It’s not “just” acne. 

Acne is one of the most common skin conditions for which patients seek dermatologic care. Approximately 85% of adolescents have acne and acne sometimes continues or may even begin as an adult. Having acne affects your everyday life. Research shows that acne can negatively impact relationships, sleep, work, and school.  

Here at Central Minnesota Dermatology, we find it important for you to feel comfortable with your skin. Today, we would like to highlight what causes acne, some common pitfalls in treating acne, and effective ways you can get back to looking your best! 

What causes acne? 

Acne is caused by several different factors that all impact your skin’s health. These include bacteria, genetic predisposition, sebum production, follicular hyperkeratinization, and inflammation. Hormones play a role in these factors, which is why we see more acne as teens become older. A strong family history of severe acne and oily skin type also contribute to acne formation. 

Some patients present to the clinic without having tried anything for their acne, while others have tried over the counter and even prescription therapy. Acne is complicated and due to its multiple causes patients typically come with marginal results from their previous efforts. It is important to target all the factors causing acne to achieve the desired results.  

Top 5 ways you may be making your acne worse at home.  

  1. Washing the face frequently or using products to “dry out” the skin. Even if your face is oily, drying out the skin with acne products will not help. Washing the face frequently and using agents that are too drying cause irritation to the skin and consequently result in causing more acne.  
  2. Using a wash rag, scrubber or cleansing wipes to scrub the face clean. Similar to using harsh products to dry the face, scrubbing acne prone areas causes more irritation and can worsen acne. Gentle skin care is key and when washing only using the fingertips is recommended.
  3. Popping or picking at your acne lesions. Sometimes acne is very painful and having a pimple is frustrating. It is tempting to “pop” the lesion to make it go away quicker. Unfortunately, picking at our skin causes more inflammation, worsens acne and increases the risk of scarring.
  4. Sleeping in makeup or using makeup or skin care products that worsen acne. You should never sleep in your makeup as this can cause the pores to become clogged and can cause an acne flare. Also, choose products that state they are non-comedogenic or non-acnegenic and never share makeup or skin products with others.  
  5. Switching acne treatments too soon and only applying medication when a breakout occurs. Acne is an inflammatory skin condition, and it can take 3-4 months of treatment directed by your dermatology provider to improve. Rapidly changing treatment plans can be not only frustrating but also a reason why your skin is not improving. Acne medications should be applied to the entire face to prevent breakouts. Spot treatments only treat acne that has already occurred and are generally ineffective in preventing acne.  

 Acne Treatments 

Acne consists of several types of lesions. These include open and closed comedones, inflammatory papules, and cysts. Comedones are commonly referred to as whiteheads and blackheads. Inflammatory papules are red painful pimples. Cysts are deeper, larger pimple lesions that are typically very painful and can be persistent for sometimes a month or more. Inflammatory papules and cysts leave behind red, purple or dark pigmentation that we call post-inflammatory hyperpigmentation. This pigmentation can take months to resolve on its own. Larger more painful lesions such as cysts can result in permanent scarring.  

Since we know that acne is caused by many different factors, it therefore must be treated in multiple ways. Your dermatology provider will discuss the type of acne you are experiencing, your family history of acne, and previously tried treatments during your visit. Each person is unique in the type of acne affecting them, their schedules, and preferences on treatment choices. Here at Central Minnesota Dermatology, we will work with you to develop a plan that you are comfortable with.  

Acne treatments can be broken down into a few categories. These include topical therapy, oral medications, and physical treatments.  

Topical Therapy 

There are many topical treatments for acne ranging from over-the-counter products to prescription. Typically, topical medications target bacteria, inflammation, improve pigmentation and are comedolytic. Some common topical medications include benzoyl peroxide, salicylic acid, retinoids, antibiotics, azelaic acid, topical spironolactone, and clascoterone. Topical medications may be used alone or with other topical and/or oral medications to treat acne.  

Oral Medications 

Acne that is not well controlled by topical therapy can be improved by adding oral therapy. Oral medications target bacteria, inflammation, and hormonal causes of acne. Some common oral medications used to treat acne include antibiotics (doxycycline & minocycline), oral contraceptives, and spironolactone.  

Intralesional Corticosteroid Injections 

A corticosteroid (Kenalog) is an injectable medication that is very effective in treating large painful cystic acne lesions. Your dermatology provider will inject this medication directly into your acne lesion for quick resolution. Often resolving the lesion in 24 hours. This is a quick and well tolerated procedure that greatly reduces the urge to pick at your pimples and reduces your risk of scarring. Side effects of this procedure include mild pain during the injection and steroid atrophy.  

Isotretinoin / Accutane 

A medication originally called “Accutane”, more properly referred to now as isotretinoin, is a very effective oral medication used to treat patients with severe acne or patients with persistent acne despite multiple targeted treatments. This medication is an oral retinoid and is taken daily for typically a minimum of 5 months or until cumulative dose is met. There are several side effects to this medication, however, it is typically well tolerated by those who take it. Your dermatology provider will monitor your symptoms monthly by asking you about side effects as well as lab monitoring to ensure you can safely continue the medication. This medication is monitored by the FDA through a program called Ipledge due to the risk of birth defects in patients who can become pregnant. Absolute abstinence or two forms of birth control are required by patients who may become pregnant while taking this medication. Common side effects of this medication include dry skin, dry cracked lips, some mild muscle aches and sometimes changes in night vision due to dryness of the eyes. Isotretinoin is a remarkably effective way to treat or even “cure” acne. Prior to starting this medication your dermatology provider will review all the risks and ways we make sure you are safe while taking this medication. 

Physical Treatments 

Other adjunct or alternative treatment options for acne include chemical peels, dermaplaning, comedone extraction, microneedling with radiofrequency (RF) energy and laser or light-based devices. All these treatment options are available at Central Minnesota Dermatology. Physical treatment options are a great way to safely give you the results you are looking for without systemic therapy. Perhaps you are noticing improvements in your acne with your treatment efforts so far but want to augment this and you aren’t comfortable with adding oral medications. Safe acne treatment for pregnant women can be limited and several physical treatment options are safe and may be very helpful. Visit the Acne Services page on our website for more information about each of these options as well as pricing.  

At Central Minnesota Dermatology we are dedicated to understanding your skin care goals. We take the time to listen to your preferences and create a plan alongside you. If you are struggling with acne, schedule an appointment with one of our providers. We can’t wait to meet you! 

 

For more information visit:  

American Academy of Dermatology Association: Acne Resource Center https://www.aad.org/public/diseases/acne 

 

References: 

American Academy of Dermatology Association. 10 Skincare habits that can worsen acne.  https://www.aad.org/public/diseases/acne/skin-care/habits-stop 

Reynolds, R. V., Yeung, H., Cheng, C. E., Cook-Bolden, F., Desai, S. R., Druby, K. M., Freeman, E. E., Keri, J. E., Stein Gold, L. F., Tan, J. K. L., Tollefson, M. M., Weiss, J. S., Wu, P. A., Zaenglein, A. L., Min Han, J., & Barbieri, J. S. (2024) Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology. DOI:https://doi.org/10.1016/j.jaad.2023.12.017