by Katherine Dee, MD on February 7, 2018
Why do we get acne?
Most people suffer from acne at some stage of life. Acne is driven by hormonal changes, but many factors can contribute such as manipulating the lesions, clothing, hair & skin products, air pollution, humidity, inflammatory foods, and allergies. Identifying the cause of persistent acne despite doing “everything” can be challenging. One person I know well suffered severe cystic acne for 20 years until she stumbled upon the cause – a dairy allergy – while experimenting with her diet. Despite all the best care (sticking to the Regimen below), if she consumes any cow milk or cream she will have 3-4 weeks of miserable cystic blemishes. This is made much worse if she consumes pro-inflammatory foods at the same time. And she was told by multiple doctors that diet “doesn’t matter.”
Food allergies causing acne are not very common, but it happens. Acne can also result from topicals we put on our faces. In fact, even some preparations of tretinoin (Retin-A – a great drug to treat acne) contain the comedogenic ingredient isopropyl myristate, a thickener found in tretinoin creams and many cosmeceuticals, though it has been known for years to cause pimples.
How acne forms:
Blemishes, or comedones (blackheads and whiteheads), form when a pore (hair follicle) becomes clogged and sebum (natural oils) builds up in the skin. Bacteria can grow in the clogged follicle, creating a pustule. Larger cystic acne can result when the contents of the pimple break down the wall of the follicle and spread into the adjacent skin.
Treatment of acne should:
- Promote exfoliation and keep pores unclogged: alpha- and beta-hydroxyacids
- Kill bacteria that contribute to acne: salicylic acid, benzoyl peroxide, antibiotics
- Promote cell turnover and exfoliation, decrease sebum production, change the skin’s reaction to hormones and stress: Retinols and Retin-A
3 steps to eliminating acne:
1. Daily Regimen: Each morning and each evening
- 10% Glycolic Acid cleanser (or Combined Glycolic/Salicylic Acid cleanser)
- Acne toner
- Light non-comedogenic moisturizer to ensure barrier repair
- Evenings Retinol or Retin-A (tretinoin) or Acne Triple Gel (contains tretinoin, clindamycin, benzoyl peroxide and niacinamide)
Use only products with pure ingredients and no fragrances or irritants. Stay on the Regimen! It takes a good 3 months to change your skin completely, but you should see an improvement within days to weeks.
2. Intense Pulsed Light treatments (IPL) and Glycolic/Salicylic Acid chemical peels can be a great help in getting rid of acne. A three month program combining these treatments along with steady adherence to the Regimen should eliminate acne in most people.
3. For acne that seems to resist all efforts to defeat it– consider allergies to products of foods. This can be challenging without help from a knowledgeable nutritionist or physician. If working on your own, consider dumping your old products and starting with the Daily Regimen and a strict anti-inflammatory diet. If acne improves, foods can be added back in one-by-one over time.
If you are not sure what products to use or need help, we can plan a program specifically for you. Please come in for a consultation.
The big Dont’s:
- Don’t pick! It can cause scarring and hyperpigmentation– which are much harder to treat.
- Don’t over-wash or use harsh scrubs– acne is not caused by dirt. Over-washing and harsh products break down the skin’s barrier and can cause red eroded areas that do not heal well.
- Don’t spend all day in your sweat– exercise heats the body and a warm wet environment promotes bacterial growth. After a workout is the perfect time to do the Regimen.
What about Accutane?
Accutane is a very effective drug for shrinking down the oil glands in the skin permanently, thus reducing or eliminating acne. However, Accutane is linked to a series of serious side effects, including bowel diseases like Crohn’s disease, liver damage, depression, and miscarriage and birth defects if taken during pregnancy.
In fact, women of childbearing age are required to enlist in a special pregnancy prevention program before beginning Accutane treatment. More than 7,000 lawsuits have been filed against Roche Pharmaceuticals, which stopped making Accutane in 2009, but generic versions of isotretinoin are still available. There are newer low-dose protocols now, which may reduce the toxic side effects. Therefore, low-dose accutane can be an effective treatment for severe refractory acne, but I would use it as a last resort.
If you want to come in and troubleshoot your acne, we are happy to help. Schedule a consultation here.