SPECIAL REPORT
Acne is one of the most troublesome and common skin-care problems for people around the world—and not just during their teenage years! Many of us have gone to great lengths to banish every blemish, only to see them return in short order, and with our skin in worse condition, dotted with red marks that are slow to heal. It's enough to make any acne sufferer throw up their hands in despair! You feel like you've tried everything, but no matter what you do, acne keeps coming back.
We reveal what causes acne and tell you how you can keep it under control with products that work instead of making matters worse!
Regardless of your age, gender, skin color, or ethnicity, what causes acne is the same for everyone, and understanding what causes it will go a long way toward helping you finally have clear skin.
The most important fact about acne is that it's an inflammatory disorder. As a result, almost everything you do to make it go away must reduce or eliminate inflammation. Yet, shockingly, countless anti-acne products contain ingredients that cause further inflammation, actually making acne worse!
Keeping the inflammation factor in mind, there is a whole series of skin factors that create the perfect environment for acne. Understanding what interrupts or stops this sequence of events from taking place will allow you to create a successful anti-acne skin-care routine at any age.
Speaking of age, when it comes to acne, age doesn't matter. Regardless of how old you are, what reduces breakouts is the same, whether you're 15, 25, 35, 45, or 55!
The five major factors (and one minor one) that contribute to the formation of blemishes are:
Inside an oil gland a type of bacteria called Propionibacterium acnes (P. acnes) finds a perfect environment for growth. Dead skin cells and excess oil in the oil gland provide just the kind of conditions that P. acnes needs to thrive. As this bacteria settles in, thanks to an abundant supply of sebum (oil), it reproduces, which causes irritation and inflammation. That's why most blemishes are red and swollen, although that doesn't explain why some of the worst blemishes seem to show up just before an important event! Interestingly, research has shown that certain strains of p. acnes bacteria may help prevent acne while others cause it!
When things are going well, the sebum smoothly leaves the pore and imperceptibly melts on the skin's surface, helping to keep the skin surface moist and smooth. When things aren't going well, the pore becomes plugged with sebum, tiny hairs, and dead skin cells. When this happens, the bacteria run amok. In response, your body produces an abundance of white blood cells, which arrive at the site to fight the bacteria. Inflammation sets in as dead bacteria and dead white blood cells accumulate (resulting in pus), and a blemish seemingly pops out of nowhere. Before you learn how to treat these unwelcome intruders, let's go over a few misconceptions.
There are four major myths about skin care you must unlearn because they only increase breakouts and make your oily skin worse.
Myth #1: You can dry up blemishes. Water is the only thing you can "dry up," and a blemish has nothing to do with skin being wet. Drying up the water and other moisture-binding contents in skin hurts its ability to heal and fight inflammation, and actually encourages bacterial growth. Absorbing oil that's on the skin's surface or in the pore is radically different from "drying up" skin with harsh ingredients.
Myth #2: Blemishes are caused by dirty skin. This mistaken belief often leads to over-cleaning of the face with soaps and strong detergent cleansers. That only increases the risk of irritation and dryness, and does nothing to prevent blemishes. It's also the perfect recipe for creating skin that feels dry and tight underneath, but is oily on top.
Myth #3: You can spot-treat blemishes. Although you can reduce the redness and swelling of a blemish with a salicylic acid (BHA)–based product or with a benzoyl peroxide–based product (both explained below), that doesn't treat the cause of the acne. Dealing with only the blemishes you see means you are ignoring the blemishes that are in the process of forming. As you may have guessed, this leads to a never-ending cycle of chasing blemishes around your face. Spot-treating tends to work best for those whose breakouts are infrequent and localized rather than ongoing and all over the face.
Myth #4: If it tingles it must be working. Ingredients that make your skin tingle, like alcohol, menthol, peppermint, eucalyptus, and lemon, show up in countless acne products, yet there is no research showing they have any benefit for acne or oily skin. These ingredients are irritating to skin, and only make matters worse! Irritating the skin triggers stress-sensing nerve endings at the base of the pore, which in turn stimulate oil production.
There are basics for fighting breakouts that are essential if you are going to have any chance of getting clear skin, but there also are things that anyone struggling with acne should avoid. For example, don't do any of the following:
Following are the basics for treating breakout-prone skin so you can get your acne under control.
Gentle cleansing is a vital first step. A mild, water-soluble cleanser helps reduce oily skin and acne without making your skin feel dry and tight. Read More
Bar soaps and bar cleansers, on the other hand, can make matters worse because they leave a film or residue on the skin that can clog pores and block the anti-acne active ingredients you apply afterwards. Bar cleansers and soaps also can be drying and they tend to be alkaline, which makes the environment more favorable for bacteria, leading to an increase in the bacterial content of skin.
