acne or pimples

Acne. This just affects teenagers, right? Wrong.

While acne and breakouts are principally seen in pre-adolescents and teenagers, it is increasingly seen in adults through age 40. While hormonal changes are usually the main cause of teen acne, there are a number of other factors than can cause acne including both internal and external issues including how you care for your skin, diet, where you live and more. Don’t reach for those over-the-counter products until you educate yourself.

What causes acne?

There are the three main causes of acne.

Follicle plugging causing clogged pores. Dead skin cells and debris accumulate in the hair follicle, which causes a traffic jam of sorts, resulting in the formation of comedones, different types of pimples more commonly known as and appear as blackheads and white heads.

Hormonal changes. As already mentioned, during our teen years, we experience increased sebum or oil production from sebaceous glands which makes skin look and feel oilier. Androgens (natural hormones in the body) including testosterone and its derivatives, skyrocket during adolescence. Boys’ voices change, facial hair appears, so does acne and excess oil.

Hormonal acne If you notice your acne flares up with your menstrual cycle, consider speaking with a dermatologist or your primary care provider about how birth control pills, with both estrogen and progestin, as well as a safe oral medication called spironolactone, can help your acne.

Forehead acne Forehead acne is different from other forms of acne because it is often caused by personal care products (hair oils or gels) or sports helmets or baseball caps.

If you wear a helmet or baseball cap regularly, clean the inside of the helmet as through that cap in the wash. Cleanse your face with a benzoyl peroxide or salicylic acid-based cleanser before and after wearing sports head gear, hats or caps.

Avoid using oil-based treatment or styling products in the hair. Try glycerin-based products instead. If you want to continue using oil, apply only to ends of hair and the middle of the scalp away from the forehead.

Acne of the chest and back (sometimes known as “Backne”).

Acne of the chest and back can be especially difficult to treat. Products containing benzoyl peroxide, salicylic acid, and sulfur are critical for these areas. You will likely need someone to help you apply these products as the affected areas are usually difficult to reach. Invest in a lotion applicator for the hard to reach areas of your back. You should also discuss treatment options with your primary care doctor or Board-certified dermatologist such as using oral antibiotics like Doxycycline, topical antibiotics such as Clindamycin, Isotretinoin

Here are a few other treatment tips for acne in this area.

  • Resist the temptation to pick at, squeeze or pop acne spots. This can cause an infection, spread the acne and leave scarring.
  • Avoid friction on your back, such as weight from a heavy backpack. This will further irritate the area.
  • Wash workout clothes after every use.
  • Shower immediately after exercise.
  • Wear loose-fitting shirts.

Nodulocystic acne

Nodulocystic acne is the most severe type of acne and the type that is most likely to scar. Consider speaking to a dermatologist about starting a treatment regimen of Isotretinoin. If this is not an option for you, a strict everyday routine including topical Tretinoin, topical antibiotics, and oral antibiotics is necessary to prevent permanent acne scarring. Always avoid picking or popping acne lesions as this can lead to scarring.

Adult female acne

Acne in adult women is becoming more and more common. Usual locations for this acne include the jaw line and chin. It is especially important, with this type of acne, to avoid harsh scrubbing and manipulation or picking of acne lesions, as these factors will worsen acne. Try to keep cell phones, office phones and hands away from your face as much as possible. Use earphones and pods instead.

Medication-induced acne

There are several medications that are known to cause acne. If you are taking any of the following prescription medications, consider speaking to your physician about switching or stopping them. Never stop a prescription medication before speaking to your physician.

Common medications that cause acne: Anabolic steroids, Lithium, Isoniazid, Prednisone, and Phenytoin, Vitamin B6 and B12.

Acne Fulminans

This is the most severe type of acne, characterized by crusty, bleeding cystic acne lesions with associated fevers, malaise, bone, muscle and joint pains. Please see a dermatologist in person immediately to prevent severe scarring and bone lesions associated with this condition. You will likely require Accutane, along with a short course of oral steroids.

When should I see a Dermatologist?

Acne can be frustrating and hard to treat, depending on the type you are dealing with. Your primary care provider can recommend a board-certified dermatologist.If you have been to a dermatologist in the past and acne medications haven’t seemed to work for you, here are some things to consider:

  • Often people apply an acne treatment for less than a month before deciding it doesn’t work. Most acne treatments require 2 to 3 months (some even 6 to 10 months) of everyday use to show treatment benefits and effects.
  • Acne treatments are often mistakenly applied as “spot treatments” to active acne, when they should really be applied to all acne-prone areas.
  • Many acne sufferers stop their treatments because they irritate their skin. Please contact your dermatologist about alternative acne treatments that are safe to use on sensitive skin.
  • Once a course of treatment is completed there may be dark spots, or post inflammatory hyperpigmentation, on affected areas, apparent on the surface of the skin. These should fade over time which can be a period of months to years.
What can I do at home to improve my acne?
Practice some basic every day and at-home tips.
  • Don’t touch your face! Don’t pick, pop, or rub acne as this will make it worse.
  • Frequently wash pillowcases, hats, and other items that touch your acne.
  • Consider changing your sheets weekly and pillowcases two to three times weekly.
Monitor your diet.
  • Avoid milk, especially skim milk, as it has been associated with acne.
  • Avoid whey protein supplements as these have been shown to fuel acne flareups.
  • Avoid processed foods. Look at your food labels. If there are several ingredients on it you don’t recognize, this is probably a processed food. 
  • Consider shredding your own cheese. Shredded cheese contains many additives including cellulose, which is made from cotton and wood pulp.
  • Cook at home as much as possible but especially avoid chain restaurants as the ingredients are more likely to be heavily processed.
  • Visit your local farmer’s market weekly. There is nothing but whole and healthy foods there.
  • Consider a low glycemic index diet that limits foods that will raise your blood sugar. It is a healthy way to eat and will help control your acne. Stop eating sugar. This includes soda, candy, chocolate, juices, breakfast pastries, cookies, cakes, and most cereals. Avoid simple carbohydrates. This includes bread, bagels, pasta, cereal, pizza, and beer. Eat more protein and fat along with plenty of vegetables, some fruits, and more complex carbohydrates such as whole grain breads, lentils, and beans.
Wear the appropriate makeup and personal care products
  • Avoid heavy lotions (Vaseline, cocoa or shea butter), makeup, or foundations as these can clog pores. Consider mineral-based makeup instead.
  • Only use lotions, sunscreens, and makeup that are non-comedogenic.
  • Shampoo regularly to prevent oils from your hair making your acne worse.
  • Avoid hair treatment oils, opting for glycerin-based products instead.
  • If you need to use hair oil, don’t apply it near your forehead and only apply at the ends of your hair.
Find a personalized skincare routine that is right for your specific skin type and needs
  • Wash your face twice daily and after sweating.
  • Remove all makeup before going to bed.
  • Avoid any harsh scrubs, toners, astringents, or exfoliants that can further irritate acne.

A gentle daily cleanser to wash away dirt and oil, allowing pores to breathe, lessening redness and irritation. And, with our newest fashion accessory, facial masks, more sweat and dirt will get caught in pores.