In this article
What Causes Acne?
Regardless of your age, gender, skin color, or ethnicity, what causes acne is the same for everyone, and understanding what causes it will go a long way toward helping you finally have clear skin.
The most important fact about acne is that it's an inflammatory disorder. As a result, almost everything you do to make it go away must reduce or eliminate inflammation. Yet, shockingly, countless anti-acne products contain ingredients that cause further inflammation, actually making acne worse!
Keeping the inflammation factor in mind, there is a whole series of skin factors that create the perfect environment for acne. Understanding what interrupts or stops this sequence of events from taking place will allow you to create a successful anti-acne skin-care routine at any age.
Speaking of age, when it comes to acne, age doesn't matter. Regardless of how old you are, what reduces breakouts is the same, whether you're 15, 25, 35, 45, or 55!
- Hormonal activity (primarily from androgens, male hormones).
- Inflammation (there's that word again).
- Overproduction of oil by the sebaceous (oil) gland. Your oil glands are an important site for the formation of active androgens that control oil production.
- Irregular or excessive shedding of dead skin cells, both on the surface of the skin and inside the pore.
- Buildup of bacteria in the pore, leading to inflammation.
- Sensitizing reactions to makeup, irritating skin-care ingredients, specific foods (rarely), allergies, or medicines.
How Are Blemishes Created?
Inside an oil gland a type of bacteria called Propionibacterium acnes (P. acnes) finds a perfect environment for growth. Dead skin cells and excess oil in the oil gland provide just the kind of conditions that P. acnes needs to thrive. As this bacteria settles in, thanks to an abundant supply of sebum (oil), it reproduces, which causes irritation and inflammation. That's why most blemishes are red and swollen, although that doesn't explain why some of the worst blemishes seem to show up just before an important event! Interestingly, research has shown that certain strains of p. acnes bacteria may help prevent acne while others cause it! When things are going well, the sebum smoothly leaves the pore and imperceptibly melts on the skin's surface, helping to keep the skin surface moist and smooth. When things aren't going well, the pore becomes plugged with sebum, tiny hairs, and dead skin cells. When this happens, the bacteria run amok. In response, your body produces an abundance of white blood cells, which arrive at the site to fight the bacteria. Inflammation sets in as dead bacteria and dead white blood cells accumulate (resulting in pus), and a blemish seemingly pops out of nowhere. Before you learn how to treat these unwelcome intruders, let's go over a few misconceptions.
Myths That Make Matters Worse
There are four major myths about skin care you must unlearn because they only increase breakouts and make your oily skin worse.
Myth #1: You can dry up blemishes. Water is the only thing you can "dry up," and a blemish has nothing to do with skin being wet. Drying up the water and other moisture-binding contents in skin hurts its ability to heal and fight inflammation, and actually encourages bacterial growth. Absorbing oil that's on the skin's surface or in the pore is radically different from "drying up" skin with harsh ingredients.
Myth #2: Blemishes are caused by dirty skin. This mistaken belief often leads to over-cleaning of the face with soaps and strong detergent cleansers. That only increases the risk of irritation and dryness, and does nothing to prevent blemishes. It's also the perfect recipe for creating skin that feels dry and tight underneath, but is oily on top.
Myth #3: You can spot-treat blemishes. Although you can reduce the redness and swelling of a blemish with a salicylic acid (BHA)–based product or with a benzoyl peroxide–based product (both explained below), that doesn't treat the cause of the acne. Dealing with only the blemishes you see means you are ignoring the blemishes that are in the process of forming. As you may have guessed, this leads to a never-ending cycle of chasing blemishes around your face. Spot-treating tends to work best for those whose breakouts are infrequent and localized rather than ongoing and all over the face.
Myth #4: If it tingles it must be working. Ingredients that make your skin tingle, like alcohol, menthol, peppermint, eucalyptus, and lemon, show up in countless acne products, yet there is no research showing they have any benefit for acne or oily skin. These ingredients are irritating to skin, and only make matters worse! Irritating the skin triggers stress-sensing nerve endings at the base of the pore, which in turn stimulate oil production.
What You Shouldn't Do
There are basics for fighting breakouts that are essential if you are going to have any chance of getting clear skin, but there also are things that anyone struggling with acne should avoid. For example, don't do any of the following:
- Don't use harsh or irritating skin-care products. Treating acne-prone skin gently is the best way to go.
