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The Ultimate Acne Guide (And How to Get Rid of it For Good)

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What is acne? Who gets it? What causes it? Can you actually prevent it? What treatment options are best? If you are suffering from acne, let this comprehensive, easy-to-understand guide, literally be your guide. We’ve put together everything you need to know, including how to properly treat it, so you can hopefully say goodbye to acne for good.

First things first, the basics.

Acne vs. Pimples – What’s the Difference?

Is acne a pimple? Are pimples considered acne? Well, yes and no. Basically, acne (otherwise known as acne vulgaris) is a chronic skin disorder and pimples are one of its symptoms1. Everyone experiences a pimple at some point in their lives, unfortunately some may also suffer from more severe forms of acne. The severity of acne can vary quite widely, but doctors generally classify it into 3 categories: mild, moderate and severe2.

Mild Acne –This is the most common and least extreme type of acne. An occasional minor breakout consisting of whiteheads (closed pores that are clogged) and/or blackheads (open pores that are clogged). These types of “pimples” typically show up on the chin, nose, forehead and shoulders, though they can appear anywhere on the body2.

Moderate Acne – This type of acne is more severe than the occasional breakout – noticeably more pimples along with inflamed papules (small bumps) and pustules (small bumps filled with yellow pus). This is also considered the turning point of the disorder. If not treated properly, moderate acne can turn into severe acne very quickly, so as always, it is important to see a dermatologist to discuss proper treatment options before it becomes too severe2.

Severe Acne – This is the least common and most extreme type of acne. People who suffer from the severe form have a lot of papules and pustules as well as nodules (painful reddish bumps) and cystic lesions (painful pus-filled bumps beneath the surface of their skin). Unfortunately, once acne has reached this stage it could lead to scarring even after it has been treated. The good news is, there are a lot of new procedures that have made their way onto the scene over the last few years to help diminish the appearance of acne scars completely2. More on that later.

What are the Causes and Triggers of Acne?

Acne happens as a result of overactive sebaceous glands (the ones that produce oil). The excess sebum, dead skin cells and bacteria build up in the pores leading to inflammation, redness and swelling, otherwise known as acne3. There are also some other triggers that contribute to the disorder and lead to its development, let’s take a look.

Hormones – This is the reason teenagers are the most prone. Acne is triggered by increased levels of hormones (and through puberty those levels are off the charts), as they cause the oil glands under the skin to grow. The enlarged glands produce more sebum-causing bacteria to accumulate and acne to form4.

Inflammation – Acne presents itself as aggravated red and sore bumps, the very definition of inflammation. Though external environmental factors play a role, there have also been a number of studies that suggest the source of inflammation on the skin may come from within5. Just another reason to follow a healthy diet plan to keep inflammation down inside the body.

Diet – While there are a number of conflicting theories on whether a bad diet triggers acne, it is widely believed that certain foods can help. Anything rich in Vitamin A, which plays an essential role in skin’s health, is thought to be of aid. Also avoiding sugary foods can do a world of good. Foods high in sugar like soda, bread, candy, etc. can cause dramatic fluctuations in blood sugar which releases other hormones causing excess sebum production, which as we know, exacerbate acne6. We will take a closer look at diet later on in the guide, so stay tuned. 

Heredity – Acne has a tendency to run in the family. If at least one of your parents are acne-prone, there is an increased chance that it is in your genes and you may develop it as well7.

Stress – Anything that affects the hormones in the body can lead to more acne, and stress is right up there on the list. Both mental and physical stress compromise the immune system making it harder for the skin to stay clear4.

What are the Myths Around Acne?

Contrary to popular belief, there are a few myths around what causes acne but they actually have little to no effect on the development.

Greasy Foods – Though they aren’t typically part of a healthy diet, greasy foods aren’t actually known to cause acne. One thing to be careful of however, is working in a greasy area, such as a kitchen with fry vats, oil can stick to the skin and block hair follicles, which help promote acne.

Hygiene – Skip a nightly face wash? No, that won’t cause acne. In fact, washing too much can actually do more harm than good. Scrubbing and/or using harsh soaps and chemical irritants can aggravate the skin and make acne worse.

