Simple tips to manage acne

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How acne forms

Acne is a common skin condition that occurs when hair follicles become clogged with oil, dead skin cells, and bacteria. It primarily affects the areas of the skin with a high density of oil glands, such as the face, chest, back, and shoulders. While many people associate acne with adolescence, it can occur at any age.

The process of acne formation typically involves four main factors:

Excess sebum production: Sebaceous glands, located beneath the skin’s surface, produce an oily substance called sebum. Sebum is necessary for maintaining healthy skin, as it helps lubricate and protect the skin. However, in individuals prone to acne, these glands may produce excessive amounts of sebum.
Hyperkeratinization: The lining of the hair follicles can undergo abnormal changes in acne-prone individuals. Skin cells that line the follicles are shed more rapidly than normal, causing them to clump together with sebum and form a plug, known as a comedo. There are two types of comedones: open comedones (blackheads) and closed comedones (whiteheads).
Bacterial colonization: The clogged hair follicles create an ideal environment for the proliferation of bacteria, primarily Propionibacterium acnes (P. acnes), which is normally present on the skin. When trapped within the follicle, P. acnes can multiply and trigger an immune response, leading to inflammation.
Inflammation: The presence of P. acnes and the subsequent immune response lead to inflammation in and around the hair follicles. Inflammation causes redness, swelling, and the formation of pimples, pustules, nodules, and cysts, depending on the severity of the acne.

What can make it worse

Several factors can contribute to the development and exacerbation of acne:

Hormonal fluctuations: During puberty, hormonal changes stimulate the sebaceous glands to produce more sebum, leading to increased acne in many adolescents. Hormonal imbalances can also occur during the menstrual cycle, pregnancy, or due to conditions like polycystic ovary syndrome (PCOS).
Genetic factors: Acne can run in families, suggesting a genetic predisposition to the condition. If your parents or siblings had acne, you may have a higher likelihood of developing it.
Diet: While the relationship between diet and acne is still being studied, certain dietary factors, such as high glycemic index foods (sugary or processed foods), dairy products, and chocolate, have been suggested as potential triggers for some individuals.
Environmental factors: Exposure to certain pollutants, humidity, and excessive sweating can contribute to the development or aggravation of acne.
Skin care and cosmetics: The use of comedogenic (pore-clogging) skin care products or heavy cosmetics can contribute to acne formation. Additionally, excessive scrubbing or aggressive skin care routines can irritate the skin and worsen acne.
Psychological factors: Stress and emotional distress do not directly cause acne, but they can exacerbate existing acne or delay its healing due to hormonal and immune system changes.

Types of acne

Generally, acne can be divided up into several main types based on severity and causes. Sometimes, treating the direct cause by itself can resolve the acne:

Comedonal Acne:

Comedones are the primary characteristic of this type of acne.
Comedones can be open (blackheads) or closed (whiteheads).
They occur when hair follicles become clogged with oil, dead skin cells, and bacteria.
Open comedones appear as black dots on the skin’s surface due to oxidation, while closed comedones are flesh-colored bumps beneath the skin.

Inflammatory Acne:

Inflammatory acne is characterized by redness, swelling, and inflammation.
It occurs when bacteria invade the blocked hair follicles, leading to an immune response and inflammation.
Depending on severity they can be divided into papules, pustules, nodules, and cysts, with cysts being the most severe form which can be filled with pus and may leave scars upon healing.

Hormonal Acne:

Hormonal fluctuations play a significant role in this type of acne.
It often occurs during puberty, menstrual cycles, pregnancy, or hormonal disorders like polycystic ovary syndrome (PCOS).
Hormonal acne typically manifests as deep, painful nodules or cysts on the lower face, jawline, and chin.

Acne Mechanica:

This type of acne results from friction, pressure, or heat on the skin.
It is commonly caused by tight clothing, helmets, straps, or constant rubbing of the skin.
Acne mechanica appears as small, localized papules or pustules in the affected areas.