- Don't wash your face with bar soaps or bar cleansers of any kind. Soap is drying, and the ingredients that hold bar soaps in their bar form clog pores.
- Don't pick at blemishes! You can "pop" a pimple, but how you do it makes all the difference between healing and scarring. Anything other than that means unsightly scabs, which turn into scars that are hard to heal.
- Don't use extreme heat or cold to clean your face or treat a blemish. Hot compresses or ice cubes are not the way to treat acne or to encourage healing; they cause inflammation, and that makes acne worse. Pores do not open and close with hot or cold water.
- Don't apply thick, waxy hair-styling products, or hairspray, especially if your hair usually touches your forehead. The ingredients in these products can clog pores if they get on your skin.
What You Can Do!
Following are the basics for treating breakout-prone skin so you can get your acne under control.
Gentle Cleansing Gentle cleansing is a vital first step. A mild, water-soluble cleanser helps reduce oily skin and acne without making your skin feel dry and tight.
Exfoliate with Salicylic Acid Salicylic acid, also known as beta hydroxy acid (BHA), is an amazing multifunctional ingredient that treats acne in several ways. It not only has potent anti-inflammatory properties, but also exfoliates to remove built-up dead skin cells on the surface of the skin as well as inside the pore. Salicylic acid also has antibacterial properties.
Disinfect Skin with Benzoyl Peroxide Benzoyl peroxide is considered the most effective over-the-counter choice for a topical antibacterial agent in the treatment of blemishes. It penetrates into the pore and kills acne-causing bacteria, preventing inflammation. Benzoyl peroxide has a low risk of irritation and it does not have the potential to create bacterial ance, which is characteristic of some prescription topical antibiotics and some antibacterial agents.
Alternative Acne Treatments
Experimenting with what works is an important way to create an anti-acne routine that works for you. A gentle, non-irritating skin-care routine is vital, but not everyone can tolerate or find success using the gold standards of benzoyl peroxide and salicylic acid. There are other options worth investigating, so let's go over these alternatives.
Tea Tree Oil has some interesting research demonstrating it to be an effective antimicrobial agent, although it's not without its drawbacks.
Niacinamide and nicotinic acid are derivatives of vitamin B3. There are a handful of studies showing they can be helpful for improving the appearance of acne, which most likely is the result of their anti-inflammatory properties.
Prebiotics and Probiotics. In vitro research has shown that prebiotics and probiotics have some activity against the bacteria that lead to inflammatory conditions such as acne.
Fatty Acids are an interesting group of ingredients that can have an effect on breakouts, but exactly what that effect is, either positive or negative, is not clear.
Sulfur can have some benefit as a disinfectant for breakouts. However, compared with other options, it is an overly strong ingredient for use on the skin, causing more irritation than needed to fight acne-causing bacteria. For this reason, using sulfur to manage acne has largely fallen out of favor.
Diet can have both a positive and negative effect on acne. Certain reactions to food can cause blemishes, while others may help reduce their occurrence
Makeup can be a causative factor for acne. This mostly has to do with not removing your makeup thoroughly each night or using thick, occlusive makeup to cover up acne.
When Over-the-Counter Options Fail
Despite some really great over-the-counter options, sometimes acne just won't give up easily. In those situations, you don't need to keep spending money on product after product—you need to see a dermatologist! There are numerous prescription options from dermatologists, but the rule of not irritating your skin should remain at the top of your list!
Prescription topical antibiotics. There are several topical antibiotics to consider; the main ones to discuss with your dermatologist are erythromycin, clindamycin, minocycline, and tetracycline.
Oral antibiotics can be extremely effective in controlling acne, but as effective as they are, they also pose serious risks that you must consider.
Dapsone is a topical disinfectant gel available by prescription in 5% strength. The brand name for this anti-acne drug is Aczone, and it is made by Allergan (of Botox fame).
Azelaic acid is believed to work against acne-causing bacteria in concentrations of 15%–20%, and it may also pack an anti-inflammatory punch.
Retinoids such as prescription tretinoin (Retin-A, Avita, Atralin, and generics) and other vitamin A derivatives such as tazarotene (Tazorac, Avage) and adapalene (Differin) can play a significant role in an acne treatment routine.
