Acne, The Lowdown

Acne is a common skin condition that has plagued many of us at some point in our lives. To treat acne properly, we first must understand what happens to the skin at the cellular level when it's affected by acne. Therapies are targeted towards the underlying mechanisms.

Acne, The Lowdown
Judy Hsu, DO
December 10, 2020, 10:08:21 PM


Acne is one of the health concerns that really distresses people because of how visible it is. It is also challenging to treat because there is no one-size-fits-all solution as everyone’s skin is so different. Even for an individual, his or her skin can behave differently in different parts of the body. It is often a frustrating experience trying to treat acne on your own with over the counter products; sometimes people have success with them, but other times these products not only do not help but also make things worse because of the added fragrance and chemicals that irritate the skin.

I often recommend people talk to their doctors about their skin concerns to get a different perspective on how to take better care of their skin. Prescription grade medications are also often times much more effective because of the active ingredients and formulations. Your doctor will also review your lifestyle with you to give you some tips on how to promote healthy skin.

Acne can be a confusing term as people usually think of acne as red pimples on the face. In fact, acne also include what we often refer to as blackheads and whiteheads. In the simplest terms, acne is a skin condition that comes about when your hair follicles become plugged with oil and dead skin cells. What this means is that acne can occur anywhere on your body that contains hair follicles but most of the time only in areas that are more active in oil production (i.e. face, back, chest). At this stage when these hair follicles are just plugged, what you see on the skin are little whitish bumps or black dots. Once these blocked hair follicles become inflamed, then the tissue surrounding them swells and becomes red, and what you see are red bumps on the skin. The yellow pus that sometimes can be found sitting on top of these red bumps are simply an aftermath of that inflammatory response.

If the inflammation starts to spread and gets deep into your skin, then a small pimple can become a giant nodules and cyst; we call it nodules when it’s just swelling and cysts when it is filled with pus. Nodules and cysts are severe forms of acne that are best treated by medical professionals as they can lead to serious scarring if not treated properly.

Treating acne requires a highly individualized approach, but the basic principles are to speed up skin cell turnover and reduce inflammation. These goals can be achieved through therapeutics and lifestyle changes.

In terms of therapeutics, you have things that you can apply on your skin and pills that you can take. The topical therapeutics can come in forms of face wash and leave-on treatment, and the oral therapeutics include antibiotics, vitamin A derivative, or hormone therapy. Some of the common active ingredients found in topical treatments include benzoyl peroxide, adapalene, tretinoin, sulfur, or clindamycin. Some of the common oral antibiotics prescribed include doxycycline or cephalexin. Hormone therapy can be useful in women if there is an imbalance between male and female hormones, and besides birth control pills, spironolactone is a blood pressure medication that is often used for its effect on reducing male hormone activity. The vitamin A derivative isotretinoin, aka Accutane, is usually reserved for severe forms of acne because of its side effects, and it works by shrinking the oil glands in the skin and inhibiting growth of bacteria that causes inflammation.

In terms of lifestyle, stress management is important to reduce overall inflammation in the body; this include getting enough sleep, nutrition and exercise. It's also important to pay attention to mindless habits like touching your face with your hand.