Acne 101

     Acne is a common skin disease with common features like blackheadswhiteheadspustules (pus-filled lesions), papules (solid elevations of varying sizes) and nodules (large-sized papules). It is commonly found in the face, back and upper chest and is most commonly found in adolescents. It often disappears after puberty but may persist. In some individuals, acne begins during adulthood. Some people believe that if you leave the blemishes alone, they will disappear over time but my advice is that  you should treat acne as soon as possible to reduce post-acne scarring which is difficult to treat.
     It starts within the pores (sebaceous hair follicles). These sebaceous follicles contain glands (sebaceous glands) which produce sebum (the natural oil that your skin produces). During the skin’s natural renewal process, dead cells shed off gradually, revealing new skin cells. If the shedding is uneven or too rapid, these dead cells can cling together forming a plug which traps sebum and bacteria within the sebaceous follicle. This process usually takes about 2-3 weeks before a blemish to appear on the surface of the skin.
     Common causes of acne include:
  • Extra sebum. If you overproduce sebum, there is an increased chance of clogging of the follicle leading to acne formation. 
  • Bacteria. The bacteria that causes acne, Propionibacterium, is normally found on skin but when a follicle is clogged, it quickly multiplies, causing inflammation.
  • Hormones. Sebaceous glands in persons who are acne-prone are over-stimulated by androgens. This is why it is more common in adolescents, before the menstrual period and in pregnancy in some individuals. 
  • Genetic. I’m a staunch believer in the following principle when it comes to beautiful skin and hair: some are born with it, some have to work hard to acquire it and some may never get it no matter how hard they try. I have friends who sleep with their makeup on and have no skin regimen and they have such great skin. For my skin to be clear, I have to follow a skin regimen. When I don’t, I tend to break out.
  • Follicle fall-out. If the process of shedding dead cells is overactive, these cells can block the follicle and increase the chance of acne formation.
  • Inflammation. This is the body’s natural response to harmful stimuli. The body responds to bacteria collection in a blocked follicle by inflammation, leading to a red, painful pimple.
I suffered from moderate acne for years but when I understood the above principles, my acne cleared up: 
The day before my wedding in August 2006 (I had foundation on!)
Taken October 2010 (with no makeup on)

I started my regimen in April 2009 and within 2 months, I saw a dramatic change in my skin. My skin is not the clearest in the world: I have post-acne scars that I’m working on and I still get occasional breakouts but it’s nothing like I used to in the past. So how did I do it? 
  1. I attacked the bacteria. My face wash was Sebamed clear face antibacterial cleansing foam. If you have dry skin, this might be not be right for you.
  2. I initially used a salicylic acid product called Neutrogena clear pore oil eliminating astringent but later changed to Stridex medicated pads maximum strength because it’s 2% salicylic acid and alcohol-free. These products are a bit drying and if you have dry skin, you might want to look for a milder product with salicylic acid. Salicylic acid exfoliates dead skin so if you have overactive dead cell formation and follicle fall-out, this will help with that. It also penetrates skin pores and keeps them clear of debris. The strength of salicylic acid over-the-counter products range from 0.5% to 2%. It can cause dryness of the skin and if you have sensitive skin, you might want to start with 0.5% and build up from there or start by using it every other day.
  3. I incorporated benzoyl peroxide into my night time regimen. The strengths available are 2.5%, 5% and 10%. I love Mary Kay Acne Treatment Gel. It’s a 5% formula. Benzoyl peroxide works by removing dead cells on the skin. It also reduces the acne-causing bacteria on the skin thus reducing inflammation on the skin. It can lead to peeling, itching, irritation and reddened skin  so you have to start out slowly. It also bleaches clothes that it comes in contact with so you should use a white pillowcase.
  4. I steamed my face once a week and applied proactiv refining mask for 15 minutes. I also like Queen Helene mint julep masque. They both contain sulfur which causes skin to dry and slough off. It also helps to unclog blocked pores and minimize skin oiliness.
  5. I used a serum to fade out my post-acne spots (they haven’t totally disappeared  yet!) I wanted to use a hydroquinone product but I couldn’t find any at the time that stated clearly that it was non-comedongenic so I used Caudalie radiance serum. It works very slowly though but I like it because it’s non-comedogenic .
  6. I stopped using facial scrubs because I felt that the particles went into my pores and clogged them.
  7. I discarded all my skin products that did not clearly state non-comedogenic.
  8. Other general stuff I did were to stop using a face towel and to wash my pillowcases often.  I noticed that every time I used a face towel I broke out. If you disinfect yours regularly, this might not be a problem for you. 
    If you have a more severe form of acne, these products might not work for you but there’s no harm in trying for at least 2 months. If they don’t, you might need to see a doctor. Prescription acne treatments include:
  • Retin-A lotion
  • Dalacin T gel (its active ingredient is clindamycin)
  • Adapalene gel
  • Oral contraceptives for hormone-induced acne
  • Isoretinoin pills. It is a prescription-only drug. The major brand name is Accutane and its manufacturers recently took it off the market although generic forms can still be obtained.
  • Tetracycline pills.
  • Chemical peels
  • Laser acne treatments

     In summary, any basic skincare regimen for acne should be followed at least twice a day to see results and should incorporate an anti-bacterial agent and a keratolytic agent (benzoyl peroxide, salicylic acid and/or sulfur):
  • cleanse with a face wash. Washing your face regularly helps to reduce extra sebum on the skin. Don’t wash more than 3 times a day because this can cause a negative feedback and lead to more sebum production. The same applies to use of products which are over drying.
  • tone
  • apply a moisturizer. Any one which is non-comedogenic and contains spf 15 is good. I currently use Ambi even & clear daily moisturizer with spf 30  Dermalogica supersensitive faceblock spf 30
  • use a targeted acne treatment 
A word of caution: You must commence any skincare regimen very slowly, adding one product at a time over a week or more. This is important so that you can determine if you react to a particular product.

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If you have any questions, feel free to contact me. Watch out for our clear skin challenge coming soon!