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What is acne?
Acne is a common skin condition affecting up to 85% of adolescents and young adults. Acne results when sebum (oil from sebaceous glands) and dead skin cells are clogging the pores (hair follicles) of your skin causing blackheads & whiteheads (comedones). Bacterial growth and inflammation lead to papules and pustules (pimples.) In more severe forms of acne, tender cysts and nodules develop and can cause scarring.
Acne can be managed with over-the-counter and/or prescription medications along with recommended lifestyle changes. There is no cure for acne, but it usually subsides as one ages. If you are committed to treating your acne, plan on most treatment regimens taking at least six to eight weeks for noticeable improvement. Medications applied to the skin are essential for acne management and require consistent use. When acne improves, continue using topical medications to prevent exacerbations of acne
Why do I have acne?
There is no single cause or factor to explain acne, but there are some factors that may increase severity of acne.
- Genetics. You may have relatives with history of acne.
- Stress and hormones. Hormones influence oil production in both sexes and contributes to the onset of acne at puberty. Many women notice acne flares monthly around their period, and using a birth control pill may help control this. Both emotional and physical stress can aggravate acne. While stress is unavoidable, it can be managed by getting enough sleep, making time for exercise and relaxation, eating a well-balanced diet, staying hydrated, limiting alcohol & caffeine, and quitting smoking. Learn more about sleep and helpful strategies for getting better sleep and managing stress.
- Diet. Eating a well-balanced diet with plenty of colorful fruits & vegetables, whole grains and lean proteins is recommended. https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/. Whey & protein supplements can worsen acne.
- Environment and sweat. Sweating with exercise or exposure to hot/humid environments is normal but may contribute to acne breakouts. This is especially true when there is friction or occlusion/pressure against the skin due to clothing, hats, headbands, straps, backpacks, etc. Make a habit of showering with antibacterial soap after periods of increased sweating and washing workout clothing regularly.
- Habits. Picking, scratching, and ‘popping’ pimples worsens acne and increases scarring. Avoid touching your face without first washing your hands.
How can I treat acne?
- Wash your face twice daily (morning and before bed) with a gentle cleanser (i.e. Cerave hydrating cleanser, Cetaphil gentle cleanser, Neutrogena/Aveeno foam cleansers, Purpose bar, Dove, Vanicream cleanser.)
- Seasonal considerations in acne treatment: Acne products which are gels, solutions or liquids are more drying than acne creams & lotions. Gels & solutions may be needed for oily skin and/or during humid summer months, but these drying products can be too harsh for the cold & dry winter months leading to skin irritation, redness, flaking. Acne creams/lotions are typically better choices during the winter. If your skin is sensitive or not very oily, acne creams & lotions are used throughout the year.
- Choose skin products that are “non-comedogenic” (will not clog pores) for sunscreen, moisturizing lotion and cosmetics. Hair products and lip balms may contribute to acne. If you have breakouts around your chin/mouth, avoid use of chapstick/lip balm at bedtime.
- For non-facial acne (i.e. back, chest,) wash with an antibacterial soap daily. Apply an acne cleanser to a back brush/washcloth/loofah, gently rub onto affected skin, wait 5 minutes before rinsing thoroughly. (i.e. Panoxyl Creamy Wash, Neutrogena Deep Clean gel cleanser or Mederma Aqua glycolic acid wash).
Over-the-counter (OTC) topical medications
Drying and antibacterial (dry skin/absorb oil, decrease bacteria)
- Benzoyl Peroxide: Apply to acne-prone skin once or twice daily (2.5% – 5% gel/cream for face, and 8- 10% body wash for back/chest acne.)
- Antibacterial soaps
Exfoliant (slough dead skin to prevent clogged pores, smooth skin, reduce appearance of scars)
- Salicylic acid 1-2% (i.e. Neutrogena Deep Clean gel cleanser)
- Sulfur bar soap
- Sulfur lotion or cream (i.e. Kate Sommerville Acne 4%sulfur lotion, Proactiv Mask.)
- Sulfur combined with 2% Resorcinol (i.e. Acnomel cream; or for oily skin use Rezamid lotion)
- Use morning and/or night
- May apply to acne-prone skin, leave on for 30 – 60 minutes daily, then rinse.
- Products are tinted and have a scent which may not be acceptable to you if worn throughout the day.
- Alpha-hydroxy acids (AHA) (i.e. Mederma Aqua glycolic wash)
- Adapalene 0.1% cream or gel (i.e. Differin)
- Apply small amount to acne-prone facial skin at bedtime/night.
- This product can cause redness, flaking of skin, so begin using this only twice weekly for first 2 weeks, then 3 times weekly for two weeks, and gradually increase to nightly.
- This product diminishes common scarring from previous acne lesions.
- Use of this product increases sun sensitivity, so use an SPF 30 sunscreen each morning and re-apply during the day if you are outdoors, even at football games on cool fall days or when skiing in the winter.