Monday, December 10, 2018

Acne: Preventive Measures, Common Pitfalls, Misconceptions, and Treatment Options

By Michael Dickson, MD
Pediatric resident physician at The University of Texas at Austin Dell Medical School 
Member, Texas Medical Association 

Acne — could anything be worse? It ranges from inconvenient pimples that show up right before you leave to important social events, to a severely disfiguring and scarring condition. Either way, acne is something most of us deal with at some point, or will grapple with in the future. Acne can cause significant social anxiety and can be a real barrier to developing self-confidence.

The good news is that acne is treatable and there are things you can do to clear your skin and minimize the possibility of future breakouts. First you should understand good skin care habits, common acne myths, and various acne treatment options.

A little background is helpful. There are four main causes of acne: hormonal changes, blocked pores, inflammation, and bacteria. During puberty, hormones can cause increased oily secretions from pores. Those oily secretions can block pores leading to whiteheads and blackheads. Whiteheads can “pop” and cause inflammation. Normal bacteria present on the skin can make inflammation worse. Long-lasting inflammation can lead to scarring.

There are two simple ways to prevent acne. First, manage hormones by managing stress. Second, follow good habits to prevent clogging your pores, including keeping your hair clean and off your face, not resting your hand or phone on your face, and not wearing hats.

Even with the best prevention, breakouts can still happen. Here are five common ways you may be sabotaging your success in managing breakouts:
The four main causes of acne are hormonal changes, blocked
pores, inflammation, and bacteria. Acne is treatable. 
  1. Washing your face several times throughout the day or scrubbing your face:  Acne is not caused by dirt or poor hygiene. Rub acne treatments into the face gently.
  2. Popping your pimples: This can cause pus, bacteria, and dead skin cells to be pushed deeper into the skin, which worsens inflammation. Let the acne medication do the work — be patient.  
  3. Changing your acne treatments frequently: Many acne treatments take six to eight weeks to work and three to four months to fully clear acne. After starting treatment, acne often gets worse before it gets better. Choose a treatment and stick with it.
  4. Applying acne medication only to your blemishes: You should apply treatment to all areas that are prone to breakouts.
  5. Using a towel to rub sweat from your skin: This irritates skin and can make acne worse. Gently pat sweat from your face instead.  
Acne is frustrating enough, so here are a few things you do NOT need to worry about:
  1. Acne is NOT caused by poor diet: There is no proven link between acne and foods like pizza, chocolate, ice-cream, or potato chips.
  2. Acne is NOT contagious: Bacteria does not cause acne, but it can make it worse.
  3. Makeup does NOT cause acne: Just be sure to get makeup that won’t clog pores or is listed as non-comedogenic.
  4. Moisturizer does NOT make acne worse: Dry skin, on the other hand, does.  Moisturizers that won’t clog pores are key to managing dry skin caused by some acne treatments. 
There are many different acne treatments available — and we often combine multiple treatment types for complete acne control. Your doctor can help you learn which treatments to try, especially if you are pregnant. Here are some common over-the-counter acne treatments:

Benzoyl Peroxide (2.5 to 10%): 
  • How it works: Kills bacteria that make acne worse and prevents pores from plugging.
  • Side effects: Skin dryness, irritation, and redness. It also bleaches clothes, towels, and bedding.
  • Pro tips: Lotion-based forms have more mild side effects. Apply in the morning.
Salicylic Acid (0.5 to 5%)
  • How it works: Prevents pores from plugging.
  • Side effects: Mild stinging or irritation.
Topical Retinoids: Adapalene
  • How they work: This course of treatment prevents pores from plugging, helps normal skin turnover, and limits inflammation.
  • Side effects: Skin dryness, irritation, and redness — which typically improves after two weeks. Skin darkening; especially in individuals with darker skin. Sun sensitivity.
  • Pro tips: Apply at night and use sunscreen when outside. Use an acne-safe moisturizer to prevent side effects.
Other options are available with a prescription from your doctor, including topical and oral antibiotics, azelaic acid (a type of ointment), oral contraceptive pills, and oral Isotretinoin, a medication that targets severe acne.

With good understanding of what causes acne, proper preventative measures, strict avoidance of common pitfalls, and consistent medication therapy, acne is definitely treatable.

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