All About Acne: Answering the Most Common Questions

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Acne is a common, widespread skin condition that affects millions of people—from infants to adults—all around the world. The American Academy of Dermatology (AAD) estimates more than 80% of people will experience acne at some point during their lifetime, especially during their teenage years. During Acne Awareness Month, Obagi is exploring the various causes of acne, who gets it, how it is treated, and when it is important to seek professional help.

What Is Acne?

Acne is a chronic skin condition that occurs when hair follicles become clogged with sebum (oil) and dead skin cells. This blockage can lead to inflammation and the formation of pimples, blackheads, whiteheads, nodules, and cysts. While acne is commonly found on the face, it can also affect the back, chest, shoulders, and other areas of the body.

What Are Some Different Forms of Acne?

Occasional Pimples

Occasional pimples are sporadic breakouts that occur due to temporary factors such as stress, minor hormonal fluctuations, or even the use of irritating skincare products. These pimples are typically short-lived and rarely require intensive treatment. A skincare routine that includes twice daily washing, moisturizer, and sunscreen can often prevent or minimize occasional breakouts.

Hormonal Acne

Also known as adult acne, hormonal acne is closely linked to fluctuations in hormone levels. It is most common in women and can be triggered by menstrual cycles, pregnancy, polycystic ovary syndrome (PCOS), or other hormonal imbalances. Hormonal acne often appears as deep, painful cysts or nodules around the jawline, chin, and neck.

Blemish-Prone Skin

Blemish-prone skin is particularly susceptible to developing acne and other imperfections. Individuals with this type of skin may experience frequent breakouts, enlarged pores, and excessive oil production. Maintaining a consistent skincare routine is essential to help manage and prevent breakouts.

What Causes Acne?

The exact cause of acne involves a combination of genetic, hormonal, environmental, and lifestyle factors. According to the American Academy of Dermatology (AAD) and the Mayo Clinic, the primary factors in acne development include:

Excess Oil Production: Sebaceous glands produce sebum, an oily substance that helps protect and moisturize the skin. An overproduction of sebum can lead to clogged hair follicles and acne.

Clogged Hair Follicles: Dead skin cells that do not shed properly can accumulate in hair follicles, forming a “plug” that blocks the pore. This blockage creates an environment that influences acne development.

Bacteria: The bacterium Propionibacterium acnes (P. acnes) naturally resides on the skin. When hair follicles are clogged, P. acnes can multiply and cause inflammation, leading to the formation of pimples.

Inflammation: Inflammatory responses play a significant role in the development of acne. When the body detects the presence of P. acnes, it triggers an immune response that may result in redness, swelling, and the formation of pus.

Hormonal Changes: Hormonal fluctuations, particularly during puberty, menstruation, pregnancy, mid-life, and hormonal disorders like polycystic ovary syndrome, can increase sebum production and lead to acne.

Stress: Stress can aggravate acne by triggering hormonal changes and inflammatory responses in the body.

Medications: Some medications, including drugs that contain corticosteroids, testosterone, lithium, and certain oral contraceptives, can contribute to acne development.

Genetics: There’s a higher risk in developing severe acne if one or both of your parents or another close blood relative had acne that resulted in scars.

Who Can Get Acne?

Acne can affect anyone at any time, regardless of age, race, or gender. According to the AAD and NHS, the groups most often affected by acne include:

Teenagers and Young Adults: Acne is most prevalent during puberty, affecting nearly 95% of people between the ages of 11 and 30. Hormonal changes that stimulate the sebaceous (oil) glands leading to clogged pores are a significant factor.

Adults: Adult acne is more common in women than in men, due to hormonal fluctuations related to menstrual cycles, pregnancy, and menopause. Adult acne affects about 15% of women and 7% of men.

Infants: Even newborns can develop neonatal acne due to maternal hormones that may be transferred during childbirth. This type of acne typically resolves on its own without treatment.

Post-Inflammatory Hyperpigmentation (PIH): Post-inflammatory hyperpigmentation (PIH) occurs when dark spots or patches develop on the skin after an inflammatory response, like an acne breakout. Excess melanin production causes these discolored areas, which are more common in individuals with darker skin tones. If left untreated, PIH can persist and may result in scarring.

How Is Acne Treated?

When it comes to treating acne, several active ingredients have been proven effective in managing and reducing breakouts and maintaining clear skin, including:

2% Salicylic Acid

Salicylic acid is a beta hydroxy acid (BHA) that is oil-soluble, allowing it to penetrate deep into the pores. It works by exfoliating the skin and removing dead skin cells, which helps prevent clogged pores and reduces the formation of pimples. Salicylic acid also has anti-inflammatory properties, making it effective in reducing the redness and swelling associated with acne.

Menthol

Menthol is a compound derived from peppermint or other mint oils. It has a cooling and soothing effect on the skin, which can help reduce irritation and inflammation caused by acne. While menthol does not treat acne directly, it provides symptomatic relief, making it a valuable addition to acne treatments.