Age – As we’ve mentioned, acne is mostly considered a “teenager problem” but in reality, acne can be present at any age. In adult life, it is actually more common in women. This is likely due to the influx of hormones during menstrual cycles, pregnancies and menopause.

What are the Treatment Options?

Fortunately with the advancement of technology, not only have there been vast improvements in acne treatments, there are many new ones available in the market today. Treatment options vary widely and range from topical to oral to procedural, so it is important to take the time with your doctor to figure out which one would be best for your skin. Read on for an overview of the treatment options available today.

Topical Treatments

Topical forms of acne treatment agents are available in creams, gels, lotions, and washes, and include medical ingredients to help treat acne. They are all designed to inhibit the growth of acne bacteria, increase skin cell renewal and decrease the formation of pimples.

Benzoyl Peroxide

What it is: Perhaps the most common topical agent in acne treatments, benzoyl peroxide has been the mainstay of acne treatments for decades. You can find it in many over-the-counter products as well as prescription acne medications8.

How it works: The bacteria responsible for acne breakouts can’t survive in overly oxygenated environments. Benzoyl peroxide delivers oxygen into the pores, killing the bacteria and reducing inflammation. It also helps clear dead skin cells, which helps in the prevention of future breakouts8.

How to use it: Though a water-based gel is preferred, gels and lotions work just as well, it is just a matter of preference. The key is to start slow with a low amount of benzoyl peroxide, around 2.5% strength, and work your way up. If you don’t see results in a couple of weeks, gradually move up in strength.

Possible side effects: The most common are dryness, redness, flaking and burning, however it is typically pretty mild and can be tempered with an oil-free, fragrance-free moisturizer.

Works best for: Mild to moderate acne.

Salicylic Acid

What it is: Salicylic acid is the active ingredient found in a variety of non-prescription, over-the-counter acne treatments.

How it works: Contrary to popular belief, salicylic acid doesn’t actually kill bacteria, nor does it have any effect on sebum production, whatsoever. It works by penetrating deep below the skin’s surface to exfoliate the skin while unclogging pores, thereby reducing acne lesions and preventing new ones from forming. Some comparative studies have also suggested that it works better at reducing acne than benzoyl peroxide10.

How to use it: Salicylic acid can be found in many forms, most commonly in creams, face washes, astringents and pads.

Possible side effects: The most common are mild skin irritation and/or slight stinging.

Works best for: Mild to moderate acne.

Retinoids

What they are: Retinoids are a derivative of vitamin A, which as we learned earlier, is the skin’s favourite vitamin. Like benzoyl peroxide, they are typically applied topically in the form of creams, gels and lotions, though they are available in capsule form to be taken orally.

How they work: Retinoids function by unclogging blocked pores and destroying the bacteria within them causing the breakout11.

How to use it: It is best to apply your preferred retinoid treatment once a day, 20-30 minutes after washing your face.

Possible side effects: These can vary depending on the strength of the treatment, the higher the dosage the more likely it is that side effects will occur. The most common are redness, discomfort, peeling and itching.

Works best for: Mild to moderate acne.

Antibiotics

What they are: These are medical treatments, usually in the form of a cream, used to treat all types of acne. The two most common topical antibiotics are Clindamycin and Erythromycin.

How they work: In short, topical antibiotics work directly by killing the bacteria that causes acne on your skin. They can also help reduce inflammation and clear clogged pores. 

How to use it: Because topical antibiotics work slowly, it is best to use this type of treatment in conjunction with other topical treatments, like benzoyl peroxide or retinoids12.

Possible side effects: Some users may experience minor skin irritation and dryness.

Works best for: Mild to moderate to severe acne.

Oral Treatments

Birth Control

What it is: Birth control is a prescription-only type of hormonal acne therapy for women that contains synthetic hormones effective in countering acne breakouts.

How it works: Androgens, a hormone present in women (one that is particularly active during puberty) cause the sebaceous glands to produce more sebum (oil). The synthetic hormones found in birth control pills (estrogen and progesterone) help decrease the oil secretions from your glands, which also helps decrease breakouts8.

