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Derm Deep Dive: Acne Awareness Month

June 2022


What You Should Know About Acne and How to Effectively Treat It

We’re back with another Derm Deep Dive, a series where we provide expert advice from one of our board-certified dermatologists about common skin conditions or treatments. June is Acne Awareness Month, so we’re speaking with Dr. Brian Connolly, MD, about acne, to understand what it is and what causes it, who is at risk, and how to treat it. 

What Is Acne and What Causes It?

Acne is a disorder of the oil glands and hair follicles, and while it can be caused by many different factors, there are 4 key events that lead to acne formation: 

  1. Plugging of a hair follicle with oil and dead skin cells. The skin produces oil and sheds skin cells regularly, which can sometimes build up in the hair follicle and clog the follicle. If the clogged follicle becomes infected, it forms a pimple.
  2. Excess oil production. The areas of the body that produce the most oil include the face, forehead, chest, upper back, and shoulders, and excess oil production can block or clog hair follicles, creating bacteria and a resulting infection that causes pimples to form.
  3. The proliferation of a normal skin bacteria called Propionibacterium acnes (P acnes). P acnes are a slow-growing bacterium that is involved in the development of acne on the skin.  
  4. Inflammation. Excess oil or dead skin cells that plug or block hair follicles can cause them to become inflamed, and when inflammation occurs deep inside the hair follicle, a cyst-like bump forms beneath the skin. When this happens across an area of the body, it results in acne.

Acne has no cure, but there are many different medications that work to effectively treat it. In most cases, anyone with acne can achieve clearer skin with the right treatment and skincare routine. 

What Are the Different Types of Acne?

There are many different types of acne that can affect individuals in different ways. However, there are three main types:

  1. Comedonal: Characterized by small, light or dark-colored bumps called comedones, and is most common on the forehead, nose, or chin. Sometimes, these comedones stay in this stage, or progress to a more serious type of acne.
  2. Inflammatory: This type of acne is characterized by bumps that are bigger than comedones and are often surrounded by redness. They may or may not possess a white head in the center.
  3. Nodulocystic: Characterized by acne bumps, called nodules, that are larger than comedones and inflammatory acne bumps. With nodulocystic acne, the bumps are deeper in the skin and may hurt or leak fluid. 

What are Common Triggers That Cause Acne Flare-Ups?

There is no single factor that causes an acne flare-up. Frequently, hormones are a major driver of acne, and hormonal changes that occur during puberty or during a menstrual cycle can have a significant effect on the skin’s oil production and the severity of acne.

Diet is a controversial topic. Although chocolate and dairy have long been thought to contribute to acne flare-ups, studies are mixed. Newer research has suggested that eating foods with a high glycemic index, such as white bread, white rice, and processed foods like crackers, sugary snacks, and soda or other sugary drinks may exacerbate acne more than chocolate or dairy.

Who Is at Risk of Getting Acne?

Everyone can expect to get acne in varying degrees once they have started puberty. In fact, mild acne with comedones can be the first sign that puberty has begun. 

Prior to puberty, acne is also common during the neonatal and infantile stages (birth to 1 year of age). Acne at this age is related to hormonal changes occurring after birth. During the mid-childhood stages (ages 1- 6 years old) acne is very rare. Women can also have a reoccurrence of acne in the peri-menopausal years (around age 40 and up).

Are Certain Skin Types More Acne-Prone?

Acne isn’t necessarily related to skin type as all skin types can suffer from acne. It is more related to hormonal changes and genetic predisposition. If your parents had mild acne, it is likely you will also have mild acne. If your parents suffered from moderate or severe acne, it is likely you will as well.

What Does Acne Treatment Look Like?

Treatment generally involves combinations of topical and oral medications designed to treat specific elements of acne formation.

For acne-prone skin, the easiest place to start is with benzoyl peroxide or salicylic acid washes, which are available over the counter. Anyone with acne should wash their face and/or body with these washes 1-2 times per day.

Avoid aggressive moisturizing of the skin as that can clog pores and promote acne development. Use light moisturizers that say “non-comedogenic” on the label. Non-comedogenic sunscreens are also good for acne-prone skin.

What Does a Home Remedy Look Like?

Everyone should try the following at-home regimen:

  • Wash with benzoyl peroxide or salicylic acid twice a day. 
  • In the evening, apply an over-the-counter medication called Differin (adapalene) 2-3 nights per week as a thin film on the entire acne-affected region. 

The skin will dry out a bit, which is necessary to make improvements to acne. Increase this regimen as tolerated to 5 nights per week, and continue for 3 months. There might be an initial flare for the first month as the skin “purges”, but keep going! We don’t declare anything a treatment failure until it has been done for 3 months. If you experience worsening of your acne or no improvement after 3 months, it’s time to seek medical help.

How Will a Dermatologist Treat My Acne?

Treatment options you can expect from your dermatologist may include:

  • Topical retinoid creams that help reduce plugged hair follicles and oil production
  • Topical antibiotic creams to help decrease the colonization of P acnes, the normal skin bacteria that can cause acne
  • Topical benzoyl peroxide washes to help to decrease the colonization of P acnes 
  • Oral antibiotics to help with the colonization of P acnes and reduce inflammation
  • Oral contraceptive pills to help control the hormonal contributions to oil production

A Good Skincare Regimen Goes a Long Way

We work with our patients to identify the right treatments and help establish lifestyle changes that can promote clearer skin. I’m currently accepting new patients – schedule an appointment with me at Optima Dermatology’s Stratham, NH clinic to discuss your questions and concerns, and begin a healthier approach to skincare!