5% Benzoyl Peroxide

Benzoyl peroxide is a powerful antibacterial agent that kills P. acnes bacteria on the skin. It also helps to clear out blocked pores and reduce the number of acne-causing bacteria. At a 5% concentration, it effectively treats moderate to severe acne and can significantly reduce the severity and number of acne lesions. It can be drying and irritating, however, so it is important to use it as directed and with a moisturizer.

20% Glycerin

Glycerin is a humectant that attracts moisture to the skin, helping to keep it hydrated and maintain its barrier function. For acne-prone skin, maintaining hydration is crucial because overly dry skin can lead to increased oil production, which exacerbates acne. A 20% concentration of glycerin ensures that the skin remains moisturized without feeling greasy, making it an excellent choice for individuals with acne.

Why Do I Need a Moisturizer?

Though it seems contradictory, moisturizer is essential for acne-prone skin. Many acne treatments, particularly those containing benzoyl peroxide and salicylic acid, can be drying and irritating. Using a moisturizer helps to maintain the skin's barrier function, prevent excessive dryness, and reduce the risk of overproduction of oil. Non-comedogenic moisturizers, which do not clog pores, are recommended for anyone with acne-prone skin.

Close Up Model Image Using Product
Close Up Model Image Using Product

Acne-Prone Skin Basic Routine

Staying consistent with a routine tailored to your skin’s needs is crucial in managing and preventing breakouts. Here’s an a.m. and p.m. routine to get you started:

Morning Routine: Cleanse & Protect

1. Start with Obagi CLENZIderm M.D.® Daily Care Foaming Cleanser with 2% salicylic acid to wash away impurities.
2. Apply CLENZIderm M.D.® Pore Therapy Toner with 2% salicylic acid and menthol to unclog pores and leave skin feeling refreshed.
3. Use a thin layer of CLENZIderm M.D.® Therapeutic Lotion with 5% Benzoyl Peroxide to help clear blemishes and deliver medication to the pores, beginning to clear acne in as little as one week.
4. Add a light layer of Obagi Nu-Derm® Exfoderm® Forte to exfoliate and encourage cell turnover, revealing softer, smoother, brighter skin.
5. Smooth on non-comedogenic, oil-free Obagi Hydrate Light® Weightless Gel Cream with humectants for 24-hour, lightweight hydration and niacinamide to control oil.
6. Finish with a broad-spectrum sunscreen like Sun Shield Tint Broad Spectrum SPF 50 to protect the skin from UV damage and help prevent post-inflammatory hyperpigmentation.

Evening Routine: Refresh & Repair

1. Use the same CLENZIderm M.D.® Daily Care Foaming Cleanser with 2% salicylic acid to wash away makeup, oil, and dirt.
2. Apply CLENZIderm M.D.® Pore Therapy Toner with 2% salicylic acid and menthol to remove dead skin cells and keep pores clear.
3. Include a layer of Obagi360® Retinol 1.0, which was clinically tested on acneic skin, to help prevent clogged pores and exfoliate skin. The use of a retinol helps with cell turnover, which prevents dead skin cells from being trapped in the skin.
4. Follow with Obagi® Rebalance Skin Barrier Recovery Cream with powerful, yet soothing post-biotics to help restore the skin microbiome, and green algae to help soothe irritation and reduce redness.
5. Finish with a lightweight, non-comedogenic moisturizer like Obagi CLENZIderm M.D.® Therapeutic Moisturizer with 20% glycerin to soothe, calm, and keep skin hydrated at night.

When Should I See a Professional?

Milder forms of acne can often be managed with the correct skincare treatments and lifestyle changes, but it’s important to see a professional if you’re experiencing any of the following:

Persistent or Severe Acne: If acne does not respond to consistent skincare treatments or becomes severe, it is important to see a dermatologist for prescription treatments.

Scarring or PIH: If acne leads to scarring or significant post-inflammatory hyperpigmentation, a dermatologist can recommend treatments to address these issues.

Hormonal Acne: Women experiencing hormonal acne—specifically related to menstrual cycles or conditions like PCOS—should consult a healthcare provider for appropriate treatments.

Always remember, you’re not alone in dealing with acne. Finding the right skincare routine or consulting with a dermatologist can lead to clearer, healthier skin and a greater overall sense of well-being.

 


 

REFERENCES:
1. American Academy of Dermatology (AAD). "What Causes Acne?". https://www.aad.org/public/diseases/acne/causes
2. American Academy of Dermatology (AAD). "Who Gets Acne?".  https://www.aad.org/public/diseases/acne/causes/acne-causes
3. National Health Service (NHS). “Acne Overview”. https://www.nhs.uk/conditions/acne/
3. Mayo Clinic. "Acne: Symptoms and Causes" https://www.mayoclinic.org/diseases-conditions/acne/symptoms-causes/syc-20368047

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