The approach to acne treatment underwent significant changes during the twentieth century. Retinoids were introduced as a medical treatment for acne in 1943. Benzoyl peroxide was first proposed as a treatment in 1958 and has been routinely used for this purpose since the 1960s. Acne treatment was modified in the 1950s with the introduction of oral tetracycline antibiotics (such as minocycline). These reinforced the idea amongst dermatologists that bacterial growth on the skin plays an important role in causing acne. Subsequently, in the 1970s tretinoin (original trade name Retin A) was found to be an effective treatment. The development of oral isotretinoin (sold as Accutane and Roaccutane) followed in 1980. After its introduction in the United States it was recognized as a medication highly likely to cause birth defects if taken during pregnancy. In the United States, more than 2,000 women became pregnant while taking isotretinoin between 1982 and 2003, with most pregnancies ending in abortion or miscarriage. About 160 babies were born with birth defects.
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The earliest pathologic change is the formation of a plug (a microcomedone), which is driven primarily by excessive growth, reproduction, and accumulation of skin cells in the hair follicle. In normal skin, the skin cells that have died come up to the surface and exit the pore of the hair follicle. However, increased production of oily sebum in those with acne causes the dead skin cells to stick together. The accumulation of dead skin cell debris and oily sebum blocks the pore of the hair follicle, thus forming the microcomedone. This is further exacerbated by the biofilm created by C. acnes within the hair follicle. If the microcomedone is superficial within the hair follicle, the skin pigment melanin is exposed to air, resulting in its oxidation and dark appearance (known as a blackhead or open comedo). In contrast, if the microcomedone occurs deep within the hair follicle, this causes the formation of a whitehead (known as a closed comedo).
A BHA product often cited includes salicylic acid, it must be between a pH between 3 and 4 to work. A BHA works to slough (to get rid of) off dead skin cells and encourage new skin growth. As a result, you may experience dry skin and scaliness around your acne, but this will dissipate over time as your skin begins to regenerate faster. Use this in a cleanser or spot treatment daily on the acne-affected areas of your skin.
The recognition and characterization of acne progressed in 1776 when Josef Plenck (an Austrian physician) published a book that proposed the novel concept of classifying skin diseases by their elementary (initial) lesions. In 1808 the English dermatologist Robert Willan refined Plenck's work by providing the first detailed descriptions of several skin disorders using a morphologic terminology that remains in use today. Thomas Bateman continued and expanded on Robert Willan's work as his student and provided the first descriptions and illustrations of acne accepted as accurate by modern dermatologists. Erasmus Wilson, in 1842, was the first to make the distinction between acne vulgaris and rosacea. The first professional medical monograph dedicated entirely to acne was written by Lucius Duncan Bulkley and published in New York in 1885.
Any acne treatment is a weeks-long experiment that you’re conducting with your skin. Acne is slow to heal, and in some cases, it can get worse before it gets better (nearly every benzoyl peroxide product we looked at emphasized the likeliness of irritating acne further, and starting off with a lighter application). April W. Armstrong, a doctor at the University of California Davis Health System, recommends waiting at least one month before you deem a product ineffective.
The Daily Skin Clearing Treatment is an all-over 2.5 percent benzoyl peroxide cream that also touts calming bisabolol and allantoin to alleviate the dryness and irritation that can crop up mid-treatment. Anyone frustrated with oil-slick skin will also love this part of the regimen — it creates a satin mattifying effect, instantly transforming shininess into a glow.
Acne scars are caused by inflammation within the dermal layer of skin and are estimated to affect 95% of people with acne vulgaris. The scar is created by abnormal healing following this dermal inflammation. Scarring is most likely to take place with severe acne, but may occur with any form of acne vulgaris. Acne scars are classified based on whether the abnormal healing response following dermal inflammation leads to excess collagen deposition or loss at the site of the acne lesion.
If your baby still has acne at 3- to 6-months-old, infantile acne may be the culprit. “These bumps tend to be more red and inflammatory,” says Dr. Kahn. “You’ll see more of the different types of acne than with baby acne, including pustules and cysts, not just whiteheads and blackheads.” And unlike baby acne, infantile acne is linked to family history: Your baby is more likely to get it if you or your partner had severe acne as a teen. Acne in older babies can also be an indication that your baby is more likely to have acne later in life. Like baby acne, infantile acne rarely needs treatment; if there’s a lot of redness and swelling, however, your doctor might want to treat it with a topical antibiotic.
This content is strictly the opinion of the author, and is for informational and educational purposes only. It is not intended to provide medical advice or to take the place of medical advice or treatment from a personal physician. All readers of this content are advised to consult their doctors or qualified health professionals regarding specific health questions.
Dermatologists aren’t sure why azelaic acid is so effective at clearing up inflammation, but it’s often used as an option for sensitive skin or pregnant patients. Linkner says the ingredient is good at treating malasma, acne, and rosacea. Your dermatologist can prescribe a foam product with azelaic acid, and you can also find beauty products with very small amounts of this active ingredient.
Hormonal fluctuations and an imbalance of estrogen and testosterone levels have proven to be a direct cause of acne. For this reason, many experience an onslaught of breakouts during puberty and pregnancy. The brain releases a GnRH hormone when an adolescent begins puberty, which in turn signals the pituitary gland to release two additional androgens. Androgens make the sebaceous glands produce more sebum, causing it to occupy too much space within the pore and preventing the full expulsion of dead skin cells and debris. Fluctuations in hormones also cause many women to experience acne during pregnancy and a worsening of breakouts during menstrual cycles.
Topical treatments on their own may not be enough to give you clear skin, especially in those with complicated, inflammatory cystic acne. There are several acne medication options approved for use by the FDA, but which one is best for you is a question for your dermatologist and/or general practitioner. Baldwin says if you have insurance and you have acne, a prescription may be the best step because "it makes no sense to try to handle the condition yourself or to use over the counter products that are always less effective than prescriptions meds." Here are a few of the acne medications you'll want to ask about:
When blocked pores become increasingly irritated or infected, they grow in size and go deeper into the skin. If pimples get trapped beneath the skin’s surface, they can form papules: red, sore spots which can’t be popped (please don’t try! Squeezing the oil, bacteria, and skin cell mixture can result in long term scars that may be unresponsive to acne treatments). They’re formed when the trapped, infected pore becomes increasingly inflamed and irritated, and they usually feel hard to the touch. Papules are small (less than 1 centimeter in diameter) with distinct borders; when clusters of papules occur near each other, they can appear as a rash and make your skin feel rough like sandpaper. Because they’re inaccessible, they’re a bit more difficult to treat, and are therefore considered moderately severe acne.
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Benzoyl peroxide (BPO) is a first-line treatment for mild and moderate acne due to its effectiveness and mild side-effects (mainly skin irritation). In the skin follicle, benzoyl peroxide kills C. acnes by oxidizing its proteins through the formation of oxygen free radicals and benzoic acid. These free radicals are thought to interfere with the bacterium's metabolism and ability to make proteins. Additionally, benzoyl peroxide is mildly effective at breaking down comedones and inhibiting inflammation. Benzoyl peroxide may be paired with a topical antibiotic or retinoid such as benzoyl peroxide/clindamycin and benzoyl peroxide/adapalene, respectively.
Diet. Studies indicate that certain dietary factors, including skim milk and carbohydrate-rich foods — such as bread, bagels and chips — may worsen acne. Chocolate has long been suspected of making acne worse. A small study of 14 men with acne showed that eating chocolate was related to a worsening of symptoms. Further study is needed to examine why this happens and whether people with acne would benefit from following specific dietary restrictions.