Considerations: Ask your doctor before using any other products on your skin while using erythromycin, as it may be too irritating. This includes other prescriptions, over-the-counter medicines (including those listed on this site), and harsh or abrasive cleansers, perfumes, or make-up.2 People report burning as the most frequent side effect, and also peeling, dryness, itching, redness, and oiliness, among others.2
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.
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.
But Accutane has mixed reviews for a reason. It makes the skin super dry and sensitive, which means it’s important to keep moisturizers and lip balm nearby while you’re on the treatment. Oh, and don’t even think about waxing your eyebrows (just imagine your skin ripping off). There’s another downside to Accutane: It requires a lot of paperwork and office visits. Since isotretinoin can cause birth defects, you have to come into the dermatologist once a month to get a pregnancy test and take a lengthy survey with embarrassing questions about your sex life to prove that you are using sufficient birth control. These precautions are intense, but dermatologists agree that the final results for Accutane are like no other. “This is one of the few medicines that I can look [patients] in the eye and guarantee them it will work,” says Friedman.
The best acne treatment system will include a cleanser, exfoliant and a treatment product that can be used daily. The idea is to have a product that cleans and clears clogged pores, kills bacteria, exfoliates to remove dead cells and spot treats trouble spots to combat stubborn blemishes and reduces inflammation and redness. For those with oily skin, a toner may be useful. For those with black heads, deep cleansing pore strips will help. If you have dry skin, foaming face wash would be something you want to avoid. The point is, a carefully tailored system is the best approach to an effective acne treatment.
Contrary to the marketing promises of “blemish banishers” and “zit zappers,” immediate results are not the trademark of acne treatments — a frustrating truth to anyone suffering through a breakout. And while pimples are personal (your stress-induced spots will look and act differently than your best friend’s breakout), the best acne treatments will include a regimen of products to hit all of acne’s root causes. We tested 43 kits to find the most well-rounded breakout-fighting solutions on the market.
Glycolic acid is another chemical exfoliant that dissolves the structural lipids that hold dead skin cells and bind them to the surface. But aside from this, studies have also shown that glycolic acid effectively encourages and stimulates the production of collagen and elastin, restoring damaged skin faster and reducing signs of environmental damage with continuous use.
Considerations: Side effects are generally mild and short lived. Most common, in 1-5% of people are itching, burning, stinging, and tingling. Other side effects were reported in less than 1% of people. There have been a few reports from darker skinned people of lightening of the skin. Azelaic acid has not been well studied in people with dark complexions.1
Harsh soaps have ingredients that strip your skin of oil will put anyone at risk of pimples and clogged pores due to dry, tightened skin. Almost all body washes, no matter how gentle they claim to be, are designed to remove excess oils from your body quickly and easily. That includes removing dirt and oil from around tougher bodily hairs and pores. But the skin and hair on your face is nothing like the rest of your body. Facial skin is thinner than body skin, even though it has more sebaceous glands (glands that secrete sebum). This makes it more tender, more prone to acne and even more susceptible to aging. Thus, it has to be treated differently than the rest of your body.
Combination therapy—using medications of different classes together, each with a different mechanism of action—has been demonstrated to be a more efficacious approach to acne treatment than monotherapy. The use of topical benzoyl peroxide and antibiotics together has been shown to be more effective than antibiotics alone. Similarly, using a topical retinoid with an antibiotic clears acne lesions faster than the use of antibiotics alone. Frequently used combinations include the following: antibiotic and benzoyl peroxide, antibiotic and topical retinoid, or topical retinoid and benzoyl peroxide. The pairing of benzoyl peroxide with a retinoid is preferred over the combination of a topical antibiotic with a retinoid since both regimens are effective but benzoyl peroxide does not lead to antibiotic resistance.
Antibiotics for acne, both topical and oral, used to be the top prescriptions for getting clear skin, but research has revealed that they aren’t the best option for most people today due to something called antibacterial resistance. This is where bacteria mutate, become immune to certain antibiotics, then reproduce offspring that are also immune, creating entire colonies of bacteria that can’t be killed by certain antibiotics.
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.
The first thing you need to do to take care of your skin is to use sunscreen. The best acne treatment never includes sunbathing and staying out in the sun unprotected will not reduce the number of blackheads or whiteheads you have. It will, however, lead to more skin problems down the road and can cause a breakout or two right now. Wrinkles, age spots and even skin cancer are on the agenda of someone who decides they don’t need to protect their skin.
Dapsone is not a first-line topical antibiotic due to higher cost and lack of clear superiority over other antibiotics. Topical dapsone is not recommended for use with benzoyl peroxide due to yellow-orange skin discoloration with this combination. While minocycline is shown to be an effective acne treatment, it is no longer recommended as a first-line antibiotic due to a lack of evidence that it is better than other treatments, and concerns of safety compared to other tetracyclines.
The dermatologist Dr. Dennis Gross did a major study on water and its effect on skin and he found that the heavy metals in tap water can actually ruin the benefits expensive lotions and serums do for skin. Some cities (New York and L.A., for example) have worse water than others (Seattle, for example). While some dermatologists aren't buying his claims, (Patricia Wexler for one), you can fight the drying effects of water on skin by cleansing with cold cream, a practice common with European women.
“Sometimes I see people try over-the-counter products just for a couple of weeks, they get frustrated, they say it’s not working, and they discontinue them,” Arthur says. “But it really does take a while to see the effectiveness. So unless you’re having a problem with the medication, like it’s causing severe irritation or dryness, it’s recommended to give it at least 2-3 months before switching to something else.”
Genetics can also affect how your immune system works. When confronted with bacteria, your skin might erupt in painful red lumps called pustules while someone else might just get a blackhead. Or maybe your friend has sensitive skin that breaks out more often than yours does. Your family history has a lot to do with the type of skin you have and how it looks and feels.
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