Comedones (blackheads and whiteheads) must be present to diagnose acne. In their absence, an appearance similar to that of acne would suggest a different skin disorder. Microcomedones (the precursor to blackheads and whiteheads) are not visible to the naked eye when inspecting the skin and can only be seen with a microscope. There are many features that may indicate a person's acne vulgaris is sensitive to hormonal influences. Historical and physical clues that may suggest hormone-sensitive acne include onset between ages 20 and 30; worsening the week before a woman's period; acne lesions predominantly over the jawline and chin; and inflammatory/nodular acne lesions.
There are two big guns used to take down acne, and they're both great at doing entirely different things. Salicylic acid is a beta hydroxy acid that comes from willow bark and works primarily as an exfoliator, breaking down fatty acids like sebum so your pores don’t clog. (Glycolic acid works similarly but is less effective.) These acids do their thing on comedones — whiteheads, blackheads, and other non-red bumps.
According to a 2016 review of research that examined how diet may impact breakouts, researchers concluded that “compelling evidence shows that high glycemic load diets may exacerbate acne.” Foods high on the glycemic index (GI) tend to be higher in refined carbs, like those found in white bread. Scientists suspect that raised insulin levels from the carbs may trigger a release of hormones that inflame follicles and increase oil production.
P. acnes also provokes skin inflammation by altering the fatty composition of oily sebum. Oxidation of the lipid squalene by P. acnes is of particular importance. Squalene oxidation activates NF-κB (a protein complex) and consequently increases IL-1α levels. Additionally, squalene oxidation leads to increased activity of the 5-lipoxygenase enzyme responsible for conversion of arachidonic acid to leukotriene B4 (LTB4). LTB4 promotes skin inflammation by acting on the peroxisome proliferator-activated receptor alpha (PPARα) protein. PPARα increases activity of activator protein 1 (AP-1) and NF-κB, thereby leading to the recruitment of inflammatory T cells. The inflammatory properties of P. acnes can be further explained by the bacterium's ability to convert sebum triglycerides to pro-inflammatory free fatty acids via secretion of the enzyme lipase. These free fatty acids spur production of cathelicidin, HBD1, and HBD2, thus leading to further inflammation.
What it is: You may have heard of tretinoin in reference to "Retin-A" wrinkle treatments. Tretinoin is retinoic acid and vitamin A acid combined, and comes in various strengths in creams, gels, and liquids for topical use on the skin. It is used to treat acne and also to treat sun damaged skin or wrinkles and is usually applied once per day.1Learn more from the U.S. National Library of Medicine.
The best acne medication differs from person to person, but because acne is caused by so many different factors, the best solution for most people is an acne treatment that includes multiple key ingredients. For the vast majority of people with acne, the best medicine for acne is a gentle, over-the-counter option that treats the causes of acne without irritation the skin. Below, we’ve included three of our favorite over-the-counter acne treatment options.
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You won't find a face wash in this list that's not universally beloved, but keep in mind that what works for one person won't work for everyone. The biggest secret to finding a great facial cleanser is choosing one that's formulated for your skin type: dry, oily, combination, sensitive or blemished. Unfortunately, few women really know their skin type.
Sudden breakouts are incredibly frustrating. And even if you eat a healthy diet, wear makeup that won't clog your pores, change your pillowcase regularly, and use acne-fighting skincare products (such as cleansers that contain ingredients like salicylic acid), you can still wake up to the unpleasant discovery that a pimple has pushed its way to the surface of your skin.
Blue light rays penetrate follicles to kill off acne-causing bacteria. For severe cases, photodynamic therapy adds a topical solution called Levulan to blue light therapy. Note that these treatments can cause temporary redness and may not be covered by insurance. Prices vary greatly depending on the location and severity of acne, but can cost at least $50 for one blue light treatment and $100 or more per photodynamic therapy session. Most patients will need multiple treatments to see effective results, but many dermatologists offer package deals.
Why is this so important? Because layers of dirt, grime, and other stuff can create a barrier between any products and the skin. Simply put, the product won’t impact the skin as it won’t be able to penetrate the overlying layer of dead skin cells, dirt, sebum and god knows what else! I love a good analogy…so imagine trying to paint a wall that’s filthy!!! Pointless.
