The best acne treatment will also include gentle cleanser. Regular bars of soap have harsher cleansers in them that can create problems of their own and encourage bacteria to spread. It is also a good idea to use makeup wipes to clean off any makeup (if you wear it) before you wash your face. Only washing your face without the wipe or wiping your face without the wash is not a good combination. You will either end up missing some of the makeup or you will end up leaving preservatives and other residues on your face.
Corticosteroid injections may be used to treat large, painful lesions. These injections can ease the pain and help clear a large lesion more quickly. A systemic acne treatment that you may have heard about is isotretinoin (aka Accutane). This is the only medication approved by the U.S. Food and Drug Administration (FDA) to treat severe resistant nodular cystic acne, the most severe form. Dr. Turner does use Accutane in appropriate patients, however it is typically a five- to six-month course of therapy, which requires monthly office visits.
The predisposition to acne for specific individuals is likely explained by a genetic component, a theory which is supported by studies examining the rates of acne among twins and first-degree relatives. Severe acne may be associated with XYY syndrome. Acne susceptibility is likely due to the influence of multiple genes, as the disease does not follow a classic (Mendelian) inheritance pattern. Multiple gene candidates have been proposed including certain variations in tumor necrosis factor-alpha (TNF-alpha), IL-1 alpha, and CYP1A1 genes, among others. Increased risk is associated with the 308 G/A single nucleotide polymorphism variation in the gene for TNF.
Acne usually improves around the age of 20, but may persist into adulthood. Permanent physical scarring may occur. There is good evidence to support the idea that acne and associated scarring negatively affect a person's psychological state, worsen mood, lower self-esteem, and are associated with a higher risk of anxiety disorders, depression, and suicidal thoughts. Another psychological complication of acne vulgaris is acne excoriée, which occurs when a person persistently picks and scratches pimples, irrespective of the severity of their acne. This can lead to significant scarring, changes in the affected person's skin pigmentation, and a cyclic worsening of the affected person's anxiety about their appearance. Rare complications from acne or its treatment include the formation of pyogenic granulomas, osteoma cutis, and solid facial edema. Early and aggressive treatment of acne is advocated by some in the medical community to reduce the chances of these poor outcomes.
For some, the right dosage can be found over-the-counter in concentrations as low as 2.5 percent or up to 10 percent, but for others, a prescription dosage is needed to see the best results. Prescription doses rarely go over 10 percent, as benzoyl peroxide is known to cause stinging, burning, itching, flaking, peeling, and redness2 when used in concentrations over 5 percent, but they may combine the benzoyl peroxide with other acne medications.
Although home remedies are generally convenient and popular, some have significant counterproductive effects on the skin. The famous Procter & Gamble product Ivory Soap is probably the world’s most frequently used acne face wash ingredient. It is also probably the world’s worst acne face wash ingredient. Often advertised as “so pure that it floats,” Ivory Soap is depicted with pictures of babies and fair-skinned blondes to imply that it is a good and inexpensive face wash for acne-affected skin. Nothing could be farther from the truth.
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.
How to Handle It: Speaking of touching, don't! Picking it, squeezing it, or poking at it will only worsen the situation. These may disappear on their own after a few days. Otherwise, Zeichner suggests visiting your dermatologist for a shot of cortisone, which will reduce inflammation and shrink it in just 24 to 48 hours. But if a last-minute appointment isn't in the cards, play mad scientist. First, ice the area, and then apply salicylic acid gel, benzoyl peroxide gel, and 1 percent hydrocortisone cream. The combo will calm skin, kill bacteria, and draw out excess oil from the pimple — all things necessary to take this down, says Zeichner.
Every expert we spoke with said the most critical part of combating acne is combating it every day. “The only way to make any medication work is to use it on a daily basis,” says Dr. Green. Fitz Patrick emphasizes that it really comes down to what you can maintain for the long term: “Kits are great because they take out all the guesswork -- you just follow the instructions. But if four steps is going to be too many for you to keep up week after week, you’ll be better off finding one that has fewer treatments.”
Antibiotics. These work by killing excess skin bacteria and reducing redness. For the first few months of treatment, you may use both a retinoid and an antibiotic, with the antibiotic applied in the morning and the retinoid in the evening. The antibiotics are often combined with benzoyl peroxide to reduce the likelihood of developing antibiotic resistance. Examples include clindamycin with benzoyl peroxide (Benzaclin, Duac, Acanya) and erythromycin with benzoyl peroxide (Benzamycin). Topical antibiotics alone aren't recommended.
Hydroquinone lightens the skin when applied topically by inhibiting tyrosinase, the enzyme responsible for converting the amino acid tyrosine to the skin pigment melanin, and is used to treat acne-associated postinflammatory hyperpigmentation. By interfering with new production of melanin in the epidermis, hydroquinone leads to less hyperpigmentation as darkened skin cells are naturally shed over time. Improvement in skin hyperpigmentation is typically seen within six months when used twice daily. Hydroquinone is ineffective for hyperpigmentation affecting deeper layers of skin such as the dermis. The use of a sunscreen with SPF 15 or higher in the morning with reapplication every two hours is recommended when using hydroquinone. Its application only to affected areas lowers the risk of lightening the color of normal skin but can lead to a temporary ring of lightened skin around the hyperpigmented area. Hydroquinone is generally well-tolerated; side effects are typically mild (e.g., skin irritation) and occur with use of a higher than the recommended 4% concentration. Most preparations contain the preservative sodium metabisulfite, which has been linked to rare cases of allergic reactions including anaphylaxis and severe asthma exacerbations in susceptible people. In extremely rare cases, repeated improper topical application of high-dose hydroquinone has been associated with an accumulation of homogentisic acid in connective tissues, a condition known as exogenous ochronosis.
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