Salicylic acid, also known as beta hydroxy acid (BHA), is an amazing multifunctional ingredient that treats acne in several ways. It not only has potent anti-inflammatory properties, but also exfoliates to remove built-up dead skin cells on the surface of the skin as well as inside the pore. Salicylic acid also has antibacterial properties. Read More
Because salicylic acid is a derivative of aspirin (both are salicylates; aspirin's technical name is acetyl salicylic acid), it has some of aspirin's anti-inflammatory properties. That means it reduces inflammation, redness, and swelling, thus significantly helping the skin heal. This in turn helps prevent scarring, while also decreasing the chance of further breakouts.
Salicylic acid's antimicrobial properties help kill the bacteria that cause acne. Together, all of these properties make salicylic acid the MVP in the game of you versus your acne.
For salicylic acid formulas to be effective, the concentration must be at least 0.5%, although 1% to 2% is far more effective; plus, the formula's pH is a critical factor, with a pH of 3 to 4 being optimal. In addition, the product must not contain any irritating ingredients, because such ingredients cause inflammation, which you must avoid as much as possible. Fortunately, well-formulated salicylic acid products do exist, and you'll find them from Paula's Choice and from other brands reviewed on Beautypedia.
Benzoyl peroxide is considered the most effective over-the-counter choice for a topical antibacterial agent in the treatment of blemishes. It penetrates into the pore and kills acne-causing bacteria, preventing inflammation. Benzoyl peroxide has a low risk of irritation and it does not have the potential to create bacterial resistance, which is characteristic of some prescription topical antibiotics and some antibacterial agents. Read More
The concentration of benzoyl peroxide in products ranges from 2.5% to 10%. A 2.5% benzoyl peroxide concentration is far less irritating than a 5% or 10% concentration (not irritating the skin is always the goal), and it can be just as effective. If your skin doesn't respond to the 2.5% concentration, then you should try a 5% concentration. Generally speaking, if your acne doesn't respond to a 5% concentration of benzoyl peroxide, it may be best to consider topical prescription options (such as a topical antibiotic mixed with benzoyl peroxide) before using a product with 10% benzoyl peroxide. Higher amounts of benzoyl peroxide can cause needless irritation, resulting in dry, flaky skin.
Experimenting with what works is an important way to create an anti-acne routine that works for you. A gentle, non-irritating skin-care routine is vital, but not everyone can tolerate or find success using the gold standards of benzoyl peroxide and salicylic acid. There are other options worth investigating, so let's go over these alternatives.
Tea Tree Oil has some interesting research demonstrating it to be an effective antimicrobial agent, although it's not without its drawbacks. Read More
When tea tree oil was compared with benzoyl peroxide, it was found that a 5% concentration was necessary to have an efficacy similar to that of 5% benzoyl peroxide. That sounds like they're equal, but there are no skin-care products being sold that contain an effective amount of tea tree oil. The highest concentration of tea tree oil we've ever seen in a cosmetic product is less than 0.5%, which makes it ineffective for treating acne. Pure tea tree oil is typically a 3% concentration diluted in a carrier oil, so even that isn't strong enough, despite the "100% tea tree oil" statement on the label.
Niacinamide and nicotinic acid are derivatives of vitamin B3. There are a handful of studies showing they can be helpful for improving the appearance of acne, which most likely is the result of their anti-inflammatory properties. Read More
When included as part of a great anti-acne skin-care routine, these B-vitamin ingredients contribute to a powerful combination of products to combat the events taking place in skin that lead to acne. Niacinamide has anti-aging benefits as well, so it's brilliant for those struggling with wrinkles and acne. Try Paula's Choice RESIST Anti-Aging Clear Skin Hydrator for niacinamide and other benefits.
Prebiotics and Probiotics. In vitro research has shown that prebiotics and probiotics have some activity against the bacteria that lead to inflammatory conditions such as acne. Read More
Prebiotics and probiotics are microorganisms that occur naturally in the body and are present in many of the foods we eat, such as yogurt. Although they can be helpful when consumed, the research on prebiotics and probiotics related to topical application and their effect on acne is non-existent, so their benefit remains theoretical. Still, there's no harm in trying this option, either via foods or supplements.
Fatty Acids are an interesting group of ingredients that can have an effect on breakouts, but exactly what that effect is, either positive or negative, is not clear. Read More
For example, while it is thought that some omega-3 fatty acids such as linoleic acid may have anti-inflammatory properties that help reduce acne and its redness, other research shows it can increase oil production.
