Ask an Expert: How to Treat Every Type of Acne


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Achieving flawless skin can be a challenge for many, especially where acne is concerned. Acne, the most common skin condition in the world, is a disorder that causes skin to break out with pimples. It usually begins during puberty and can continue well into adulthood. Acne during puberty is often associated with oily skin, while adult acne is usually linked to drier skin. Both can take the form of a few pimples bugging the complexion to more difficult to treat breakouts that completely mar the face, back and chest.

Letting acne run its course is not always the best advice. Without proper treatment, acne can get worse or, as the acne clears, dark spots and permanent scars can appear, which all can be a blow to a person’s self-esteem. Luckily, there are many effective acne treatments available.

Causes of Acne

Genetics and hormonal shifts are the main causes of acne. While it is important to maintain clean skin, acne is not caused by dirt itself, as many think. Some people have a hereditary trait that inhibits dead skin cells from shedding normally. When these cells build up, they mix with the skin’s sebum and this mixture leads to clogged pores and breakouts. Hormonal changes also have significant effects on skin, which is why it is common for women to breakout pre- or mid-menstrual cycle.

Different Types of Acne

There are many types of acne, but most cases fit within one of the following categories:

Acne vulgaris is the most common form of acne. This type of acne is made up of whiteheads, blackheads, papules and pustules plus nodules and cysts. Blackheads and whiteheads are the least severe form of acne vulgaris. They are commonly referred to as comedones, pores that are clogged with too much oil and dead skin cells. Blackheads are comedones that are open at the surface of the skin (they appear black because the oil oxidizes with the air). When the comedones are closed, they are called whiteheads (since they are blocked from air, they’re usually clear or white). This type of acne usually responds well to over-the-counter topical products.

Papules and pustules are more moderate forms of acne vulgaris. They‘re inflamed bumps on the surface of the skin that occur when P. acnes bacteria is added into the mix of oil and dead skin cells. Pustules resemble whiteheads and are filled with white or yellow pus, surrounded by irritated, red skin. Papules, on the other hand, are small red and pink bumps that are inflamed and sometimes sensitive to the touch. Both can be treated with over-the-counter preparations, but sometimes prescription medication is needed.

Nodules and cysts are more severe forms of acne. Nodules are firm, large, inflamed bumps that develop deep within the skin and are often painful to the touch. Cysts are large, deep-rooted, painful, boil-like bumps. Treating this type of acne can be a bit more difficult. They don’t respond well to over-the-counter treatments and require medical attention.

Acne cosmetica is acne caused or worsened by cosmetics, skincare products or haircare products. The condition develops over a period of weeks and appears as small, itchy or rash-like bumps. It affects areas like the cheeks and forehead where the products are most frequently applied. This type of acne can be addressed easily by determining which products are triggering the breakouts and discontinuing use.

Acne mechanica is caused by heat, friction or pressure on skin or when skin isn’t exposed to the air. It’s common in athletes and can be caused by protective gear rubbing against skin. This type of acne usually responds well to topical products formulated for acne-prone skin. Precautionary steps like wearing absorbent material under sports equipment or cleansing after sweaty activity usually resolve the problem, though.

Plan of Action

Depending on whether you have mild, moderate or severe acne, your course of treatment will vary. Often, a dermatologist will suggest a combination of treatments depending on the severity of the acne.

Treating Mild to Moderate Acne

When treating mild cases of acne, there are many effective treatments available. According to Dr. Joshua Zeichner, director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City, blackheads and whiteheads are best treated over the counter with salicylic acid. “Salicylic acid is a beta hydroxy acid that works to dissolve the top layer of cells and also reduce sebaceous follicle blockages that lead to breakouts. It also has antimicrobial properties, which makes it very effective for caring for acne-prone and acne-erupted skin,” continues Elena Arboleda, head esthetician at Mario Badescu Skin Care in New York City. Dr. Jeannette Graf, FAAD, likes treating the comedones with a topical retinoid to prevent pore blockage.

For inflammatory bumps, like papules and pustules, Graf recommends spot treating with salicylic acid, sulfur or benzoyl peroxide to dry the pustules. “They all have excellent antibacterial coverage.” Sulfur works to dissolve the surface layer of cells and has the ability to reduce oil gland activity. Benzoyl peroxide kills acne-causing bacteria. Be sure to use the micronized version so that your skin absorbs it more efficiently. Arboleda suggests not only investing in products that contain acne-fighting ingredients like salicylic acid and sulfur, but also those that contain soothing ingredients like aloe and chamomile to calm skin. “Thyme extract is another great ingredient for acne-prone skin; like salicylic acid, it is antibacterial and naturally antiseptic,” says Arboleda.