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Dapsone is a topical gel medicine sold under the brand name Aczone for treating severe acne, and it’s perfect for people who want a low-maintenance acne treatment plan. Unlike many of the best acne medications, dapsone only needs to be applied once daily, and it is the only medications most people will need, though it’s always good to include a face wash and moisturizer in your skin care routine if possible. Dapsone can function on its own because it is both antibacterial and anti-inflammatory10, effectively taking care of two of the biggest causes of acne.
Considerations: Regardless of the type of antibiotic prescribed, only about one half of patients respond. When antibiotics do produce results, these results are moderate at best.5-8 Oral antibiotics should be used for only a short period of time, up to 6 months. However, even within this short time frame, antibiotics have been implicated in the proliferation of resistant colonies of bacteria. Some antibiotics cause increased sensitivity to sunlight. Exposure to the sun could cause a rash, itchiness, or redness, and you may be burnt more easily, so you'll want to wear protective clothing and sunscreen.2 Side effects may include upset stomach, diarrhea, nausea, headache, vomiting, dizziness, or light-headedness as your body becomes accustomed to it.2 Minocycline is less prescribed because it works no better than any other antibiotic and comes with safety concerns, including the possibility of irreversible skin pigmentation.8-11
Try not to sweat. Wash at least twice a day, sweating only increases acne. Properly use a cleanser. Wash your face with cool water and apply a little on your fingers. Gently massage the product into the skin with slight massage movements, then wash several times thoroughly. Do not use a sponge under any circumstances; this will only increase irritation. Pay attention not only to the face but to other parts of the bode that are prone to acne.
Active Ingredients Check the product label for key active ingredients like salicylic acid or benzoyl peroxide, advises dermatologist Sandy Skotnicki, MD, founder of Toronto's Bay Dermatology Centre and author of the skincare book Beyond Soap. Other ingredients to look for include oils that can help to moisturize skin — just make sure the package says non-comedogenic, which means that it won’t clog pores.
^ Jump up to: a b GBD 2015 Disease and Injury Incidence and Prevalence, Collaborators. (8 October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
Chemical peels – Professionally-administered (don’t try it at home) chemical peels involve the use of acids to remove superficial areas of the skin. The strength of chemical peels varies from treatment to treatment but work best on people with lighter skin, because the acids used in the peel may cause darkening of the skin. It’s imperative that you talk with a dermatologist before using chemical peels for acne treatment if you have darker skin. The good news, however, is that people with darker skin can use OTC products that contain the same chemicals used in chemical peels (but at a lower percentage).
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 estrogen and progestin (Ortho Tri-Cyclen, Yaz, others). You may not see the benefit of this treatment for a few months, so using other acne medications with it the first few weeks may help.
Tea Tree Oil – Another anti-bacterial ingredient that is common in over-the-counter treatments, tea tree oil combats acne-causing bacteria. While the FDA hasn’t officially approved it for acne treatment, some dermatologists say it’s almost as effective as benzoyl peroxide for clearing skin, although it doesn’t work quite as fast. It can be used for spot treatment as well.
Benzoyl peroxide is an antibacterial ingredient, and it’s very effective at killing the P. acnes bacteria that causes breakouts. But benzoyl isn’t without its downsides. The leave-on creams and cleansing treatments can dry out sensitive skin types and bleach clothing if you aren’t careful. Board-certified dermatologist Eric Meinhardt, M.D., previously told SELF that it's best to stick to formulations that have no more than 2 percent of benzoyl peroxide listed on the active ingredients chart; stronger concentrations are harder on your skin without being any tougher on bacteria.
Your pimples need TLC, too. The study on acne vulgaris found that, in an attempt to dry out acne lesions, patients often use too many products or apply excessive amounts to problem areas, resulting in further irritation and over drying of the skin. Vigorous scrubbing and using harsh exfoliants can make acne worse by rupturing whiteheads and blackheads, turning them into painful red ones. And remember: no matter how satisfying it is, picking and popping your zits will also increase inflammation and opportunity for infection.
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