Other fatty acids, such as lauric, oleic, and palmitic acids, can have an antibacterial effect on P. acnes. However, stability is an issue: The fatty acid must be carefully formulated to ensure it can exert an antibacterial action before breaking down. If these fatty acids in skin-care products are packaged in a jar, chances are good they'll break down before they can really help your skin.
Sulfur can have some benefit as a disinfectant for breakouts. However, compared with other options, it is an overly strong ingredient for use on the skin, causing more irritation than needed to fight acne-causing bacteria. For this reason, using sulfur to manage acne has largely fallen out of favor.
Diet can have both a positive and negative effect on acne. Certain reactions to food can cause blemishes, while others may help reduce their occurrence. Read More
Reactions to foods such as dairy products, gluten, shellfish, peanuts, or too much sugar (glycemic load index), or other food allergies also can set off an acne breakout. Identifying which, if any of these, are true for you can make a significant and relatively immediate improvement in your skin. It takes experimentation to see what is true for you.
On the other hand, theoretically, a diet high in foods known to have anti-inflammatory properties, such as antioxidants and beneficial fatty acids, potentially can fight acne from the inside out. Whole grains, fresh fruits and vegetables, and other healthy foods just might help your acne, too!
Makeup can be a causative factor for acne. This mostly has to do with not removing your makeup thoroughly each night or using thick, occlusive makeup to cover up acne. Read More
Breaking out may result from using a product whose texture is too thick or greasy for your skin, and some people's skin may even react to specific coloring agents in cosmetics, although that is less common. If a specific makeup product tends to worsen your breakouts, the best solution is to stop using it and try some alternatives.
Despite some really great over-the-counter options, sometimes acne just won't give up easily. In those situations, you don't need to keep spending money on product after product—you need to see a dermatologist! There are numerous prescription options from dermatologists, but the rule of not irritating your skin should remain at the top of your list!
Prescription topical antibiotics. There are several topical antibiotics to consider; the main ones to discuss with your dermatologist are erythromycin, clindamycin, minocycline, and tetracycline. Read More
These can be used alone, but a good deal of research indicates that you can derive greater benefit by combining one of these antibiotics with benzoyl peroxide to create a far more potent, effective treatment. When combined with benzoyl peroxide, the antibiotics act more quickly, they are significantly more effective against inflamed and total lesions, and they are better tolerated, which should improve usage. These products typically are applied after cleansing and exfoliating skin.
Oral antibiotics can be extremely effective in controlling acne, but as effective as they are, they also pose serious risks that you must consider. Read More
Because oral antibiotics kill the good bacteria in the body along with the bad bacteria, ongoing use can result in chronic vaginal yeast infections as well as stomach problems.
In addition, the acne-causing bacteria can become immune or resistant to the oral antibiotic. That means that if you have been taking an oral antibiotic to treat your acne for longer than six months, it can, and almost always does, stop being effective (but the negative side effects will continue).
New research about taking low doses of oral antibiotics to fight acne is changing the concern about bacterial resistance and adaptation. "Sub-antimicrobial" doses of oral antibiotics taken long term can improve acne, while minimizing, if not completely eliminating, the problem of the bacteria becoming resistant. It seems that lower doses of oral antibiotics have anti-inflammatory benefits instead of antibacterial benefits, but they still kill P. acnes. However, that doesn't mean you won't still suffer possible systemic effects; so, regardless of whether you opt for regular or low-dose oral antibiotics, be sure to discuss the pros and cons with your dermatologist.
Dapsone is a topical disinfectant gel available by prescription in 5% strength. The brand name for this anti-acne drug is Aczone, and it is made by Allergan (of Botox fame). Read More
Dapsone is a drug of the sulfone family of pharmaceuticals, and its relation to sulfur explains its antibacterial activity.
Double-blind, large-scale studies examining dapsone's effectiveness on adolescent acne (paid for by Allergan) have shown that it is well-tolerated and that it brought about "clinically meaningful" improvements in acne lesion count after 12 weeks, with improvements continuing with ongoing usage. Its side effects were similar to those of the "vehicle gel," which Allergan did not identify in the studies.
Although Aczone is an option for inflammatory acne and research on its efficacy is positive, what's lacking are critical comparative studies with other known, established anti-acne drugs (both prescription and over-the-counter). Unless benzoyl peroxide, retinoids, and salicylic acid have failed you, Aczone is not the first line of defense to consider.
Azelaic acid is believed to work against acne-causing bacteria in concentrations of 15%–20%, and it may also pack an anti-inflammatory punch. Read More
Azelaic acid was approved for the treatment of acne in the United States in 2002, and also is prescribed to manage the symptoms of rosacea (some of which are similar to those of acne). It is definitely on the A-list of options for treating acne and tends to cause less irritation than prescription retinoids such as Retin-A or tazarotene.
