Spotting the enemy

Acne occurs when the dead skin cells, sebum and bacteria naturally present in the skin become trapped inside of a pore. Because the bacteria responsible for acne, P. Acnes, is anaerobic and does not need oxygen to survive, it flourishes in blocked pores, leading to either non-inflammatory or inflammatory breakouts. Non-inflammatory lesions include:

• Blackheads (open comedones) are plugs of dead skin and sebum which block the pore opening and resemble tiny pepper flecks. They are most often seen around the nose, on the chin and sometimes even the cheeks, and rarely turn into inflammatory acne.
• Whiteheads (closed comedones) are blockages that are too large for the pore opening, resulting in a raised plug of white blood cells, often called pus. Unlike blackheads, white heads can very easily turn into inflammatory acne.

Inflammatory acne is the more serious form of acne that exhibits much larger, deeply impacted blemishes that are red and inflamed:

• Papules, pustules, nodules and cysts are painful, hard bumps deep within skin. These infections are often irritated and red and can be extremely difficult to treat with over-the-counter products.

How acne forms

Multiple factors can trigger an outbreak of acne, wreaking havoc on skin.

• Oil production. During puberty, sebaceous glands begin churning out sebum (oil), the body’s natural moisturizer. When too much sebum is excreted by the skin, acne can often appear as a result.
• Dead skin cells. As skin cells die; they are sloughed off and replaced by new ones. When too many dead skin cells build up along the lining of the pore, they 'stick' together with the excess sebum and block the pore opening, leading to whiteheads and blackheads.
• Bacterial growth. The P. Acnes bacteria thrives and multiples rapidly in the dark, warm confines of a pore. When the contents of the pore swell past normal, a small eruption can occur in the cell wall, spewing the dead skin cells and bacteria into surrounding tissues. When this happens, white blood cells are sent to investigate, leading to redness and inflammation.
• Hormones. In addition to being linked to all things manly, testosterone is a major culprit in the appearance of acne. Not only does this hormone signal the skin to increase oil production, it starts raging in early teen years, which can kickoff a long fight with blemishes. Beyond teen years, certain glandular disorders may also boost testosterone production, leading to acneic skin conditions.

A fighting chance for clear skin

Now that you know where acne comes from, it’s time to learn how to combat these factors. Several active ingredients, such as salicylic acid and benzoyl peroxide, are all-stars in the game plan to clear up the skin. But be patient — most treatments take several weeks or more to work.

• Salicylic acid exfoliates away the dead skin cells that block the pore opening and encourages cell turnover. For overall clarity, use a cleanser with salicylic acid twice a day such as Anthony Logistics Anti Acne Cleanser. Individual blemishes will soon be gone with the extra-help of Murad Acne Spot Treatment, which features sulfur and zinc oxide to encourage healing. Apply to individual blemishes two to three times a day.
• Benzoyl peroxide (BP) kills the P.Acnes bacteria by releasing oxygen into the pore. Look for it in concentrations ranging anywhere from two to ten percent, or higher, but be cautious; higher concentrations can leave the skin overly dry and flakey. Start with a lower percentage and work up from there. Cleansers are available for the entire face, such as PCA Skin pHaze 31 BPO 5% Cleanser. You can also try a spot-treatment for smaller areas, such as Menscience Acne Spot Repair.

Because both ingredients make skin more vulnerable to UV rays, which could lead to sunburn or skin cancer, use of a daily sunscreen is a good idea. A moisturizer with an SPF is ideal to both lock in hydration and protect the skin: Jack Black Sun Guard Oil-Free Very Water/Sweat Resistant Sunscreen SPF 30+ is perfect for daily use as well as outdoor activities and sports.

Prescription treatments

If you have tried over-the-counter products and still aren’t seeing a reduction in breakouts, it’s time for a trip to the dermatologist for clinical strength, prescription treatments.

• Retin-A (Tretinoin). Retin-A is a topical retinoid derived from vitamin A that clears out clogged pores and reduces oil production by the sebaceous glands. Results may take several months and side effects such as drying, peeling or flaking are possible. Sunscreen must be worn daily — Retin-A makes skin more sensitive to UV rays.
• Antibiotics. These can be either oral or topical — lotions, creams or gels — that are used on a daily basis to kill the bacteria that causes acne. Results may take several months to appear and as with Retin-A, sun protection must be worn each day.
• Accutane (isotretinoin). This oral medication wages war on acne in several important ways: it shrinks sebaceous glands, lowers oil production, stops bacterial growth and calms inflammation. Unfortunately, severe side effects can occur, including dry, irritated skin, headaches, nausea, stomach pain, diarrhea, joint and muscle pains, hair loss, vision problems and mood changes. Inform your doctor immediately if you notice any of these changes.

Learn everything you need to know about acne-fighting skincare in our Complete Acne Handbook.

See also:

Benzoyl Peroxide

Choosing an Acne Treatment System

Treating Teen Acne