\u201cWhat that triggers is more of an inflammatory cascade, which then you\u2019ll get more bacteria, more inflammation,\u201d Dr. Fine added.<\/p>\n
No simple solution for acne
\n\u201cThere is no cookie cutter treatment for acne\u2014not everyone gets the same four ingredients or products,\u201d Dr. Fine said. \u201cSo, doing a good physical exam and a full history will enable you to figure out what\u2019s best.\u201d<\/p>\n
\u201cGuidelines stratify treatment options for acne vulgaris depending if the acne is mild, moderate or severe and where the acne is located on the body,\u201d Dr. Johnson-Jahangir said. \u201cMild acne is often treatable using an over-the-counter acne cleanser that contains benzoyl peroxide, which reduces acne-causing bacteria like Propionibacterium acnes and breaks down clogged pores.<\/p>\n
\u201cNewer formulations can be more moisturizing and less irritating,\u201d she said, noting \u201cbenzoyl peroxide is often combined with a topical retinoid medication that ranges from over-the-counter adapalene to a variety of prescribed options.\u201d<\/p>\n
Additionally, \u201cretinoid creams are best for \u2018comedonal acne\u2019 that appear as small bumps or pores filled with dead skin cells,\u201d Dr. Johnson-Jahangir said. \u201cTopical antibiotics, usually clindamycin, when used, should only be used in combination with benzoyl peroxide to prevent antibiotic resistance that rapidly develops when topical clindamycin is used alone.\u201d<\/p>\n
\u201cFor moderate or severe acne, oral antibiotic medication can be considered for a brief course to provide quicker relief by more rapidly reducing skin inflammation for clearing deeper bumpy skin lesions,\u201d she said. But \u201cwe don\u2019t use oral antibiotics long term due to health risks such as altered microbiome and antibiotic resistance.\u201d<\/p>\n
\u201cWhen a hormonal trigger is identified, select oral contraceptive medications or androgen reducing medication such as spironolactone is considered,\u201d Dr. Johnson-Jahangir said. \u201cOral isotretinoin is offered for moderate or severe acne in many situations when other treatments are ineffective or not tolerated, to address incipient scarring, psychosocial distress or other needs.\u201d<\/p>\n
Prior authorization can delay care
\nThe downside is there can be some disruptions to care due to prior authorization.<\/p>\n
\u201cFor some insurances, it can be a step process to get to and some of the requirements are illogical and inappropriate,\u201d Dr. Johnson-Jahangir said. For example, \u201csome of them require prescription of oral antibiotics for mild acne in order to get a retinoid cream, which is illogical because the proper treatment is not antibiotics, and they are riskier.\u201d<\/p>\n
\u201cSo, there\u2019s some insurance required processes for some of them that are not what you would think makes sense and not in step with treatment guidelines,\u201d she said. \u201cUnfortunately, it just highly depends on the type of insurance, which can vary for different states and regions.<\/p>\n
\u201cAnd for each insurance, sometimes there\u2019s no prior authorization, sometimes there is and sometimes there\u2019s step therapy requirements. It just varies,\u201d Dr. Johnson-Jahangir added.<\/p>\n
Treatment doesn\u2019t cause IBD
\n\u201cOral isotretinoin, commonly known as Accutane, has been used for the effective treatment of severe acne for over 30 years,\u201d Dr. Johnson-Jahangir said.<\/p>\n
But while questions around the association between inflammatory bowel disease (IBD) and certain acne medications come up a lot, this association is simply \u201cnot true,\u201d Dr. Fine said, noting \u201ca recent meta-analysis from 2022 looked at this very question and there is not an association.\u201d<\/p>\n
\u201cThe American Academy of Dermatology has concluded there is not enough evidence to show a relationship between taking isotretinoin and getting IBD,\u201d Dr. Johnson-Jahangir said. \u201cIt\u2019s possible there is a relationship between having acne and getting IBD, and this is an area of research.<\/p>\n
\u201cDermatologists continue to prescribe isotretinoin safely for appropriate patients,\u201d she added.<\/p>\n
There are some side effects
\n\u201cCommon side effects of many topical acne medications are tendency to cause skin irritation that can limit tolerability,\u201d Dr. Johnson-Jahangir said. That is why \u201cit can take finesse and practice to optimize use.\u201d<\/p>\n
\u201cA physician and their team can help give best instructions for use to help manage expected effects and set up for success,\u201d she said, noting \u201coral medications should be prescribed under the care of a physician who will address each medication\u2019s specific concerns.\u201d<\/p>\n
\u201cMost commonly used medications are well tolerated, but some do have potentially serious risks to consider,\u201d Dr. Johnson-Jahangir said.<\/p>\n
It takes time to see improvements
\n\u201cTreatments work better at preventing new acne instead of clearing up what\u2019s there,\u201d Dr. Johnson-Jahangir said, noting \u201cit often takes a few months to see improvement, and most medicines will need to be continued long term to keep up the benefit.<\/p>\n
\u201cPhysicians will see acne patients back to check if the medication can be used long term or if a change is needed,\u201d she added, noting that \u201coral isotretinoin therapy is the only medication that can lead to long term resolution after a course of the therapy.\u201d<\/p>\n
If acne is scarring, get treatment
\n\u201cIf you\u2019re getting any sort of acne that\u2019s leaving significant marks or scars, it really does need to be treated because certain types of scarring can be permanent,\u201d Dr. Fine said. \u201cEven mild acne can cause significant discoloration in darker skin types, and it is often the post inflammatory color change that can take the longest to fade and be the most bothersome to the patient. Rarely, acne can clear up on its own or by using over-the-counter acne treatments alone.\u201d<\/p>\n
