Acne

What is acne?

So what exactly causes acne? We all know not to touch our faces, leave our makeup on too long, workout and skip the face wash, etc, but what about when we do all these things and still experience those annoying blemishes?

Our skin is composed of three main layers. The epidermis is the topmost layer and contains our melanocytes (skin pigment producing cells). Next is the dermis containing hair follicles, and sebaceous (oil) and sweat glands. Finally, the hypodermis contains connective tissue and fat.

Acne occurs when hair follicles in the dermis get clogged. This can be caused by oil, dead skin cells, and bacteria (specifically, propionibacterium acnes). The areas where acne most commonly occurs, like the face, back, and chest contain the highest numbers of oil glands.

Sebum (oil) regulation is closely correlated to our hormones. Can you think of some crazy hormone times? Puberty, menstruation, and pregnancy commonly cause acne flare ups. Also, since birth control is used to regulate female hormones certain formulations can actually benefit acne.

Acne flare ups can range from mild comedones like whiteheads and blackheads to deeper, sometimes painful, cystic acne. The severity of acne is correlated to the underlying cause. Genetics, hormones, stress, environmental factors, and diet will all contribute to the formation of acne.

What are the main concerns related to acne issues?

To better understand how your acne lesions are classified let’s start breaking down the general categories of acne.

1. Non-Inflammatory Acne: Refers to mild lesions like comedones (a.k.a. whiteheads and blackheads) that are relatively superficial and do not swell.
2. Inflammatory Acne: These are the lesions that are red, swollen, and sometimes tender. Cystic acne and nodular acne fall into this category.

To continue our breakdown, let’s look at the subcategories within the inflammatory and non-inflammatory designations.

• Blackheads (a.k.a. open comedones): Non-inflammatory lesions that occur when the pore remains open despite being clogged with excess oil (sebum) and dead skin cells. This causes a dark-colored spot on the surface of the skin.
• Whiteheads (a.k.a. closed comedones): Non-inflammatory lesions that form when the pore closes on top of a buildup of sebum and dead skin cells resulting in a small bump.
• Papules: Small, tender inflammatory lesions resulting in pink or red bumps due to hair follicle wall break down.
• Pustules (a.k.a. pimples): Inflammatory lesions that form like papules, but are infected, and, therefore, filled with pus. These appear with a red base and white or yellow tip.
• Cysts: Pus-filled, inflammatory lesions growing up from deep into the skin layers causing red and white bumps to appear at the surface level.
• Nodules: A more severe cyst. These large, firm inflammatory lesions occur when clogged pores are further irritated and deepen.
• Comedones: Like whiteheads and blackheads, are relatively common and superficial. The more severe forms of acne, like papules, pustules, cysts, and nodules are correlated to increased irritation, inflammation, and possibly infection.

Types of Acne

Who may wish to seek an acne treatment?

Acne is a nuisance. While the spectrum of acne varies greatly, there are treatment options for all forms regardless of severity. Any individual frustrated by persistent and noticeable acne that is resistant to daily over the counter skin care may wish to seek professional assistance. A logical first step is to create a consistent skincare routine, trial skincare regimens, alter the diet, and identify potential triggers. If these methods fail, a trip to a professional is the next step.

What are the most effective professional acne treatments?

When it comes to acne, treatments are uniquely tailored to the individual. Acne treatments include topical antibiotics, facial peels, skincare products, and retinol creams. The treatment depends on the type of lesion. A dermatologist can diagnose acne vulgaris, and recommend an array of professional and/or home remedies to clear skin and prevent future breakouts.

• For Comedones (Blackheads and Whiteheads): Superficial lesions like comedones respond well to less invasive therapies. Facials and chemical peels exfoliate the skin clearing blockages and sebum/skin cell buildup. Topical retinoids can be used regularly at home to promote cellular turnover and clear lesions. LED Light Therapy can kill acne bacteria and also clear breakouts.
• For Cysts, Nodules, Papules, and Pustules: More severe forms of acne necessitate more involved treatments to penetrate deeper into the dermal layers. Benzoyl Peroxide is one of the most popular treatments for severe acne. This topical antiseptic is applied directly to the skin to help it exfoliate and clear pores. Isotretinoin (a.k.a. Accutane) is an oral acne medication that alters the body’s oil production. Spironolactone is a common blood pressure medication. It also has anti-androgen (sex hormone) properties, which can help women combat hormonal acne.

For a complete look at the treatment options outlined above, check out our guide to Acne Solutions.

How can you treat acne at home?

From skincare to diet and lifestyle, there is plenty you can do from the comfort of your own home to treat and prevent acne.

Over-the-Counter Skincare for Acne

Skincare products with antibacterial and anti-inflammatory ingredients can help to heal and prevent breakouts. Most of these over-the-counter skin care treatments simultaneously exfoliate and rejuvenate the skin:

• Alpha Hydroxy Acids (AHAs): These exfoliating water-soluble acids include lactic, glycolic, malic, and more, and are ideal for ridding the skin of the dead cells that cause acne.
• Retinoids: Best for treating comedonal acne (whiteheads and blackheads). The multi-purpose vitamin A derivative improves cell turnover, thereby helping to clear dead skin cells and excess oil that leads to breakouts.
• Salicylic Acid: Unlike water-soluble AHAs, this common acne treatment is an oil-soluble beta hydroxy acid that can deeply exfoliate the pores to remove dead skin cells and excess sebum.
• Sulfur: Applied topically, sulfur has antimicrobial properties that help to dry out acne lesions by absorbing excess oil from the skin. Commonly found in spot treatments and drying lotions, it is considered a more gentle solution than benzoyl peroxide and salicylic acid.
• Tea Tree Oil: Though it lacks FDA-approval for treating acne, the American Society for Microbiology found the antiseptic and anti-inflammatory extract to be an effective natural alternative for combating breakouts.

Diet and Lifestyle Modifications for Acne

While there is no specific research supporting a correlation between diet and acne, certain high-glycemic foods, such as chips and candy, can trigger excess sebum production. A healthy lifestyle limiting these foods in combination with sleep, hydration, and exercise can alleviate acne.