ACNE

Acne is very common in teenagers and young adults. It occurs when the pores of the skin become clogged and inflamed due to a bacteria called P. acnes—not because of dirt. Over-washing or scrubbing the skin can make things worse. The dark spots left behind by acne are part of the skin’s normal healing process; once the acne is controlled, these spots will gradually fade. There are very effective treatments, and with consistency, you can achieve much clearer, healthier skin.

Acne Regimen AM

• Wash your face gently with your hands and a mild soap or gentle cleanser, rinse and pat dry.
• Apply clindamycin and/or benzoyl peroxide all over the area where you get acne.
• Apply a non-comedogenic moisturizer with a sunscreen (at least SPF 30) as needed.

Acne Regimen PM

• Wash your face gently to remove the day's oils and makeup.
• Apply a retinoid (e.g., tretinoin, adapalene, tazarotene) all over the area where you get acne.
• Apply a moisturizer if needed.

Is my diet part of the problem?

It could be. A healthy diet is important in the treatment of acne. All of the following have been associated with acne flares and should be minimized: milk (especially skim milk), whey protein, ultraprocessed foods (think ice cream, chocolate, sugary drinks, all sweets--anything high glycemic).

What diet should you focus on? More fish, fruits and vegetables, especially ones with vitamin C, e.g. oranges. It has been shown that increased consumption of omega-3 oils reduce acne--which you can get thru seafood consumption or supplementation. You may want to consider taking 1000 mg/day of omega-3 fatty acids (e.g. Nature Made or Nature's Bounty) Note, not all fish oil is omega-3. Make sure to buy omega-3.

More Acne Tips

• Wash your face twice a day but no more, unless you exercise/sweat.
• Using a mild soap, e.g., Dove, is absolutely fine, but if you prefer, a gentle cleanser e.g., CeraVe Face Wash Acne Treatment or Cetaphil Face Wash is great as well. Some cleansers are for oily skin and some for dry. Pick what is best for you. Some cleansers contain salicylic acid which can help as well, as long as it doesn't irritate your skin.
• Don't pick at your face! That often messes up the color of the skin and causes more scarring than the acne itself.
• Don't spot treat. Instead, put the medication all over the area where you get acne. The goal is to prevent acne and maintain clear skin.
• Make sure anything you put on your face is okay for acne-prone skin. Look for that term "non-comedogenic" or "non-acnegenic" or "oil-free".
• For acne along the hairline, cut back on hair conditioners and don't use 2-in-1 (combined) shampoo and conditioners as these products are notorious for causing this problem.
• If you have sensitive skin, you may want to start with just one product and even every other day use for a week or two. Increase to the daily regimen as tolerated.
• Be patient. Give any acne regimen about two to three months to work.
• Keep up the treatment, even when you are better.
• If you have any problem or questions about your acne, please see your dermatologist.

Medications Commonly Used for Acne

• Tretinoin (Retin A) was the first retinoid developed for acne and is excellent at clearing out the blackheads and whiteheads. As with all retinoids, it can burn or sting initially. If this happens, you can do one of two things: 1) Switch to applying every 3rd night and increase as tolerated to daily. 2) Use less each night and, if needed, mix with your moisturizer. Instead of a pea-sized amount, use a rice-sized amount. Gradually increase over weeks to months for either approach until you are able to use the retinoid by itself nightly.
• Differin (adapalene) is the only over-the-counter retinoid and is excellent as well. There is a higher concentration available by prescription. Some find it less irritating than tretinoin.
• Tazarotene is the strongest of the retinoids by a slight margin, but some find it more irritating.
• Clindamycin is an excellent topical antibiotic prescribed for acne. It is applied once or twice a day and may come alone or in combination with benzoyl peroxide.
• Benzoyl Peroxide (BP) is excellent for the pimples of acne and may be applied in the morning instead of or in combination with clindamycin. Make sure to avoid contact with towels, robes, clothing, etc., as BP can bleach out the color, forming white spots (use a white towel). Note, benzene (a carcinogen) can be formed if BP is left in a hot place. To prevent this, keep BP out of the heat. Finally, the leave-on products are stronger than the washes.
• Doxycycline is a pill given for three to four months to control more severe acne. It can make you sensitive to the sun so be very careful especially in the summer. It can upset the stomach so take with food, but no dairy. Take with lots of water and don't take just before going to bed. Rarely, it can stay in the esophagus and cause severe chest pain. (Wait at least 30 minutes before lying down.)
• Minocycline is another pill given for acne and is excellent. Rarely, it can cause dizziness with the first few doses, especially in women, or joint pains. Very rarely it can cause blue spots in the skin, or bruises that don't go away, and if used for years, it can give a bluish color to the teeth and nails.
• Spironolactone is blood pressure medication that at low doses can be excellent for acne in women. Rarely, it can cause dizziness or lightheadedness while standing. Because spironolactone can occasionally cause breakthrough bleeding, it is often given with birth control pills (which prevents the breakthrough bleeding).
• Isotretinoin (Accutane) is the go-to drug for persistent, scarring or treatment-resistant acne. It is taken for four to six months and can cure your acne. But women must absolutely not get pregnant while on it as it can harm the fetus.