Acne: Frequently asked questions.

What is acne?

Acne is a two-step process. The first step is that the hair follicle becomes plugged with oil and dead skin cells. This causes the skin lesions known as blackheads and whiteheads, which are known to dermatologists as comedones. The second stage of an acne lesion is overgrowth of bacteria in the plugged follicle. This infection and the inflammatory response by the immune system cause the painful red bumps (zits) and pustules of acne.

Do foods affect acne?

There is no evidence that specific foods cause acne or make it worse. Some physicians suggest that people eating a high-sugar western diet may be more prone to acne, but there is no good evidence yet to support this theory.

How do acne medications work?

All prescription acne medications work by preventing new acne lesions, not by treating existing ones. Therefore, they should be used over all acne-prone areas, not just on individual lesions. A pea-sized drop of the topical medications should be sufficient for the entire face. It usually takes 6 weeks before improvement is noticeable because it takes that long for your existing lesions to resolve. Once your skin is clear, you should continue using the medications to prevent new lesions. Some acne medications are unsafe during pregnancy; ask your doctor. There are 3 types of prescription acne medication:

1) Retinoids: Medications in this class include tretinoin, adapalene, and tazorotene. They work by changing the hair follicle to prevent it from becoming clogged. The most common side effects are redness, irritation, and scaling.

2) Topical antibiotics: These include benzoyl peroxide, clindamycin, and erythromycin. These medications work by destroying bacteria on the skin and reducing the chances that clogged hair follicles will become infected. The most common side effect of medications containing benzoyl peroxide is that they may bleach towels or clothing.

3) Oral antibiotics: The oral antibiotics most commonly used in the treatment of acne are tetracycline, doxycycline, and minocycline. They work similarly to the topical antibiotics in decreasing the number of skin bacteria, but also decrease the inflammation when follicles do become infected. Sun sensitivity and sunburns are the most common side effect of tetracycline and doxycycline. Dizziness is the most common adverse effect of minocycline. Any oral antibiotic my cause vaginal yeast infections or stomach discomfort.

What cleanser should I use?

Gentle cleansers such as warm water, Dove soap, or Cetaphil liquid cleanser are appropriate. Astringents and excessive scrubbing should be avoided.

What moisturizer should I use?

Any moisturizer made for the face that is non-comedogenic or non-acne forming may be used. Cetaphil lotion or Free and Clear are two possibilities. If you are using tetracycline or doxycycline, look for a facial lotion with sunscreen in it.

What cosmetics should I use?

Any cosmetic listed as non-comedogenic or non-acne forming is appropriate. Loose powders are less likely to cause acne than a pressed powder from a compact.
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