Oral supplements, including various vitamins, herbs, or minerals of any kind or in any combination have little research proving they help reduce breakouts.
Birth control pills (some types) have been shown to reduce acne lesions and oil production, in part by decreasing androgens (male hormones), which are largely responsible for causing blemishes.
What About My Oily Skin?
Acne and oily skin almost always go hand-in-hand, but controlling oil production is difficult. Topically, there is very little you can do to change how your body produces oil. Oral birth control pills can be helpful in this regard, but they don't work for everyone and, of course, aren't advised for men struggling with oily skin. However, because oil production also can be stimulated by irritation on the surface of the skin, eliminating anything that irritates the surface of your skin without imparting a benefit is critical.
From a skin-care point of view, absorbing oil with clay masks works well as a temporary fix, as long as the mask doesn't contain irritating ingredients. Turning to makeup, powders, mattifying foundations, and oil-absorbing primers are all options worth test driving to see how they work for you.
The Battle Can Be Won!
As you've seen, there are numerous options available to manage, and in some cases eliminate, acne. Gentle, effective skin-care products with proven anti-acne ingredients are the best place to start, followed by avoiding any source of needless irritation. From there, you can consider various prescription options and alternative therapies in conjunction with a skin-care routine you follow consistently. With patience and perseverance, you can gain control of your acne and have the clear, blemish-free skin you want!
Sources: Journal of Investigative Dermatology, January 2013, ePublication; Biomaterials, August 2009, pages 6035–6040; Dermatologic Clinics, January 2009, pages 33-42; Advances in Biochemical Engineering/Biotechnology, volume 111, 2008, pages 1–66; Journal of Drugs in Dermatology, December 2008, pages 1149–1152; January 2008, pages 13–16; October 2007, pages 981–987, and September 2007, pages 878–880; Lipids in Health and Disease, October 2008, page 36; Journal of Reproductive Medicine, September 2008, pages 742–752; Seminars in Cutaneous Medicine and Surgery, September 2008, pages 170–176 and pages 183–187; British Journal of Dermatology, August 2008, pages 480–481, February 2008, pages 208–216, January 2008, pages 122–129, March 2007, pages 428–432, and May 2000, pages 885–892; Archives of Dermatological Research, July 2008, pages 311–316; American Journal of Clinical Dermatology, June 2008, pages 369–381, and June 2004, pages 459–462, and 2001, volume 2, issue 4, pages 263–266; Expert Opinions in Pharmacotherapy, April 2008, pages 955–971; Dermatology Therapy,– March-April 2008, pages 8695; Cutis, August 2008, pages S5–S12, February 2008, pages 171–178, January 2008, pages 81–86; November 2007, pages 400–410, and July 2006, supplemental pages 34–40; Antisepsis, Disinfection, and Sterilization, by Gerald E. McDonnell, 2007, ASM Press, page 135; Clinical Therapy, June 2007, pages 1086–1097; Journal of the American Academy of Dermatology, March 2007, pages e10–e20, and August 2000, supplemental, pages 47–50; Journal of Cosmetic Laser Therapy, June 2006, pages 96–101; International Journal of Cosmetic Science, February 2007, pages 63–64; Skin Pharmacology and Physiology, May 2006, pages 283–289; Journal of Trace Elements in Medicine and Biology, January 2006, pages 3–18; Dermatologic Therapy, 2004, volume 17, supplemental 1, pages 16–25; Clinical Dermatology, September-October 2004, pages 360–366; Journal of Cosmetic Dermatology, April 2004, pages 88–93; Journal of Cosmetic Science, January-February 2004, pages 65–80; Dermatology, January 2003, pages 17–23; Journal of the European Academy of Dermatology and Venereology, December 2001, page 43; Journal of Ethnopharmacology, November 2001, pages 99–102, and December 1995, pages 127–132; Cosmetic Dermatology, October 2001, pages 65–72; Medical Electron Microscopy, March 2001, pages 29–40; Journal of Cutaneous Medical Surgery, January 2001, pages 37–42; Archives of Dermatology, November 2000, pages 1390–1395; International Journal of Dermatology, January 2000, pages 45–50; The Medical Journal of Australia, October 1990, pages 455–458; and Seminars in Dermatology, December 1990, pages 305–308.