Acne


 

Acne is due to plugged pores (= comedones = blackheads) and subsequent  inflammation. The bacterium Propionibacterium acnes is also thought to make acne worse by activating white blood cells, which leads to more inflammation. Untreated acne may result in permanent scarring.

Acne cosmetica refers to acne that is caused by ingredients in cosmetics and skin care products that plug pores, also known as comedogens. Since comedogenic ingredients such as petrolatum, lanolin, and oils clog pores, they should be avoided on the face and other acne-prone areas. It is also very important to wash your face before bed to remove all makeup and sunscreen. Currently, the term ‘non-comedogenic’ is not regulated or overseen by the FDA and is defined by skin care companies.
Acne is typically seen in teenagers, but can affect people of all ages and may persist for years. There are several factors that may cause acne  including hormones, genetics, medications, and occupational exposures.
  • Endocrine abnormalities including polycystic ovarian syndrome and insulin resistance may predispose people to develop acne.
  • Certain hereditary traits may make people more likely to develop acne in association with other medical conditions.
  • Certain medications such as steroids, and lithium, among others, can make  acne worse.
  • Occupational exposures to industrial substances that clog pores such as chlorinated hydrocarbons, petroleum, and coal tar, may also cause acne.

 

ACNE SCARRING

Acne scarring induces substantial social and psychological distress among affected people. There are various types of acne scars, including ice-pick, box-car, rolling, depressed, thickened, dark, or red scars. The type of acne scarring you will develop depends on acne severity and how well you heal. Most affected people often have a combination of acne scar types. Therefore, to prevent scarring, it’s important to treat your acne sooner than later. Discuss treatment options with your dermatologist if OTC products are not able to control your acne. There are a few treatment options for acne scarring, such as laser resurfacing, local steroid injections for thick scars, and filler injections for depressed scars. If you have dark spots from acne, it’s also important to use facial sunscreen regularly to prevent the dark spots from getting darker in sunlight. Remember to pick a sunscreen that won’t clog your pores and worsen acne.

OTC PRODUCTS FOR MILD ACNE

FDA approved ingredients for OTC acne self-treatment include benzoyl peroxide (BP), salicylic acid (SA), and sulfur. While these ingredients are effective, they may cause dryness or irritant contact dermatitis if used inappropriately or combined with other products.  Skin irritation from these ingredients may be reduced by using the products less frequently, in lower concentration, or in combination with moisturizers. BP may make you more sensitive to the sun and should be used with sunscreen. BP may also bleach dyed fabrics and therefore, BP cleansers should be thoroughly washed off. These active ingredients should also be avoided during pregnancy or while breastfeeding.

While BP and SA are not recognized skin allergens, in very rare cases, they may be associated with a different, severe, potentially life-threatening, allergic reaction characterized by hives, throat tightness, swelling of the eyes, face, lips or tongue, or difficulty breathing. Based on the available information, however, the FDA is unable to determine if these severe reactions were triggered by BP, SA, the inactive ingredients, or a combination thereof. Read more>>

PRESCRIPTIONS FOR MODERATE TO SEVERE ACNE

Prescription medications such as retinoid cream or oral antibiotics may be needed for moderate to severe acne that doesn’t improve with OTC therapies discussed above. Consult with your dermatologist to determine which treatment is best for you.

 

Acne FAQs

What is acne?

Acne is an inflammatory skin condition that usually starts with plugged pores (= comedones = blackheads). The bacterium Propionibacterium acnes is also thought to make acne worse by activating white blood cells, which leads to more inflammation. Uncontrolled acne may result in permanent scarring.

What causes acne?

There are several factors that may cause acne including hormones, genetics, medications, and occupational exposures.

Endocrine abnormalities including polycystic ovarian syndrome and insulin resistance may predispose affected individuals to develop acne. Certain hereditary traits may make people more likely develop acne in association with other medical conditions. Certain medications such as steroids, and lithium, among others, can make  acne worse. Occupational acne is due to exposure to industrial substances that clog pores such as chlorinated hydrocarbons, petroleum, and coal tar.

The bacterium Propionibacterium acnes is also thought to make acne worse by activating white blood cells, which leads to more inflammation.

How can I treat my acne?

FDA approved ingredients for OTC acne treatment include benzoyl peroxide (BP), salicylic acid (SA), and sulfur. Prescription medications such as vitamin A creams or oral antibiotics may be needed for moderate to severe acne that doesn’t improve with OTC products. Consult with your dermatologist to determine which treatment is best for you.

Can acne treatment be hypoallergenic?

It is possible for acne products to be hypoallergenic, per our definition, if they have the least number of high-risk skin allergens. Most of the active ingredients used to treat acne such as benzoyl peroxide (BP), salicylic acid (SA), and vitamin A derivatives often cause dryness or irritant contact dermatitis if used inappropriately or in combination. Since irritant contact dermatitis is not an immune-mediated reaction, these ingredients are not currently considered to be sensitizing skin allergens. Skin irritation from these ingredients may actually be reduced by using the products less frequently, in lower concentration, or in combination with moisturizers. However, it’s important to realize that one or more inactive ingredients in acne products may be high-risk skin allergens.

While BP and SA are not recognized skin allergens, in very rare cases, they may be associated with a severe, potentially life-threatening, allergic reaction characterized by hives, throat tightness, swelling of the eyes, face, lips or tongue, or difficulty breathing. However, based on the information, the FDA is unable to determine if these severe reactions were triggered by these active ingredients, other inactive ingredients, or both. Read more>>