Acne 101
One of the most frequently treated skin concerns in Dermatology is acne vulgaris, the type of acne which typically causes inflammation in your face and upper back.
As a common skin condition, acne affects people of all ethnic backgrounds, gender and ages beyond puberty. Acne can also cause post-inflammatory hyperpigmentation (PIH) and severe scarring, especially in skin of color.
– Interestingly, many patients come to see their doctor because they want to get rid of their PIH when they should be treated for the primary cause: their acne –
A good acne treatment doesn’t only consist of the proper agents. Having a good doctor-patient relationship is important as well because patient compliance and trust is of utmost importance when dealing with a visible skin condition. Acne can involve long treatment periods and even lead to body dysmorphia . Additionally, acne usually begins in teenage years when most of us aren’t too confident anyways.
To understand the treatment, let’s take a closer look at the central causes for acne:
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Causes of Acne Vulgaris
These are the main causes of the development of acne vulgaris simplified:
Excessive Sebum
oil produced in the glands of our skin
Follicular Hyperproliferation (German: Verhornungsstörung)
excessive build up of the uppermost layer of skin
Inflammation
in short: a process of the immune system to protect your body from potential harm
Cutibacterium Acnes
a bacteria found on everyone’s skin, yet it is overproduced in acne prone skin (former name: propionibacterium acnes)
Other Factors that may cause Acne with particular focus on skin of color:
Skin Bleaching Cream that contain Corticosteroids
dermatologists refer to this as steroid acne and it can severely worsen hyperpigmentation and also causes more discoloration
Comedogenic Skin Products
like cocoa butter, coconut oil etc.
Also, beware of hair products!
Things like pomade (hair gel, olive oil, beeswax, mineral oil, petroleum jelly) can easily cause acne. Pomade acne causes small papules along the hairline and sideburns.
Treatment approaches
Keeping these causes in mind, we can discuss ways to treat and prevent acne vulgaris: Your treatment regime should target the following:
reduce sebum production
reduce inflammation
reduce amount of cutibacterium acnes
exfoliate the upper layer of the epidermis
—When treating skin of color, it is important to always keep in mind that harsh treatment agents or irritants can cause PIH —
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To reduce inflammation and bacteria, there are topical and systemic antibiotics as well as a topical antimicrobial agent called BPO (benzoyl peroxide). Certain popular combinations are BPO + Retinol (like Adapalene). This combination is what we call an all-rounder, targeting follicular hyperproliferation, hyperpigmentation and oil production. However, irritation and dryness are common and even are expected side effects of retinol. To make this more tolerable we advise to start by using topicals which contain retinol every other night and in low concentration.
Remember, when using Vitamin A derivatives like retinol, UV Protection is highly recommended.
Any acne treatment, whether topical or systemic, should include gentle cleansers and hydrating moisturizers in order to reduce additional irritation of the skin. The formulation plays a big role — cream is preferred over gels as gels have higher water content and can cause more dryness. Don’t be misguided: Acne skin is sensitive to irritants, so physical exfoliators should not be used.
What is the deal with adult acne and why do I still break out in my 30s ?
Adult acne basically has the same causes as “teen acne”. Also, any changes in hormones (like menstruation or pregnancy) can trigger oil production. Many will notice a flare up just before their menstruation for example.
Other causes like stress, lack of sleep, lifestyle or diet play a role too… so get them in check.
We also take into account that an oilier skin type and a family history of acne will lead to more acne prone skin.
