This FAQ information addresses some of the common questions asked by people with acne. Please remember that your dermatologist is always the best source of specific information about individual health issues, including acne.
What causes acne?
The causes of acne are linked to the changes that take place as young people mature from childhood to adolescence (puberty). The hormones that cause physical maturation also cause the sebaceous (oil) glands of the skin to produce more sebum (oil). Sebaceous glands are found together with a hair shaft in a unit called a sebaceous follicle. In addition, normal skin bacteria called P. acnes, begins to multiply rapidly in the clogged hair follicle. In the process, these bacteria produce irritating substances that can cause inflammation. Sometimes, the wall of the follicle bursts, spreading inflammation to the surrounding skin. This is the process by which acne lesions, from blackheads to pimples to nodules, are formed.
I wash my face several times a day. Why do I still get acne?
Many people still believe that acne is caused by dirty skin. The truth is, washing alone will not clear up or prevent acne. Washing does, however, help remove excess surface oils and dead skin cells. Washing the skin twice a day gently with water and a mild soap is usually all that is required.
Does stress cause acne?
In some cases stress may actually be caused by the acne lesions, not the other way around! If the acne is being treated effectively, stress is not likely to have much impact on the majority of people.
I never had acne as a teenager. Why am I now getting acne as an adult?
Usually, acne begins at puberty and is gone by the early 20s. In some cases, acne may persist into adulthood. These types of acne include severe forms that affect the body and the face (males more than females) and acne associated with the menstrual cycle in women. Adult acne is more likely to affect females than males.
As females age, the pattern of changes in hormones change. Ovarian cysts and pregnancy may also cause hormonal changes that lead to acne. Some women get acne when they discontinue birth control pills that have been keeping acne at bay. Sometimes young women may wear cosmetics that are comedogenic–that is, they can set up conditions that cause comedones to form.
What role does diet play in acne?
Following a strict diet will not, clear your skin. There is no scientific evidence that suggests food causes or influences acne. You may avoid any foods which personally seem to worsen your acne and, for your overall health, eat a balanced diet–but diet shouldn’t really matter if the acne is being appropriately treated.
Dietary cause is one of the most persistent myths about acne. The following are more likely to bring on or worsen acne:
- Hereditary factors
- An increase in male hormones found in both males and females
- Oil and grease from cosmetics, work environment
Does the sun help acne?
There is no proven effect of sunlight on acne. In addition, ultraviolet light in sunlight increases the risk of skin cancer and early aging of the skin. It is, therefore, not a recommended technique of acne management. Moreover, many acne treatments increase the skin’s sensitivity to ultraviolet light, making the risk of sun exposure all the worse for causing ageing.
What is the best way to treat acne?
Everyone’s acne must be treated individually. If you have not gotten good results from the acne products you have tried, consider seeing a dermatologist. A dermatologist will decide which treatments are best for you.
What kind of cosmetics and cleansers can an acne patient use?
Look for “noncomedogenic” cosmetics and toiletries. These products have been formulated so that they will not cause acne. Ask the pharmacist or cosmetic sales person.
Some acne medications cause irritation or pronounced dryness particularly during the early weeks of therapy, and some cosmetics and cleansers can actually worsen this effect. The choice of cosmetics and cleansers should be made with your dermatologist or pharmacist or cosmetic sales person.
Heavy foundation makeup should be avoided. Most acne patients should select powder blushes and eye shadow over cream products because they are less irritating and noncomedogenic. Camouflaging techniques can be used effectively by applying a green undercover cosmetic over red acne lesions to promote color blending.
Is it harmful to squeeze my blemishes?
Yes. In general, acne lesions should not be picked or squeezed. In particular, inflammatory acne lesions should never be squeezed. Squeezing forces infected material deeper into the skin, causing additional inflammation and possible scarring.
Can anything be done about scarring caused by acne?
Scarring is best prevented by getting rid of the acne. Dermatologists can use various methods to improve the scarring caused by acne. The treatment must always be individualized for the specific patient. Chemical peels may be used in some patients, while dermabrasion or laser abrasion may benefit others. It is important that the acne be well controlled before any procedure is used to alleviate scarring.
How long before I see a visible result from using my acne medication?
The time for improvement depends upon the product being used, but in almost all cases it is more a matter of weeks or months instead of days. Most dermatologists would recommend the use of a medication or combination of medications daily for 4 to 8 weeks before they would change the treatment. It is very important for patients to be aware of this time frame so they do not become discouraged and discontinue their medications.
Would using my medication more frequently than prescribed speed up the clearing of my acne?
No–always use your medication exactly as your dermatologist instructed. Using topical medications more often than prescribed may actually induce more irritation of the skin, redness and follicular plugging, which can delay clearing time. If oral medications are taken more frequently than prescribed, they won’t work any better, but there is a greater chance of side effects.
My topical treatment seems to work on the spots I treat, but I keep getting new acne blemishes. What should I do?
Topical acne medications are made to be used on all acne-prone areas, not just individual lesions. Part of the goal is to treat the skin before lesions can form and to prevent formation, not just to treat existing lesions. Patients are generally advised to treat all of the areas (forehead, cheeks, chin and nose) that tend to break out rather than just individual lesions.
My face is clear! Can I stop taking my medication now?
If your dermatologist says you can stop, then stop–but follow your dermatologist’s instructions. Many times patients will stop their medication suddenly only to have their acne flare up several weeks later. If you are using multiple products, it may be advisable to discontinue one medication at a time and judge results before discontinuing them all at once.
Are there any acne treatments specifically for people with dark skin? Are there any treatments specifically harmful to dark skin?
There are no acne treatments specifically for use on dark skin. Acne treatments are generally as safe and effective on dark skin as on light skin. Some treatments for acne scars may cause temporary lightening of dark skin.
Acne is a common skin disease that has the same causes and follows the same course in all colors of skin.
Darker skin has a tendency to develop post-inflammatory hyperpigmentation (excessive skin darkening at places where the skin was inflamed). Severe inflammatory acne may result in dark spots. The spots resolve over time; a dermatologist may be able to recommend cosmetic measures to make the spots less apparent until they resolve. Some acne treatments, such as topical retinoids and azelaic acid, may also help fade the discoloration.
Removal of acne scars by dermabrasion or chemical peeling may cause temporary lightening or darkening of dark skin in the areas of treatment. Scar treatment should be discussed with a dermatologist or dermatologic surgeon before it is undertaken.