in a stepwise fashion, depending on the severity of the disease. Keep in mind that, with any of these interventions, it may take one-to-two months of trying something before the peak benefit is noticed.

  • Diet and lifestyle: Unfortunately, most studies indicate that there’s not much you can do at home to change the course of acne. However, it makes sense, given the associations noted above, that a trial period in which one avoids milk, whey protein supplements, and B vitamins might be worthwhile. In addition, there is some evidence that diets low in sugar and starch might reduce acne formation. A 2008 research paper reported on five individuals who experienced improvement of mild to moderate acne while taking a supplement that included EPA, zinc, selenium and chromium among other things (Perfect Skin, by General Health, Inc. of Toronto, Canada; this is not an endorsement).
  • Washing the skin vigorously or frequently has not proven to help either. Nevertheless, experts recommend washing affected skin twice daily with a gentle pH-balanced, non-medicated skin cleanser. Harsh facial cleansers can be counterproductive as they may disrupt healthy, protective bacteria and cause irritation and inflammation. Facial toners can be helpful, whereas some cosmetics may aggravate acne.
  • Topical medication
  1. Topical benzoyl peroxide, most strengths of which are available over the counter, is usually applied twice a day. Wash the face with a non-medicated cleanser, rinse with clean water, and apply. Benzoyl peroxide should be applied over the entire area where spots tend to develop and be left on for at least an hour before being washed off.
  2. Topical retinoids can be added to benzoyl peroxide, although these require a prescription. A similar process to the use of benzoyl peroxide, the face should be washed gently, then patted dry. A thin film of cream, gel, or lotion is applied over the affected areas—just enough to lightly cover. This is usually done at bedtime and then left on through the night. In the morning, wash it off. Since retinoids tend to dry the skin, the frequency of treatment may need to be adjusted. For example, if daily application results in extremely dry skin, back off and use it only every other day or so.
  3. Topical antibiotics are next, the most common of which is clindamycin. This can be combined in the same formulation as benzoyl peroxide (although pre-mixed combinations tend to be significantly more expensive than purchasing individual agents separately—you generally pay for convenience).
    Other options, should these fail, include switching to a different retinoid, salicylic acid applied topically, or topical dapsone, azeliac acid cream, or sodium sulfacetamide.


Read part 2 of this article.

Principal source: DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - 2017. Record No. 115279, Acne; [updated 2017 Jun 27, cited 2017 Dec 10]; [about 17 screens]. Available from http://search.ebscohost.com/login.aspx?direct=true&db=dnh&AN=115279&site=dynamed-live&scope=site. Registration and login required.

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