Acne is a frustrating condition affecting most teenagers and many adults. The most effective acne treatment will address four underlying factors to help you achieve clear skin. With the help of a board-certified dermatologist like Dr. Zena Gabriel, you will find a unique treatment plan that works for you.
Acne is a multi-factorial disorder that is hormonal, genetic, and can be environmentally induced. Typically, diet is not associated with acne. However, a high-inflammatory diet, such as diets high in sugar and animal meats, can worsen acne if you already have it.
Some patients (less than ten percent) are dairy-sensitive, and dairy can induce acne in some patients. However, it does not immediately cause it, and restricting dairy can improve some acne but not most.
There are four main reasons we get pimples.
The four pathologic features of acne must all be addressed to fully eliminate acne – and there is a specific treatment for each effect:
Clogged follicles are formed because, normally, the skin sheds about every two weeks. However, the epidermis does not shed properly sometimes, particularly at the hair follicle level, and the skin builds up on itself. This causes something known as follicular plugging or a clogged pore.
Clogged pores or follicular plugging is best treated with medication like retinols. These are known to help the shedding process of the skin. Retinols also cause increased cell turnover, so whatever debris you have in those hair follicles, retinols will clean them out. Retinols come in over-the-counter forms as well as prescription forms. Prescription retinol can be irritating to the skin but tend to be more effective overall.
The sebaceous units are attached to a hair follicle, and every hair follicle on your body has at least one sebaceous gland. The hair follicles on your face have multiple sebaceous glands attached to each follicle.
Oil stimulation occurs when endogenous hormones stimulate the oil gland epithelium to produce oil. If your hair follicles were open, the oil would travel out of the hair follicle to the surface of the skin. When a pore is clogged, oil cannot escape, so it gets trapped.
The medication most effective for oil production is isotretinoin (Accutane). Accutane is used in varying dosages and regimens and can be a safe and very effective treatment – especially for scarring nodulocystic acne. Other oral medications like spironolactone have an anti-androgen effect and these medications are also used in hormonal acne – or acne that is mainly in the jawline and worse with the menstrual cycle. Spironolactone works best for those with hormone-related acne and can only be used in women. A new option is Winlevi, a spironolactone cream. These medications all work by inhibiting oil production.
Our hair follicles contain bacteria, which are usually controlled by exposure to oxygen. Clogged follicles allow bacteria to overgrow in this enclosed environment. These bacteria contribute to the development of acne.
Medications that can be used to treat acne-causing bacteria include clindamycin, erythromycin, dapsone, and benzoyl peroxide. Most dermatologists consider benzoyl peroxide the standard of care for antibacterial acne treatment. Other antibiotics have anti-inflammatory properties that make them effective against rosacea-like acne.
Not all pimples are inflamed. Blackheads and whiteheads are clogged pores without inflammation. However, inflammation is a critical part of the acne process. Due to differences in immune systems, some people have a stronger inflammatory response to acne. Inflamed acne can cause painful cysts and acne scarring.
Sulfur-based products are a widely used option for controlling inflammation. We also use antibiotics, particularly the tetracycline family, in acne therapy. They are used in acne for their anti-inflammatory properties.
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Lorraine Grassmann
OFFICE Manager
Lorraine Grassmann
OFFICE Manager
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