Retinoids and retinoid-like drugs. These come as creams, gels and lotions. Retinoid drugs are derived from vitamin A and include tretinoin (Avita, Retin-A, others), adapalene (Differin) and tazarotene (Tazorac, Avage). You apply this medication in the evening, beginning with three times a week, then daily as your skin becomes used to it. It works by preventing plugging of the hair follicles.
Exfoliating cleansers and masks: A variety of mild scrubs, exfoliants, and masks can be used. These products may contain salicylic acid in a concentration that makes it a very mild peeling agent. These products remove the outer layer of the skin and thus open pores. Products containing glycolic or alpha hydroxy acids are also gentle skin exfoliants.
The medical term for pimples or acne is “acne vulgaris”. For years it has been postulated that hormones and medication can cause acne. According to Ref.1 there are several steps that work together in causing acne. The hair follicle and sebaceous gland work as one unit. Male hormones, called androgens play an important role in the development of acne, both in males and females. Testosterone in males is not only produced in testicles, but also in the skin itself. It gets converted by an enzyme, 5-alpha-reductase, into the much more active metabolite dihydrotestosterone. In individuals with hypersensitive receptors in the sebaceous gland this will cause blockage in the sebaceous gland duct and at the same time stimulate the sebaceous gland oil production leading to the formation of a keratotic plug. White heads and black heads are formed this way. Contributing factors are inflammatory substances that are caused by insulin release stimulated by sugar, wheat and starch intake. This stimulates IGF-1 receptors in the skin, which causes growth of the subcutaneous skin layers, which is pushing up from the layer below the skin, kinking the sebaceous gland duct and causing acne pustules (pimples) to form. A skin bacterium, called Propionibacterium acnes (P. acnes), is getting trapped in the pimple causing a local skin infection, which in turn can cause acne cysts and furuncles, particularly in males where there is a family history of acne. High cortisol levels from stress can also be a contributing factor in causing acne. Today’s teenagers are exposed to a lot of stresses from exams, competitive sports and
A doctor’s prescription is required to obtain antibiotics. The antibiotics listed on this page were available in New Zealand in April 2014. Other antibiotics or brand names are available on prescription in other countries.
Reed says she advises patients to look for “noncomedogenic” or “for acne-prone skin” products. Noncomedogenic products don’t contain ingredients that tend to clog pores in people with acne-prone skin.
A randomized controlled trial with 128 women showed a reduction in acne lesions of 63% with 35 μg ethinylestradiol and 3 mg drospirenone and a 59% reduction with 35 μg ethinylestradiol and 2 mg cyproterone acetate.34 Antiandrogen therapy is usually needed for at least three to six months to see significant improvement.
The major symptoms and signs of cystic acne include red tender, elevated soft bumps on the face, chest, and/or back. Some of these may be surmounted by one or more pustules. Generally, such lesions are tender and painful.
Systemic antibiotics are indicated for moderate to severe acne and should be used in combination with topical retinoids. However, monotherapy of systemic antibiotics isn’t a mainstay therapy because of the resistance developing against antibiotics and the reported correlation between systemic antibiotics and the development of inflammatory bowel disease, pharyngitis, and Clostridium difficile infections. Patients who have started systemic antibiotics should be reevaluated every 3 to 6 months and have their use discontinued as early as possible.
Alhusayen RO, Juurlink DN, Mamdani MM, Morrow RL, Shear NH, Dormuth CR, et al. Isotretinoin use and the risk of inflammatory bowel disease: a population-based cohort study. J Invest Dermatol. 2013 Apr. 133 (4):907-12. [Medline].
Medication isn’t the only thing you put in your mouth that could be affecting your acne. Studies have found that excess insulin from foods with a high glycemic index, like packaged foods as well as pasta, bread, and rice, may play a role in the effects of androgens (like oil-encouraging testosterone) on acne. Meanwhile, foods that are heavy in hormones, like dairy products, are often at the top of the list of things dermatologists recommend cutting out for clearer skin. “Milk naturally contains a great number of hormones — there is no such thing as hormone-free milk,” says William Danby, an assistant professor of dermatology at the Geisel School of Medicine at Dartmouth, who has published many studies about diet and skin. Danby advises acne patients to cut down on dairy and eliminate straight-up milk altogether.
Isolaz. This treatment combines a vacuum with a broadband light. The vacuum cleanses pores and extracts excess oil, while the light helps destroy the acne-causing bacteria as well as reducing the activity of the oil gland.