Retinoids such as prescription tretinoin (Retin-A, Avita, Atralin, and generics) and other vitamin A derivatives such as tazarotene (Tazorac, Avage) and adapalene (Differin) can play a significant role in an acne treatment routine. Read More
Retinoid is the name of the general category for any and all forms of vitamin A. Prescription retinoid options are viable treatments for blemishes because they change the way skin cells are formed in the layers of skin as well as in the pore, improving how skin cells shed while unclogging pores, thereby significantly reducing inflammatory lesions.
Topical tretinoin and many antibacterial agents have complementary actions, and they work well together, but if your antibacterial agent is benzoyl peroxide, then you must apply them separately and at different times because the benzoyl peroxide will render the tretinoin ineffective if applied at the same time. The solution is to apply benzoyl peroxide in the morning and your tretinoin product at night.
Alternatively, you could use Differin, which is not negatively affected by combined, concurrent use with benzoyl peroxide.
Oral supplements, including various vitamins, herbs, or minerals of any kind or in any combination have little research proving they help reduce breakouts. Read More
A handful of studies have compared oral antibiotics to zinc, with zinc showing some benefit, but there are far more negatives than positives. Zinc is not a benign supplement; high doses can be toxic. Plus, an increased level of zinc means the body requires more copper and manganese. There is a very fine line between safe and unsafe amounts of oral supplementation of zinc.
Pantothenic acid (vitamin B5) is touted as being effective for acne. However, there is only one study supporting this notion and it dates from the early 1980s. There is no current research showing this to be an effective treatment.
Vitamin A is another oral supplement thought to be helpful for acne. In one study, which showed it to have a positive impact, participants were given 300,000 IU per day. Considering that the recommended daily allowance for adults is 2,700–3,000 IU, the dose of 300,000 IU is large enough to be possibly toxic, and is not recommended. Vitamin A is a fat-soluble vitamin, so the body stores what it doesn't use, which is what causes problems when excess amounts are consumed.
There are a couple of studies pertaining to the use of standardized ayurvedic herbs for managing acne, but "standardized herb" is not defined, so myriad concoctions abound—and that means you don't know what you're really getting.
Birth control pills (some types) have been shown to reduce acne lesions and oil production, in part by decreasing androgens (male hormones), which are largely responsible for causing blemishes. Read More
Birth control pills are a combination of different synthetic estrogens and progestins (female hormones). Some progestins can increase the amount of androgens in the body, while others block the production of androgens. Because androgens stimulate oil production, blocking androgens for those prone to breakouts and oily skin is a good thing.
As a result, some of the birth control pills that block androgens have been approved by the FDA and other regulatory organizations for the treatment of acne, including Ortho Tri-Cyclen (active ingredient norgestimate/ethinyl estradiol), YAZ (active ingredient drospirenone/ethinyl Estradioland), and Estrostep (active ingredient norethindrone/ethinyl estradiol). Diane 35 (chemical name ethinylestradiol cyproterone acetate) has been approved in Canada.
Keep in mind that there are risks associated with taking any type of birth control pill (especially if you smoke), and you should discuss these with your doctor. Birth control pills also should not be the sole therapy for acne; rather, they can serve as a good adjunct for those with mild to moderate acne who are following a skin-care routine designed to reduce acne.
Acne and oily skin almost always go hand-in-hand, but controlling oil production is difficult. Topically, there is very little you can do to change how your body produces oil. Oral birth control pills can be helpful in this regard, but they don't work for everyone and, of course, aren't advised for men struggling with oily skin. However, because oil production also can be stimulated by irritation on the surface of the skin, eliminating anything that irritates the surface of your skin without imparting a benefit is critical.
From a skin-care point of view, absorbing oil with clay masks works well as a temporary fix, as long as the mask doesn't contain irritating ingredients. Turning to makeup, powders, mattifying foundations, and oil-absorbing primers are all options worth test driving to see how they work for you. For more information on how to deal with oily skin, click here.
As you've seen, there are numerous options available to manage, and in some cases eliminate, acne. Gentle, effective skin-care products with proven anti-acne ingredients are the best place to start, followed by avoiding any source of needless irritation. From there, you can consider various prescription options and alternative therapies in conjunction with a skin-care routine you follow consistently. With patience and perseverance, you can gain control of your acne and have the clear, blemish-free skin you want!
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Paula Begoun is the best-selling author of 20 books on skin care and makeup. She is known worldwide as the Cosmetics Cop and creator of Paula's Choice. Paula's expertise has led to hundreds of appearances on national and international TV including:
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