How to use it: Taken daily, users can expect to start seeing results in the first 2-3 months.

Possible side effects: Taking birth control can put you at an increased risk of developing blood clots or heart issues.  However, most healthy women do not have any side effects, whatsoever. Another possible side effect is the development of melasma or dark patches on the face. Using safe sun practices can help prevent those from occurring.

Works best for: Decided on a case-by-case basis, this type of treatment is strictly for those who have a hormonal acne pattern and have not responded to first lines of therapy, including topical over-the-counter and prescription creams.

Spironolactone

What it is: Another type of hormonal acne therapy for women available by prescription only, it can be used in conjunction with birth control for the best results.

How it works: Considered an anti-androgen treatment, it works by blocking androgen receptors in the body (the hormone responsible for contributing to acne breakouts). It’s important to note that because of the way spironolactone works, only women who have hormonal acne will see results with this treatment8.  

How to use it: Like birth control, spironolactone needs to be taken daily (ideally at the same time as the birth control). Users can expect to start seeing a decrease in oil and breakouts in as little as a few weeks.

Possible side effects: Some users may experience irregular/more painful periods, breast tenderness and/or breast enlargement. Other possible side effects include fatigue, headaches and dizziness.

Works best for: Like birth control, this hormonal-based therapy will only work for those who have hormonal acne patterns. If other topical treatments have had no effect on your acne, speak to your dermatologist to see if hormonal therapies will work for you. 

Antibiotics

What they are: Prescription-only medications available in many forms, from tablets to capsules to elixirs.

How they work: Like their topical counterpart, oral antibiotics kill bacteria, only the oral variety does so within the pores. They also have an anti-inflammatory effect on acne breakouts12.

How to use them: Taken daily, they work best when started at high doses. As you acne improves, your doctor can lower the dose as needed.

Possible side effects: Users may experience rashes, gastrointestinal discomfort and sun sensitivity.

Works best for: Moderate to severe forms of acne.

Isotretinoin

What it is: Isotretinoin is the active ingredient in the prescription medication and is considered one of the most effective treatments for severe acne. It is a vitamin A derivative, so your body reacts to it in the same it does to vitamin A (which we’ve learned is essential for healthy skin).

How it works: Isotretinoin is the only therapy that can impact all of the factors responsible for acne. It helps disrupt the progression of cell-cycles, it decreases changes within the cells and impacts cell survival, resulting in a significant reduction of oil production – up to 90% within 6 weeks14.

How to use it: Isotretinoin is typically taken twice daily with meals for 15-25 weeks (or as directed by your doctor) and comes in the form of a tablet or capsule. It is important to note that your acne may worsen during the first few days of taking the medication, and it may take up to a month to start seeing results.

Possible side effects: Redness, burning and other signs of inflammation, skin rash and bone/joint pain.

Works best for: Severe acne.

Procedural Treatments 

Corticosteroid injection

What it is: Cortisone is concentrated anti-inflammatory steroid medication that gets injected into acne cysts to speed their healing. They are typically used on the deepest cystic lesions that do not go away on their own and may turn into scarring.

How it works: The minute the cortisone is injected into the lesion, it starts working immediately to bring down inflammation and heal the lesion from the inside out15. Within 24 hours, the cysts are noticeably flattened and the potential of scarring is greatly reduced.

How it is administered: Cortisone treatments are performed in-office with a dermatologist who injects a diluted corticosteroid directly into the trouble cyst or nodule.

Possible side effects: Users will likely experience mild discomfort for a couple of hours after the procedure.

Works best for: Severe acne.

Chemical peels

What they are: Chemical peels use a chemical solution formulated to improve the appearance of acne scars. Generally, salicylic, glycolic and lactic acid peels are the most commonly applied.

How they work: These are designed to cause controlled (and safe) cosmetic injury to the skin so it acts as an exfoliant on the top layers. This helps heal the acne and encourage the growth of new, healthy skin cells in its place16

How it is administered: Though there are milder at-home versions available, the procedures performed in the dermatologist office can lead to better results (due to more refined equipment). Expect 3-6 treatments, 2-4 weeks apart as well as maintenance peels once every few months.

