Acne: What you need to know

When the teenage years arrive, they often come with those annoying, distinctive pimples on the face, and often on the chest and back too. These little skin imperfections tend to go away as we get older, but for some of us, the painful, red and sometimes yellow "zits" may last a lot longer into adulthood. Acne is one of the most common skin problems in teenagers and young adults, and causes significant emotional distress for many.

Acne is caused by inflammation in the pilosebaceous unit, the place that harbors the hair follicle and the sebaceous gland. The sebaceous gland produces sebum, an oily substance that lubricates the skin. We still don't know how this inflammation happens, but it seems that sebum overproduction clogs the sebaceous gland, which can lead to inflammation and eventually bacterial infection.

Is acne related to diet?

When I was a child, I remember my mother blaming the chocolate I ate for all the pimples I had. I've heard other people say that dairy products and sodas may cause acne. Although there are a lot of theories, we still cannot categorically say that specific foods cause acne. Some studies show an association between acne and high-glycemic-load diets that include a lot of sugar, sodas, juices, white bread, pasta, and heavily processed cereals. Small research trials showed less acne when people eat a low-glycemic-load diet, or a diet with plenty of whole foods, rich in fruits and vegetables, and low in processed and refined products. There is also research linking dairy consumption and acne. The evidence is still weak, and none of these studies establish a clear cause and effect, just an association. It is nonetheless interesting that a pro-inflammatory and processed diet is associated with more acne. It's yet another reason to eat more fruits and vegetables and avoid processed foods rich in sugar and flour.

Treating acne

The first step when treating acne is to determine how bad the problem is. Severe cases should be handled in the doctor's office. You can manage most mild cases with some simple recommendations and over-the-counter products. What does mild acne look like? The bumpiness is not widespread and includes just a few whiteheads, blackheads, and small pimples. The treatment is not that complicated, but there are no magic bullets. It may take two to three months before you see improvement. Treat mild acne with these five simple recommendations:

• Limit washing your skin to twice a day.
• Use gentle cleansers for sensitive skin.
• Remember that skin irritation is common even with over-the-counter treatment. The irritation is at its worst around two weeks of treatment. After a few months, the irritation and dark areas eventually go away.
• A fragrance-free moisturizer applied on top of the medication can reduce the irritation.
• Using sunscreen is a good idea for people who have dark skin zits after treatment. The sunscreen can prevent further darkening.

What over-the-counter products should you use?

There is no need to buy expensive online products to treat mild acne. There are three over-the-counter medications that work very well: adapalene, salicylic acid, and benzoyl peroxide. (Watch out if you use benzoyl peroxide, as it can bleach your clothes, linens, and towels.) All these medications are quite effective for mild acne, and combining them can work even better. Skin irritation is a common side effect, and it can be more intense when using two different products at once. If the irritation is significant, take a break for a few days before applying again. Your skin will be happier and thankful.

If mild acne doesn't improve with home care

If this approach does not work as expected, consider prescription medication. Primary care physicians and dermatologists use a stepwise approach to treat acne, trying increasingly significant treatments (oral medications like antibiotics, retinoid lotions, or procedures like peels or laser treatments). Acne is not only a cosmetic problem. People with acne have higher rates of depression and anxiety, and it can be emotionally devastating for some. Don't give up, as there are many treatment options to try. It can take time to find the one (or ones) that work for you.

Resource

Clinical Practice: Acne Vulgaris, New England Journal of Medicine, October 2018.