Acne 101: why and what to do about it

Acne can be so difficult to treat. It’s chronic. It’s boring. It flares up randomly. He will not respond to treatment. Why is that? Dr. Mary Pierson, Medical Director at ArtMed, explains.

Acne is a multifactorial problem and that means treatment needs to be strategic. There are basically four main factors that contribute to acne:

  1. Hormonal problems and associated excess oil production
  2. Propionibacterium acnes (p.acnes bacteria) colonization (the oilier the skin, the more bacteria)
  3. Inflammation
  4. Abnormal or disorderly peeling of skin cells from the surface of the skin

In order to treat acne most effectively, all four factors must be considered in the treatment plan.

Hormonal problems can be treated with oral contraceptive pills in women, and sometimes with a medicine called spirinolactone (more commonly used in adult acne) and these will usually reduce oil production. For men, there really is no way to reduce oil production except with the use of Accutane (an oral medication that is a potent derivative of vitamin A). Accutane is only indicated for very severe acne, especially if the acne results in disfiguring scars.

bacteria can be treated topically and orally with prescription medications. Topically, there are antibiotic preparations (such as clindamycin) and drugs that are not antibiotics in the traditional sense but have antibiotic properties such as benzoyl peroxide. Oral antibiotics should be low dose and slow release if possible. Often, -cycline antibiotics are used like minocycline, doxycycline or tetracycline because they also have anti-inflammatory properties. There is a low-dose, slow-release form of doxycycline available by prescription that is safer for long-term use.

Inflammation is a serious symptom that is often underestimated. Some people may be more pro-inflammatory and therefore more prone to the cysts, nodules, redness and pustular lesions seen with severe acne. Topical and oral agents that reduce inflammation are an important part of any treatment plan. Again, benzoyl peroxide is an inexpensive option that works well. Skin rubbing, dermabrasion, powerful cleansing brushes, etc. may contribute to increased inflammation and should therefore be avoided.

Messy peeling or peeling is often the least understood factor that contributes to acne. When your skin renews itself, new cells are produced in the dermis and slowly mature from the basal layer of the skin to the epidermis. Eventually, mature epidermal cells are shed and replaced from below. When it comes time to get rid of these skin cells, sometimes the bonds between the cells do not break easily and the cells come off unevenly or too slowly, resulting in thickening of the top layer of the skin. skin. This can lead to blocked sebaceous glands and oil backflow. Excess oil promotes bacterial overgrowth leading to infection and inflammation – in other words, serious skin rashes. Treatments that facilitate regular desquamation of the epidermis are of crucial importance.

Messy flaking can be treated with retinols and acids (alpha and beta hydroxy acids, salicylic acid, lactic acid, etc.). Chemical peels can restart the peeling process by dissolving the thickened top layer of skin, and topical retinols or acids can keep peeling even. Retinols can be quite irritating if used in too high a concentration. Thus, low-dose, slow-release retinols at night are better tolerated and the dose can be increased slowly over time. Moisturizing before applying retinol also helps. Regular use of higher dose retinols can also improve acne scars over time. Accutane is the granddaddy of all retinols, and both dry out oil and cause significant ongoing flaking, which is why it’s so effective at putting acne into remission.


Acne management plans must address all four causes of acne in order to be optimally effective.

Seeing a medical esthetician and healthcare provider experienced in acne management can be very helpful. Acne sufferers have unique skin issues, some people are more hormonal, others more inflammatory, etc. A treatment must be developed to address the unique balance of this person’s problems. Commitment to the treatment plan is also very important.

Once the acne is in remission and the breakouts are fewer and less severe, the long-term adverse effects of acne can be treated. This includes the redness, hyperpigmentation, and scarring that is commonly seen in severe acne.

Redness and hyperpigmentation can often be treated with IPL (intense pulsed light therapy). Generally 3 or 4 treatments are necessary. Chemical peels can also help in this area. Mild to moderate scars can often be improved with micro-needling treatments and more severe scars (depressed or ice pick scars) are best treated with the use of profractional laser which can also improve hyperpigmentation (4 to 5 treatments are often necessary).

Scars should not be treated until the acne is well in remission, because you don’t want to invest in scar management just to keep acne scarring your skin.

Acne can be very frustrating. But with careful attention to all of the acne-causing factors and a commitment to a treatment plan, you can win the battle against this common and unwanted skin condition.

To learn more, visit or email [email protected]
Dr. Mary Peerson

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