Acne Cosmetica:

Acne cosmetica is caused by the use of comedogenic or pore-clogging cosmetics and skincare products.
It manifests as small, superficial pimples, usually on the face, neck, and hairline.

At home treatments

Over-the-counter creams

Topical over-the-counter treatments for acne are readily available without a prescription and can be an effective option for mild to moderate acne. Here is an outline of some common topical OTC treatments for acne and how they work:

Benzoyl Peroxide:

Mechanism of action: Kills bacteria, reduces inflammation, and unclogs pores.
How to use: Apply a thin layer to the affected areas once or twice daily. Start with a lower concentration (2.5% or 5%) and gradually increase if tolerated.
Effectiveness: Benzoyl peroxide is effective for mild to moderate acne, including whiteheads, blackheads, and inflamed pimples.

Salicylic Acid:

Mechanism of action: Unclogs pores, exfoliates the skin, and reduces inflammation.
How to use: Cleanse the affected area and apply a thin layer of salicylic acid gel or solution. Use once or twice daily as directed.
Effectiveness: Salicylic acid is effective for mild acne, particularly non-inflamed comedones (whiteheads and blackheads) and occasional inflamed pimples.

Sulfur:

Mechanism of action: Kills bacteria, unclogs pores, and reduces oil production.
How to use: Apply a thin layer of sulfur-based cream or ointment to the affected areas once or twice daily. Leave it on for the recommended time and then rinse off.
Effectiveness: Sulfur is effective for mild to moderate acne, including non-inflamed comedones and occasional inflamed pimples. It may be less effective for severe or cystic acne.

Tea Tree Oil:

Mechanism of action: Has antibacterial and anti-inflammatory properties.
How to use: Dilute tea tree oil with a carrier oil and apply it to the affected areas using a cotton swab or pad. Start with a low concentration (5% or less) and gradually increase if needed.
Effectiveness: Tea tree oil is effective for mild acne, including non-inflamed comedones and occasional inflamed pimples. It may be less effective for severe acne.

Retinoids:

Mechanism of action: Exfoliates the skin, unclogs pores, and reduces inflammation.
How to use: Apply a thin layer of the retinoid cream or gel to clean, dry skin once daily. Start with a lower concentration and gradually increase if tolerated.
Effectiveness: Retinoids are effective for mild to moderate acne, however, only prescription forms, like adapalene, are likely to be most effective.

Alpha Hydroxy Acids (AHAs):

Mechanism of action: Exfoliates the skin, removes dead skin cells, and helps unclog pores.
How to use: Apply a thin layer of AHA-based cream or gel to clean skin once daily. Start with a lower concentration and gradually increase if tolerated.
Effectiveness: AHAs, such as glycolic acid or lactic acid, are effective for mild acne, including non-inflamed comedones and occasional inflamed pimples. They can also improve the texture and tone of the skin.

Don’t overdo it

Excessive washing, harsh facial soaps, and aggressive scrubbing can irritate the skin, leading to a counterproductive response. When the skin is irritated, it produces more oil and sheds more dead skin cells, ultimately worsening acne.

To prevent this, it’s important to wash the affected area only when necessary, using a gentle cleanser. Astringents, masks, and facial peels should be avoided on a regular basis as they can further aggravate the skin.

Additionally, it is advisable to steer clear of greasy or oily products on acne-prone areas. These products can clog pores, increasing the risk of acne breakouts. Moreover, resist the urge to pick or squeeze acne blemishes. Such actions can result in scarring or infection and prolong the healing process.

In summary, practicing gentle skincare routines, avoiding harsh products, and refraining from picking or squeezing acne are crucial steps in managing and promoting the healing of acne.

Dietary therapies

Diet can affect the acne of certain people, however it’s important to note that diet alone may not completely resolve the condition. Also their effect is typically slower than that of topical therapies.

