Decoding Acne

Is acne caused by dirt? Will chocolate or soda make it worse? Are teenagers the only ones who experience acne? What about stress and anxiety? Does sunscreen cause acne? Should we wash our face frequently to prevent acne?  What about makeup?

Contrary to the myth that only teenagers experience acne, studies show that significant numbers of adults still get acne well into their 30s, 40s, and even 50s. Approximately 85% of people between the ages of 12 and 24 experience acne and 20% of adults also have acne problems.  Studies further show an increase in the number of younger children getting acne as well.

Hormonal Acne

Hormonal changes that increase the amount of oil your skin produces can clog pores and lead to acne. This oil, called sebum, interacts with bacteria and dead skin cells in hair follicles, triggering an immune response that causes inflammation and red spots. Hormonal acne can appear as blackheads, whiteheads, cysts, nodules, pustules, and papules and is common in women after puberty, especially during pregnancy, menopause, and around menstrual periods.

Other factors that can worsen acne include:

• Stress: Circulating androgens can stimulate oil glands in hair follicles
• Diet: Eating a lot of carbohydrates or dairy can make skin problems worse
• Medications: Some medications like corticosteroids, testosterone, or lithium, can cause acne

Myths & Facts

Chocolate and soda do not directly cause acne. The diet-acne connection isn’t well-established. However, some studies suggest that milk products might influence acne due to hormones and bacteria in the milk.

While stress may play a role, it’s hard to quantify. Not everyone with acne experiences increased breakouts during stressful times, so stress hormones may not significantly worsen acne. 

Sun exposure does not cure acne; it can actually worsen it by causing skin damage.  It is important to wear sunscreen. Sunscreen with zinc oxide is recommended if you are prone to acne.

Washing your face twice a day is effective, but more than that isn’t necessary and can dry out your skin.  Leave-on products like retinoid creams are more effective.

Yes, makeup can cause acne, also known as acne cosmetics, which can appear as whiteheads, blackheads, or tiny bumps on the face. Some makeup ingredients, like oils, fragrances, dyes, acrylics, parabens, and silicones, can clog pores and trigger breakouts. Other factors that can contribute to acne include:

• Sharing makeup: Bacteria, dead skin cells, and oil from other people's skin can spread to your skin through shared makeup brushes and applicators.
• Sleeping with makeup on: This can lead to clogged pores and bacterial growth.
• Using expired products: These can also introduce bacteria to your skin.
• Using heavy or oily products: Thick foundations, concealers, and primers can clog pores.
• Using products that aren't compatible with your skin type: Not all products are suitable for every skin type. 

Tips to Prevent Acne

To help prevent acne, you can try these tips:

• Use makeup, sunscreen, skin, and hair care products that are labeled "non-comedogenic" or "won't clog pores".
• Avoid heavy, greasy products that contain ingredients like cocoa butter, mineral oil, or cold cream.
• Look for ingredients like glycerin and hyaluronic acid, which help retain moisture in the skin.

Treatment Options: Topical Medications

Acne medications work by reducing oil production and swelling or by treating bacterial infections. With most prescription acne drugs, you may not see results for four to eight weeks. It can take many months or years for your acne to clear up completely.

The most common topical prescription medications for acne are:

• Retinoids and retinoid-like drugs contain retinoic acids or tretinoin are often useful for moderate acne. These come as creams, gels, and lotions.
• Antibiotics work by killing excess skin bacteria and reducing redness and inflammation.
• Azelaic acid is a naturally occurring acid produced by yeast. It has antibacterial properties. A 20% azelaic acid cream or gel seems to be as effective as many conventional acne treatments when used twice a day.
• Salicylic acid may help prevent plugged hair follicles and is available as both wash-off and leave-on products. Studies showing its effectiveness are limited. The side effects include skin discoloration and minor skin irritation.
• Dapsone (Aczone) 5% gel is recommended for inflammatory acne, especially in women with acne.

The American Academy of Dermatology indicates that topical ointments approved by the FDA, such as benzoyl peroxide, adapalene and tretinoin are effective for pre-adolescent children and don't cause increased risk of side effects. If your child has acne, consider consulting a dermatologist. Ask about drugs to avoid in children, appropriate doses, drug interactions, side effects, and how treatment may affect a child's growth and development.

Treatment Options: Oral Medications

• Antibiotics. For moderate to severe acne, you may need oral antibiotics to reduce bacteria. Usually, the first choice for treating acne is a tetracycline (minocycline, doxycycline) or a macrolide (erythromycin, azithromycin). A macrolide might be an option for people who can't take tetracyclines, including pregnant women and children under 8 years old.
  
  Oral antibiotics should be used for the shortest time possible to prevent antibiotic resistance. And they should be combined with other drugs, such as benzoyl peroxide, to reduce the risk of developing antibiotic resistance.
  
  Severe side effects from the use of antibiotics to treat acne are uncommon. These drugs do increase your skin's sun sensitivity.
  
  
• Combined oral contraceptives. Four combined oral contraceptives are approved by the FDA for acne therapy in women who also wish to use them for contraception. They are products that combine progestin and estrogen (Ortho Tri-Cyclen 21, Yaz, others). You may not see the benefit of this treatment for a few months, so using other acne medications with it for the first few weeks may help.

What to do if over-the-counter remedies are not working?

If you've tried over-the-counter (non-prescription) acne products for several weeks and they haven't helped, ask your doctor about prescription-strength medications. A dermatologist can help you:

• Control your acne
• Avoid scarring or other damage to your skin
• Make scars less noticeable

The treatment regimen your doctor recommends depends on your age, the type and severity of your acne, and what you are willing to commit to. For example, you may need to wash and apply medications to the affected skin twice a day for several weeks. Topical medications and drugs you take by mouth (oral medication) are often used in combination. Treatment options for pregnant women are limited due to the risk of side effects.

Talk with your doctor about the risks and benefits of medications and other treatments you are considering. Make follow-up appointments with your doctor every three to six months until your skin improves.