Possible side effects: Peels may cause crusting and hyperpigmentation, however that usually resolves within a few months and is less common in the winter (due to reduced sun exposure).

Works best for: Mild to moderate acne.

Laser and light-based therapies

What they are: Increasingly popular treatments for acne and acne scarring, laser and light-based therapies are a more modern approach in the therapeutic arsenal.Lasers vary from infrared wavelengths and pulsed dye lasers while light devices include blue light, red light and broadband light. These treatments can also be used in combination with other pharmaceutical treatments to maximize effectiveness17.

How they work: Otherwise known as phototherapy, light-based treatments use a specific type of light (ie. red, blue, red + blue or Intense Pulsed Light) that once applied to the skin, kill the bacteria that causes acne. Light therapies also work to shrink the oil glands in the skin, thereby decreasing the amount of pore-clogging oil produced. Infrared lasers work by penetrating deep into the skin to target water within the sebaceous glands. This disrupts the sebaceous glands, seizing oil production and thereby reducing acne18.

How they are administered: Though there are a number of at-home devices on the market, your dermatologist will have the best equipment available to perform laser and light-based therapies in-office. Either way, a professional consultation is always recommended before starting any kind of treatment.

Possible side effects: When it comes to light-based therapies, there are virtually no side effects. Laser treatments are a little more invasive and may cause pain, redness and swelling within the first couple of days after treatment. Users may also experience dry, sensitive skin.

Works best for: Mild to moderate acne.

Extraction treatments

What they are: Acne extraction is a straightforward procedure designed to remove hard material or fluid within the lesion, allowing medication to be applied to the open pore, promoting healing.

How they work: Performed in-office, a dermatologist uses sterile instruments to extract whiteheads and blackheads. To remove larger cysts or nodules, the  dermatologist may perform a procedure called incision and drainage. This treatment involves using a sterile needle or surgical blade to open the blemish and drain the contents. 

Possible side effects: There will likely be mild pain and redness after any extraction procedure. Ice is recommended to relieve pain and inflammation as well as aid in swelling.

Works best for: Mild to moderate to severe acne.

The Anti-Acne Diet: Does it Work?

Through the years there have been a number of studies suggesting that what we eat has an impact on the formation and treatment of acne. The results of these studies have provided conflicting opinions so there seems to be no clear evidence that directly links certain types of foods with acne development and prevention. One thing we do know is that acne is caused by inflammation in the body and though the diet can’t cure that, eating certain types of foods and avoiding others, can help bring down inflammation within the body, which helps reduce inflammatory conditions. Here are a few diet tips that may help.

Avoid High Glycemic Foods – These include breads (particularly white bread), soda, processed sugar, pastries, sweetened breakfast cereals, some high sugar fruits and vegetables (like melon, pineapple and potatoes), enriched pastas, white rice and fried foods. These foods can cause dramatic fluctuations in blood sugar, increasing the level of insulin in the body. They can also stimulate the release of other hormones, promoting the production of excess sebum.

Cut Back on Milk and Dairy Products – It has been studied that milk and dairy products promote insulin secretion and the production of the hormones known to contributors to acne development, so limiting these food may help.

Eat Whole Foods – Getting your fill of fruits, vegetables and lean meats can help tame inflammation. Also, adding anti-inflammatory omega-3 fat sources such as fatty fish and chia seeds, can also be beneficial to the immune system.

Diet net takeaway: Controlling blood sugar, limiting dairy products and eating whole foods is extremely important in the fight against inflammation, therefore it may also be a factor in helping control or prevent acne.

Conclusion

Acne is an extremely complex skin disorder with many manifestations and treatment options. The treatment options available are all aimed to decrease sebum production, kill acne bacteria, normalize skin shedding and reduce inflammation. Most mild forms of acne can be treated with over-the counter topical treatments, while others require more prescription-based treatments and/or in-office procedures due to their severity. And though there are a ton of opinions around diet, consuming foods that helps bring down inflammation in the body, and avoiding the ones that wreck havoc, can certainly help.