Reducing dairy intake

Reducing dairy intake as a potential approach for fighting acne has been the subject of scientific research. While the exact mechanisms are not fully understood, several hypotheses have been proposed:

Hormonal influence: Dairy products, particularly milk, contain hormones such as insulin-like growth factor 1 (IGF-1) and androgens, which may contribute to increased sebum production and acne development. This may be a bigger problem for countries that actively use growth factors to increase milk supply like the United States.
Inflammatory response: Some studies suggest that dairy consumption may trigger an inflammatory response in the body, leading to acne flare-ups.
Insulin response: Dairy products, especially those with a high glycemic index, can cause a spike in insulin levels, potentially exacerbating acne by promoting inflammation and increasing sebum production.
Milk proteins: The proteins found in milk, such as whey and casein, have been implicated in promoting the production of insulin and IGF-1, which may influence acne development.

While the research on the link between dairy intake and acne is not definitive, some studies have shown a correlation between the two. However, it’s important to note that individual responses to dietary changes can vary, and not everyone will experience improvements by reducing dairy consumption.

If you’re considering implementing a reduction in dairy intake to help fight acne, here are some steps you can take:

Assess your current dairy intake: Keep a food diary to track your dairy consumption and identify the primary sources in your diet, such as milk, cheese, yogurt, or ice cream.
Gradual reduction: Instead of eliminating dairy products abruptly, consider gradually reducing your intake over time. This approach allows your body to adjust and helps you identify any changes in your skin.
Substitute dairy with alternatives: Replace dairy products with non-dairy alternatives like almond milk, soy milk, or oat milk. There are also numerous dairy-free cheese and yogurt options available in the market.

Reduce high-glycemic foods

Research suggests a potential link between the consumption of high-glycemic index (GI) foods and acne development. High-GI foods are quickly digested and cause a rapid increase in blood sugar levels, leading to an insulin surge.

This insulin surge may trigger a cascade of hormonal changes that can increase sebum production, stimulate oil gland activity, and contribute to the development of acne. Lowering the consumption of high-GI foods may help mitigate these effects. Here’s how you can implement this approach:

Understand high-GI foods: High-GI foods are typically processed carbohydrates that quickly raise blood sugar levels. Examples include white bread, white rice, sugary snacks, and sugary beverages.
Choose low-GI alternatives: Opt for low-GI foods, which are digested more slowly, resulting in a gradual and steady increase in blood sugar levels. Examples include whole grains, fruits, vegetables, legumes, and nuts.
Emphasize complex carbohydrates: Choose whole grain options such as whole wheat bread, brown rice, quinoa, and oats, which have a lower GI compared to their refined counterparts.
Include fiber-rich foods: Fiber slows down digestion, reducing the glycemic response. Include fruits, vegetables, legumes, and whole grains in your diet to increase fiber intake.
Combine carbohydrates with protein and healthy fats: Combining carbohydrates with protein and healthy fats helps slow down the digestion and absorption of sugars, reducing the overall glycemic impact of the meal. For example, pair whole grain bread with nut butter or have a salad with added lean protein.
Avoid sugary drinks and snacks: Sugary beverages and snacks can cause rapid spikes in blood sugar levels. Opt for water, herbal tea, or unsweetened beverages, and choose healthier snack options like fresh fruit, nuts, or yogurt.

Greasy and oily foods?

The relationship between greasy or oily foods and acne development has been a topic of interest and speculation. However, the scientific evidence linking the consumption of greasy or oily foods directly to acne is limited and inconsistent. Multiple studies have not found a significant correlation between the intake of greasy foods and acne. Nevertheless, it’s worth noting that certain greasy foods, such as potato chips or fast food, often have a high glycemic index.

It’s important to understand that the potential impact of greasy foods on acne is likely indirect, primarily related to their glycemic index rather than their grease content. Therefore, it’s the high-GI nature of some greasy foods rather than the grease itself that may be a contributing factor to acne flare-ups.

Supplements

Some supplements show promise in managing acne, however individual responses may vary, and they should be used as part of a comprehensive treatment plan.