When choosing over-the-counter formulations, it’s important to use products that will address the breakouts without being so harsh that your skin becomes unbalanced. You can tell that skin is out of whack when it is red, irritated, painful, peeling and generally uncomfortable. Heavy products formulated with rich oils should also be avoided.

“Less is more. You don’t always need a higher concentration for an effective treatment. For example, 2.5 percent benzoyl peroxide is a great place to start. It can effectively treat pimples and may be less irritating than the products that contain the higher 5 percent or 10 percent concentration,” says Zeichner.

Also, don’t use too many acne products at once. This can lead to added irritation as well as to confusion as to which product is working and which one isn’t. “Make sure to follow correct application with detailed instructions from your dermatologist,” adds Graf. And if over-the-counter treatments are not helping after two to four weeks, seek professional care. “Not getting an effective treatment early can lead to permanent scarring that can be avoided with prescription medications from your dermatologist,” says Zeichner.

Treating Severe Acne

When dealing with very severe acne, it is best to seek the care of a dermatologist. Your medical skincare provider may prescribe one or more of the following:

  • A prescription-strength retinoid. Retinoids are a form of vitamin A. They clear out the oil and debris that are clogging your pores.
  • An isotretinoin. Commonly known by its brand name Accutane, this highly effective prescribed pill treats acne by regulating cell turnover, by reducing skin inflammation and by decreasing sebum production. It should only be used after other acne treatments have been tried and failed. This drug can cause birth defects in humans; thus, women are advised not to become pregnant while taking this medication.
  • Topical or oral antibiotics. Topical antibiotics, such as clindamycin, and oral antibiotics, such as tetracycline, reduce inflammation and minimize bacterial growth.
  • Birth control pills. They help regulate hormones.
  • Spironolactone. It’s a pill that helps rid your body of unneeded water and it also works as a hormone blocker.
  • Photodynamic therapy (PDT). It uses light treatments to destroy bacteria that cause breakouts. Treatments can be performed in a doctor’s office, but there are also effective, handheld blue light therapy devices that you can use at home.

How Your Diet Relates to Acne

Your diet can affect the condition of your skin. Like with any other organ, when you drink water and eat balanced, nutritious meals that consist mainly of vitamin- and mineral-rich foods, your skin (along with the rest of you) will be healthier. “Inflammatory, acid-producing foods, including sugar, chocolate, soft drinks (particularly colas), milk and other dairy products can create an environment that aggravates acne,” warns Graf.

There may be hormones or growth factors in cow’s milk, especially skim milk, that stimulate acne. “High glycemic index foods, aka sugary or starchy foods that raise your blood sugar levels, promote inflammation that may predispose certain people to breakouts. Thus, skim milk is more problematic than whole milk because of the relatively higher concentration of sugar relative to fat,” adds Zeichner.

Additional Acne-Fighting Tips

  • Never pick or squeeze blemishes. It will lead to scarring.
  • Regulate stress.
  • Try to get back to a healthy weight if you are overweight. Obesity is associated with increased acne.
  • Rubbing ice cubes on the affected areas can sometimes bring down inflammation.
  • Don’t over-scrub or over-cleanse skin. This can cause increased irritation.
  • Use a clean washcloth every time you cleanse your face. You don’t want your skin near the bacteria trapped in a dirty towel.
  • Wipe your work phone or cell phone daily with a sterile wipe to reduce the bacteria and oil that may get transferred to your skin.
  • Avoid unconscious face touching. The bacteria and oils on your fingers can contribute to breakouts.
  • Don’t sleep with makeup on. It will clog your pores.
  • Use a face wipe to clean your face if you’re too lazy to wash it.
  • Change your pillowcase every night. Dead skin cell debris, hair and face oils and dirt can build up on the case, leading to more breakouts.
  • If using benzoyl peroxide, sleep on a white pillowcase. The medication can bleach fabric.

Remember, it will take time, discipline and patience to achieve clear skin. Everyone’s skin is different and different people respond to different products and ingredients. So, don’t lose hope — it may take a little trial and error before you find a regimen that works for you.

Presented by Vichy Laboratories