“You unfortunately cannot determine the strength of a product strictly by the percentage of its active ingredients because how well a product works depends on how well its inactive ingredients help it penetrate the skin,” explains Dr. Green. “In other words, a 2 percent benzoyl peroxide may be more effective than another brand’s 5 percent benzoyl peroxide because there are other ingredients helping out.”
The main hormonal driver of oily sebum production in the skin is dihydrotestosterone. Another androgenic hormone responsible for increased sebaceous gland activity is DHEA-S. Higher amounts of DHEA-S are secreted during adrenarche (a stage of puberty), and this leads to an increase in sebum production. In a sebum-rich skin environment, the naturally occurring and largely commensal skin bacterium P. acnes readily grows and can cause inflammation within and around the follicle due to activation of the innate immune system. P. acnes triggers skin inflammation in acne by increasing the production of several pro-inflammatory chemical signals (such as IL-1α, IL-8, TNF-α, and LTB4); IL-1α is known to be essential to comedo formation.
Some people use natural treatments like tea tree oil (works like benzoyl peroxide, but slower) or alpha hydroxy acids (remove dead skin and unclog pores) for their acne care. Not much is known about how well many of these treatments work and their long-term safety. Many natural ingredients are added to acne lotions and creams. Talk to your doctor to see if they’re right for you.
“We’ve seen it work against a wide range of organisms, including 27 of the 32 strains of acne-causing bacteria,” says Michael Murray, ND, a naturopath and coauthor of The Encyclopedia of Natural Medicine. Multiple studies, including a review of research in the International Journal of Dermatology, back the plant’s power. You can find tea tree oil in a wide variety of soaps, skin washes, and topical solutions. Look for a minimum concentration of 5 percent of the oil to test how your skin reacts. If you find it is too irritating as an all-over treatment, you can use tea tree as a simple spot treatment for more stubborn pimples.
Any acne treatment is a weeks-long experiment that you’re conducting with your skin. Acne is slow to heal, and in some cases, it can get worse before it gets better (nearly every benzoyl peroxide product we looked at emphasized the likeliness of irritating acne further, and starting off with a lighter application). April W. Armstrong, a doctor at the University of California Davis Health System, recommends waiting at least one month before you deem a product ineffective.
Dr. Turner and her staff can offer many effective acne treatments. Before recommending a treatment plan, many factors are considered, including your gender, age and the severity of your condition. For women, other considerations are whether you are pregnant, nursing or trying to become pregnant. Before starting any treatment, be sure to tell Dr. Turner if any of these apply. This information will help her to create an appropriate treatment plan.
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