\u201cHormones and stress are the most common triggers for adult-onset acne, but there are other factors to consider,\u201d she said. \u201cWhile dietary factors are not strongly linked to most acne cases, there is clear evidence that excessive daily intake as well as over consumption of foods with a high glycemic index can cause flaring for certain people.\u201d<\/p>\n
That is why \u201cit is imperative to obtain a thorough history to determine if lifestyle or dietary factors are playing a role,\u201d Dr. Fine said. \u201cAnother reason it is important to see a board-certified dermatologist\u2014even for mild cases\u2014is to educate the patient as to what and what not to be doing.<\/p>\n
\u201cUsually once a patient is in my office, they have tried over 10 different acne treatments. Yet they are still in my office,\u201d she added, noting \u201csuccessful treatment involves first going through a patient\u2019s current regimen and explaining what is and what is not needed.\u201d<\/p>\n
\u201cOften, I\u2019ll find they are using 3 different products that contain ingredients that serve to exfoliate. While all may be effective choices, using all three products together will cause excessive dryness and irritation and further exacerbate the issue,\u201d Dr. Fine said. \u201cWhen the skin barrier is compromised from over doing it with products it will just trigger more inflammation and make any medication less effective.\u201d<\/p>\n
Do not pick or pop a pimple
\nThis is important. When a pimple first appears, most people immediately try to pop it. Don\u2019t do that.<\/p>\n
\u201cWhen you pop a pimple, essentially what is happening is you\u2019re putting this pressure that typically ends up driving the sebum or oil deeper into the skin and can actually lead to more inflammation and then make the pimple more likely to sprout friends,\u201d Dr. Fine said. \u201cSo, if you have a very painful pimple that is really coming to a head, it\u2019s juicy, you see that whitehead, use a warm compress.<\/p>\n
\u201cGently lay it on the skin for a few minutes and then apply very mild pressure not directly to the lesion but to the skin around the lesion. That is as close to popping as I will ever advocate,\u201d she added.<\/p>\n
Keep your skincare routine simple
\n\u201cGentle skin care is key. To maintain a healthy skin balance, use a gentle skin cleanser (no harsh soaps) daily, an oil-free facial skin moisturizer and broad-spectrum facial sunscreen of at least SPF 30 or combination sunscreen and moisturizer,\u201d Dr. Johnson-Jahangir said. \u201cThese all work to keep skin healthy without scrubbing or drying out. That can make acne worse. Products designed for use on the face are tested to not make acne worse, called non-comedogenic.\u201d<\/p>\n
\u201cAvoid aggressive exfoliation or treatments designed to strip the skin of its natural oils,\u201d she said. \u201cHarsh soaps or aggressive use of toners or exfoliation can have the opposite effect of irritating the skin, stimulating increased skin oil production and acne.\u201d<\/p>\n
Additionally, \u201csome over-the-counter acne preparations are chemical exfoliants like salicylic acid or glycolic acid and work by breaking up dead skin cells but need to be used with care to avoid over-exfoliation, skin irritation and worsening of acne. They are not tolerated by everybody.\u201d<\/p>\n
Skip junk food and excessive dairy
\n\u201cDietary factors and stress are not direct causes of acne. They certainly play a strong role, especially if people are predisposed to acne,\u201d Dr. Fine said. \u201cThere have been studies that do conclusively show that for certain individuals, excessive dairy intake and foods that have a high glycemic index\u2014junk food, sugary foods, foods that make your blood sugar go up very fast and then drop very fast\u2014can play a role in acne.\u201d<\/p>\n
\u201cThere is a correlation between those two food groups. So, if you are predisposed to acne and if you had a very dairy-rich, junk-food diet, yes, that could worsen acne,\u201d she said. \u201cI\u2019m never going to recommend doing crazy elimination diets or completely cutting out any food group, but if you\u2019re someone who maybe has a smoothie every day, eats a lot of yogurts, be more aware of those two.\u201d<\/p>\n
Find ways to minimize stress
\n\u201cStress isn\u2019t a direct cause of acne but is theorized to worsen acne if increases in cortisol alter the hormone balance or neurogenic pathways that affect the skin,\u201d Dr. Johnson-Jahangir said.<\/p>\n
\u201cStress affects every part of your body in ways that most people don\u2019t even realize,\u201d Dr. Fine. \u201cBecause inflammation is one of the key factors in the acne process, stress bumps your inflammation pendulum towards a more proinflammatory state.\u201d<\/p>\n
Visit a dermatologist for acne care
\n\u201cIn my practice, I do a lot of treatment of severe scarring from severe acne, which can really go on to affect someone\u2019s whole life\u2014their confidence, their ability to feel comfortable around other people,\u201d Dr. Fine said, noting that any acne that\u2019s bothersome should be treated by a physician \u201cbecause now more than ever, the skin-care market is crazy and it\u2019s ever expanding.\u201d<\/p>\n
\u201cIt\u2019s very hard\u2014even with mild acne\u2014to go into the drug store and know what products you should use to treat your acne,\u201d she said. \u201cThere are great drug-store products you can treat some acne with \u2026 but it does require a visit to the doctor to explain what\u2019s going on, what you need and what you don\u2019t need.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"
\u201cWhat that triggers is more of an inflammatory cascade, which then you\u2019ll get more bacteria, more inflammation,\u201d Dr. Fine added. No simple solution for acne \u201cThere is no cookie cutter treatment for acne\u2014not everyone gets the same four ingredients or products,\u201d Dr. Fine said. \u201cSo, doing a good physical exam and a full history will…<\/p>\n