This article was medically reviewed by Hilary Baldwin, MD. Baldwin, medical director of the Acne Treatment Research Center, is a board-certified dermatologist with nearly 25 years of experience. Her area of expertise and interest are acne, rosacea and keloid scars. Baldwin received her BA and MA in biology from Boston University. She became a research assistant at Harvard University before attending Boston University School of Medicine. She then completed a medical internship at Yale New Haven Hospital before becoming a resident and chief resident in dermatology at New York University Medical Center.
Inflammatory Acne: Inflammatory acne is red bumps and pustules, not whiteheads, blackheads and comedones. It doesn't necessarily start as them, either. It arises on its own. Whiteheads, blackheads or comedones that become inflamed can be painful and unsightly. Persistent inflammatory acne may require treatment by a physician or dermatologist, in addition to over-the-counter acne remedies.
Washing your face with regular soap isn't enough to make acne better. The best face wash for acne is effective at removing oil and dirt, but still gentle enough to use regularly without overdrying your skin. Look for topical acne medication ingredients salicylic acid and/or benzoyl peroxide in your face wash and use gentle, nonabrasive cleansing techniques.
What is a pimple in the first place? A pimple is a small comedone, pustule or papule that forms a skin lesion; the more technical term is acne vulgaris. There are numerous causes, but regardless of the cause, pimples develop when the sebaceous glands (oil glands) get clogged and infected from bacteria. This is why pimples swell up and become red, pus-filled lesions on the surface, and just under the surface, of the skin. (2)
The costs and social impact of acne are substantial. In the United States, acne vulgaris is responsible for more than 5 million doctor visits and costs over US$2.5 billion each year in direct costs. Similarly, acne vulgaris is responsible for 3.5 million doctor visits each year in the United Kingdom. Sales for the top ten leading acne treatment brands in the US in 2015, have been reported as amounting to $352 million.
Alternative and integrative medicine approaches used in the treatment of acne include fish oil, brewer's yeast, probiotics, oral zinc and topical tea tree oil. More research is needed to establish the potential effectiveness and long-term safety of these and other integrative approaches, such as biofeedback and traditional Chinese medicine. Talk with your doctor about the pros and cons of specific treatments before you try them.
Like baby acne, eczema is very common in newborns, but it’s usually caused by dry (not oily) skin. Mild eczema can cause lots of small bumps, similar to baby acne. Since it often starts on the cheeks, it’s easy to confuse with baby acne. But, if it spreads into a rash that covers the skin or develops in other areas of your baby’s body, such as the folds of his elbows and knees, then it’s probably eczema, not acne. Eczema isn’t usually serious. You can treat it by using a gentle hydrating lotion on your baby’s skin after bathtime.
Isotretinoin is an oral retinoid that is very effective for severe nodular acne, and moderate acne that is stubborn to other treatments. One to two months use is typically adequate to see improvement. Acne often resolves completely or is much milder after a 4–6 month course of oral isotretinoin. After a single course, about 80% of people report an improvement, with more than 50% reporting complete remission. About 20% of patients require a second course. Concerns have emerged that isotretinoin use is linked with an increased risk of adverse effects, like depression, suicidality, anemia, although there is no clear evidence to support some of these claims. Isotretinoin is superior to antibiotics or placebo in reducing acne lesions. The frequency of adverse events was about twice as high with isotretinoin, although these were mostly dryness-related events. No increased risk of suicide or depression was conclusively found. Isotretinoin use in women of childbearing age is regulated due to its known harmful effects in pregnancy. For such a woman to be considered a candidate for isotretinoin, she must have a confirmed negative pregnancy test and use an effective form of birth control. In 2008, the United States started the iPLEDGE program to prevent isotretinoin use during pregnancy. iPledge requires the woman under consideration for isotretinoin therapy to have two negative pregnancy tests and mandates the use of two types of birth control for at least one month before therapy begins and one month after therapy is complete. The effectiveness of the iPledge program has been questioned due to continued instances of contraception nonadherence.