Omega-3 Fatty Acids:

Mechanism of action: Possess anti-inflammatory properties.
How they work: Omega-3 fatty acids, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA),
help reduce inflammation in the body, including inflammation associated with acne.
Evidence: Studies have shown that omega-3 supplementation can improve acne symptoms, reduce inflammatory markers, and decrease sebum production.

Zinc:

Mechanism of action: Exhibits anti-inflammatory and antimicrobial effects.
How it works: Zinc plays a role in regulating sebum production and has anti-inflammatory and antimicrobial properties, which can help reduce acne severity.
Evidence: Research suggests that zinc supplementation can reduce acne lesions and inflammation, particularly in individuals with zinc deficiency.

Probiotics:

Mechanism of action: Modulate gut microbiota and immune function.
How they work: Probiotics help restore the balance of beneficial bacteria in the gut, which can positively influence immune function and reduce systemic inflammation that may contribute to acne.
Evidence: Some studies have shown improvements in acne severity and inflammatory markers with probiotic supplementation. However, more research is needed to establish definitive recommendations.

Vitamin D:

Mechanism of action: Regulates immune function and reduces inflammation.
How it works: Vitamin D plays a role in modulating immune responses and has anti-inflammatory properties, which can help alleviate acne symptoms.
Evidence: Some studies suggest a correlation between vitamin D deficiency and acne severity. Vitamin D supplementation may improve acne symptoms, particularly in individuals with low vitamin D levels.

Niacinamide (Vitamin B3):

Mechanism of action: Modulates skin barrier function and reduces inflammation.
How it works: Topical niacinamide helps regulate sebum production, improves the skin’s protective barrier, and exhibits anti-inflammatory effects.
Evidence: Clinical studies have shown that topical niacinamide can reduce acne lesions and improve the overall appearance of the skin.

Medical treatments

Prescription medication

Your doctor or dermatologist may prescribe medication for more serious cases of acne. Sometimes prescription medications will combine the effects of multiple acne-fighting agents:

Topical Retinoids:

Mechanism of action: Exfoliate the skin, unclog pores, and reduce inflammation.
How they work: Topical retinoids, such as tretinoin or adapalene, work by normalizing the skin cell turnover, preventing the formation of comedones (clogged pores), and reducing inflammation.
Effectiveness: Topical retinoids are highly effective for mild to moderate acne, including non-inflamed comedones, inflamed pimples, and some cases of hormonal acne.

Topical Antibiotics:

Mechanism of action: Kill acne-causing bacteria and reduce inflammation.
How they work: Topical antibiotics, like clindamycin or erythromycin, inhibit the growth of bacteria on the skin and help control acne-related inflammation.
Effectiveness: Topical antibiotics are effective for mild to moderate inflammatory acne, particularly for reducing the number of inflamed papules and pustules.

Oral Antibiotics:

Mechanism of action: Kill bacteria and reduce inflammation from within.
How they work: Oral antibiotics, such as doxycycline or minocycline, target bacteria throughout the body, reducing the number of acne-causing bacteria and helping to control inflammation.
Effectiveness: Oral antibiotics are effective for moderate to severe acne, especially when there are widespread inflammatory lesions, and are often used as a short-term treatment due to concerns about antibiotic resistance.

Hormonal Treatments:

Mechanism of action: Regulate hormonal imbalances.
How they work: Hormonal treatments, such as oral contraceptives (birth control pills) or spironolactone, work by regulating hormone levels that contribute to acne, particularly hormonal acne in women.
Effectiveness: Hormonal treatments are effective for acne influenced by hormonal factors, such as hormonal breakouts, severe premenstrual acne, or acne that is resistant to other treatments.

Isotretinoin (Accutane):

Mechanism of action: Reduces sebum production and targets multiple acne causes.
How it works: Isotretinoin is a powerful oral medication that targets several acne-causing factors, including reducing sebum production, normalizing skin cell turnover, and reducing inflammation. It is reserved for severe or treatment-resistant acne.
Effectiveness: Isotretinoin is highly effective for severe acne, including cystic acne and acne that hasn’t responded to other treatments. It often provides long-term remission, but it has potential side effects and requires careful monitoring.

