What causes Acne and how do we treat it? An overview.

Acne is a common skin condition, in fact at least 85% of the world will experience acne to some degree during their life. but understanding its root causes can help tailor an effective treatment plan. There are three main factors involved in acne formation:

1. Microcomedone Formation: Acne often starts with a microscopic blockage in the hair follicle known as a microcomedone. Dead skin cells and oil accumulate, leading to the formation of blackheads, whiteheads, and other acne lesions.

2. Excess Oil Production: Hormonal changes, particularly during puberty, increase oil production from sebaceous glands. This excess oil (sebum) can clog pores, creating the perfect environment for acne development.

3. Inflammation and Bacteria: The bacteria C. acnes thrives in clogged pores, leading to inflammation, which contributes to the red, swollen bumps of acne.

With this framework in mind, while genetics play a large role in susceptibility to acne there are absolutely certain lifestyle factors that can worsen breakouts such as stress, diet, and comedogenic cosmetics/skincare products.

The American Academy of Dermatology (AAD) guidelines recommend a multimodal approach to acne treatment, targeting as many of these factors as possible. This is why even if you suffer from "hormonal" or "cystic" acne, targeting treatment to several factors can ultimately help improve your acne.

Treatment Strategies

• OTC Management: Over-the-counter (OTC) products and routines personalized to your skin type can help address mild acne, and are a crucial component of the overall treatment strategy for moderate and severe cases. Beyond finding products that have active ingredients that help control acne, it's also critical to avoid ingredients that can worsen acne. For help building an effective acne routine and finding acne-safe products, consider using the free dermatologist-developed All Skin app - it helps you analyze any skincare product on market to understand how it impacts your skin, including for acne.

• Topical Therapy: Prescription creams, such as retinoids, are often recommended to prevent microcomedone formation and reduce oil production. Several other topical agents may be used concurrently such as benzoyl peroxide, clindamycin, salicylic acid, azelaic acid and others.

• Oral Therapy:

  • Hormone-Modulating Medications: Medicines like spironolactone or birth control pills help regulate hormones, reducing oil production.

  • Antibiotics: Short-term use of oral antibiotics can target C. acnes bacteria, reducing inflammation.

  • Accutane (Isotretinoin): For severe or scarring cases, Accutane is highly effective and safe when monitored by a dermatologist. It addresses all the major causes of acne, including oil production and inflammation, and can have permanent effects on acne clearance.

• Energy-Based Treatments: Emerging therapies like Photodynamic Therapy (PDT), Pulsed Dye Laser, Fractional Ablative Resurfacing, and Radiofrequency (RF) microneedling can also target acne while also helping to manage discoloration or scarring.
  

Dr. Lewinson's Personalized Approach

With extensive experience treating acne, Dr. Ryan Lewinson tailors treatment plans based on the best available evidence, your specific concerns, and your skincare goals. Whether you're dealing with mild acne or more severe, scarring cases, Dr. Lewinson will guide you through options to find the most effective solutions for your skin health.