As always, no matter which course of action you decide to take in your fight against acne, it is really important to speak to your dermatologist before beginning any treatment program. They will work with you to figure out which treatment option will work best for your specific condition and steer you away from anything that may cause more harm than good. To get the most out of your treatment, exercise diligence, be sure to do things properly and continue treatments for as long as recommended, even if you experience some side effects. Remember, any treatment option you choose will take some time to show results and sometimes it has to get worse before it can get better.

References

  1. Vishwanathan, Rajesh M.D. (2014) Acne or Pimples. Retrieved from: http://drrajeshv.com/acne-or-pimples/
  2. Chim, Christine, Pharm. D., BCACP (2016) Acne Vulgaris. Retrieved from: https://www.accp.com/docs/bookstore/acsap/a2016b2_sample.pdf
  3. Canadian Dermatology Association (2020) Acne. Retrieved from: https://dermatology.ca/public-patients/skin/acne/
  4. Liu Kristina MD, MHS, Nassim Janelle, MD (2019) Adult acne: Understanding underlying causes and banishing breakouts. Retrieved from: https://www.health.harvard.edu/blog/adult-acne-understanding-underlying-causes-and-banishing-breakouts-2019092117816
  5. Acne.org (2019) What causes acne? Retrieved from: https://www.acne.org/causes-of-acne.html
  6. Pappas, Apostolos (2009) Sep-Oct; 1(5): 262-267. The relationship of diet and acne Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2836431/
  7. Dréno, Brigitte (2014) Acne and heredity. Zouboulis C., Katsambas A., Kligman A. (eds) Pathogenesis and Treatment of Acne and Rosacea. Retrieved from https://link.springer.com/chapter/10.1007/978-3-540-69375-8_37
  8. Rathi, Sanjay K (2011)Indian J Dermatol Jan-Feb;56(1): 7-13. Acne Vulgaris Treatment: The Current Scenario. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3088940/
  9. Titus, Stephan, MD and Hodge, Joshua MD (2012) Am Fam Physician Oct 15; 86(8):734-740. Diagnosis and Treatment of Acne. Retrieved from: https://www.aafp.org/afp/2012/1015/p734.html
  10. Zander E, Weisman S (1992) Clinical Therapeutics, 14(2):247-253. Treatment of acne vulgaris with salicyclic acid pads. Retrieved from: https://europepmc.org/article/med/1535287
  11. Leyden James, Stein-Gold, Linda and Weiss, Jonathan (2017) Dermatol Ther (heidelb) Sep; 7(3):293-304./ Why Topical Retinoids Are Mainstay of Therapy for Acne. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574737/
  12. Kraft, John, MD and Freiman, Anatoli, MD (2011) Apr 19; 183(7): E430-E435. Management of acne. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3080563/
  13. Russell, John J. MD, (2000) Am Fam Physician Jan 15;61(2):357-365. Topical therapy for Acne. Retrieved from: https://www.aafp.org/afp/2000/0115/p357.html
  14. Layton, Alison (2009) Dermatoendocrinol. May-Jun; 1(3): 162-169. The use of isotretinoin in acne. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2835909/
  15. Taub AF (2007) Dermatol Surg. Sep;33(9):1005-26. Procedural treatments for acne vulagris. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/17760592
  16. Arif, Tasleem, (2015) Clin Cosmet Investig Dermatol 8: 455-461. Salicylic acid as a peeling agent: a comprehensive review. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4554394/
  17. Pei, Susan, Inamadar, Arun C., Adya, Keshavmurthy A., and Tsoukas, Maria M. (2015) Indian Dermatol Online J. May-Jun;6(3): 145-157. Light-based therapies in acne treatment. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439741/
  18. Alexiades M. (2017) Clin Dermatol. Mar-Apr;35(2):183-189. Laser and light-based treatments of acne and acne scarring. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/28274357
  1. Acne vs. Pimples – What’s the Difference?
  2. What are the Causes and Triggers of Acne?
  3. What are the Myths Around Acne?
  4. What are the Treatment Options?
  5. The Anti-Acne Diet: Does it Work?
  6. Conclusion