Acne is so common that sometimes we tend to ignore it.  But it’s worth treating, early and completely.  It can lead to social problems and even low self esteem.  Untreated acne can cause permanent facial scars, which may lead to social problems as an adult.  But acne treatment is very easy in most cases.

Acne is often related to puberty, or menstrual periods.  But it can occasionally appear several years before puberty, or last well afterwards; this is not a sign of a hormonal problem.

What nonmedical habits help control acne?

Bathe daily.  Wash your face twice a day, and after sweating. Use just your hands to apply a gentle, non-abrasive cleanser, foaming face wash, or glycerin bar, then rinse it off. Sometimes you can just rinse with plain lukewarm water.  (Scrubbing with a washcloth or mesh sponge can irritate the skin.)  Dry off with a clean towel. 

Launder your towels, and your bed sheets, at least once or twice a week.

Shampoo regularly.  If you have oily hair, shampoo every day.

Perspiration can make acne worse, especially when trapped by a hat or sports helmet.  So wash your skin as soon as possible after sweating.  Quickly rinse the sweat off helmets and straps after play, and let them dry overnight.

If you use a skin cleanser, use gentle products that are alcohol-free. Products with salicylic acid or glycolic acid (AHA) are ok to try.  Do not use products that irritate your skin, which may include astringents, toners and exfoliants.  If it hurts, don’t use it.

Use make-up that is labeled to reduce acne (“oil-free/water based”, “non-comedogenic”, “won’t clog pores”).  Don’t sleep in your make-up.  Don’t share make-up, brushes etc. with anyone else.

If your face feels dry, you can use a moisturizer 2-3 times per day that is specifically labeled to avoid acne.

Let your pimples heal naturally. If you pick, pop or squeeze your acne, it may scar.

Keep your hands off your face. Touching your skin throughout the day can cause flare-ups.  (But if your acne hurts or itches, that’s a sign that it needs medical treatment.)

Use sunscreen, every time you’re out – even if it’s cloudy weather!  Avoid sunburn and tanning beds; UV light further damages the skin.  In addition, some acne prescriptions sensitize skin to ultraviolet (UV) light.

For more information, you can refer to good advice from the American Academy of Dermatology:
https://www.aad.org/public/diseases/acne

For people of color, the American Academy of Dermatology has excellent advice about acne skin care, here:
https://www.aad.org/public/diseases/acne/diy/skin-color

What treatments can be prescribed?

Benzoyl peroxide 2.5% is available over the counter, and it may help, but it’s not the best option.  It has become more expensive, it isn’t the most effective treatment, and it may leave bleach marks on clothes, sheets and towels.

Instead, I usually start treatment with a twice-daily prescription of topical clindamycin.  Often, this is sufficient, and it’s less expensive than other prescriptions.  I always ask patients to return for a recheck after a month, to evaluate effectiveness. If the acne is not controlled, I may add topical retinoic acid.

Topical treatment works best if it’s used twice a day.  If you use it only once a day, or even less, it’s much less effective.  But if it causes irritation or pain, let me know, so that I can prescribe something different.

Oral antibiotics are reserved for cases in which topical treatment isn’t effective, even if used regularly. If treatment isn’t helping, consultation with a dermatologist is the next step.  (Occasionally we may also refer patients to an OB/Gyn, to ask if birth control pills may help persistent acne.)

 

     --  Dr. Epstein