Medical procedures

Sometimes physical measures are taken to reduce acne. These medical procedures are typically performed by dermatologists or qualified skincare professionals:

Chemical Peels:

Mechanism of action: Exfoliate the skin, unclog pores, and reduce acne-related pigmentation.
How they work: Chemical peels involve the application of a chemical solution to the skin, which causes controlled exfoliation, removing dead skin cells, unclogging pores, and promoting cell turnover. This process helps improve acne and reduce the appearance of acne scars and hyperpigmentation.
Effectiveness: Chemical peels are effective for various types of acne, including comedonal acne, mild inflammatory acne, and acne-related pigmentation issues. Multiple treatments may be required for optimal results.

Microdermabrasion:

Mechanism of action: Exfoliate the outermost layer of the skin and unclog pores.
How it works: Microdermabrasion involves the use of a device that gently sprays fine crystals or uses a diamond-tipped wand to exfoliate the skin’s surface. This process removes dead skin cells, unclogs pores, and stimulates cell turnover, improving the appearance of acne.
Effectiveness: Microdermabrasion is effective for mild acne, including comedonal acne and mild acne scarring. It may require multiple sessions for noticeable improvement.

Laser and Light Therapies:

Mechanism of action: Target bacteria, reduce inflammation, and promote skin healing.
How they work: Laser and light therapies use specific wavelengths of light to target acne-causing bacteria, reduce inflammation, and promote healing. Different types of lasers and lights, such as blue light or pulsed dye lasers, may be utilized based on the specific goals of the treatment.
Effectiveness: Laser and light therapies can be effective for inflammatory acne, particularly for individuals who have not responded well to other treatments or who prefer non-invasive options. The number of sessions required and the effectiveness may vary depending on the individual and the severity of acne.

Acne Extraction:

Mechanism of action: Physically remove comedones (clogged pores) and superficial acne lesions.
How it works: Acne extraction is a manual procedure performed by a dermatologist or esthetician. It involves the gentle removal of comedones and superficial acne lesions using specialized tools, helping to unclog pores and alleviate acne.
Effectiveness: Acne extraction can be effective for comedonal acne, inflammatory acne, and for quick relief of isolated lesions. It should be performed by a trained professional to avoid skin damage and scarring.

Myths

Myth #1: Acne is caused by poor hygiene.
Reality: Acne is not caused by lack of cleanliness or poor hygiene. Excessive washing or scrubbing can actually irritate the skin and worsen acne. Acne is primarily influenced by factors such as hormones, genetics, and the overproduction of sebum.

Myth #2: Eating greasy or oily foods causes acne.
Reality: While some greasy or oily foods may have a high glycemic index, which can indirectly contribute to acne flare-ups, there is no direct evidence linking the consumption of greasy foods to acne development. The relationship between diet and acne is complex and varies from person to person.

Myth #3: Acne is only a teenage problem.
Reality: Acne can affect individuals of all ages, including adults. While hormonal changes during puberty often trigger acne, it can persist into adulthood or develop for the first time in adulthood due to various factors such as hormones, stress, and lifestyle choices.

Myth #4: Sun exposure helps clear up acne.
Reality: Sun exposure may initially improve the appearance of acne due to its drying and anti-inflammatory effects. However, prolonged sun exposure can lead to skin damage, inflammation, and potentially worsen acne in the long run. Additionally, some acne medications increase skin sensitivity to the sun, making protection even more crucial.

Myth #5: Popping pimples helps them heal faster.
Reality: Picking, popping, or squeezing acne blemishes can actually worsen the condition. It increases the risk of scarring, infection, and inflammation, and can delay the healing process. It’s best to allow acne to heal naturally or seek professional help for safe extraction.

Myth #6: Stress causes acne.
Reality: While stress can potentially exacerbate existing acne, it does not directly cause acne. However, stress can influence hormone levels and trigger inflammatory responses in the body, which may contribute to acne flare-ups.