Lear Everything about Acne

A ton of information on everything you want to know about acne is available. In fact, many people spend an enormous amount of time and money trying to learn about them. For some people, this just simply isn’t enough. They want to find out everything they can about the problem and they want to know how to fix it.

The Internet has made it so easy for us to find answers to all our questions. It is easier than ever to learn all about acne and about what to do about it. You can read tons of articles and books on acne that are written by experts.

You can also read all the blogs and message boards about acne. It’s truly amazing to see the information about this problem that you can find. You can learn so much from these sources. That’s why if you are serious about learning everything you want to know about acne, then you should visit some forums and message boards that talk about acne.

You can’t help but think that there is one thing that everyone who has acne wants to do. For most people, the only thing that they want to do is get rid of it. You might be one of those people.

You might be saying to yourself, “Well, I’ve tried all these things and I still have acne”. There is a good chance that you want to know how to cure acne. Or, you may just want to learn the real cause of your problem.

One thing that you need to do is learn how to use a skin care product properly. You don’t want to use something that will make the problem worse. Too much scrubbing doesn’t help anything at all.

You can learn how to get rid of acne, but you have to take care of your body on the inside. Make sure that you drink lots of water, exercise regularly, and eat the right foods. Those are all things that you need to get into a daily routine to make sure that you are healthy and your body is working correctly.

If you want to know everything you want to know about acne, then continue reading this blog that talks everything about acne. We can answer any questions that you have. We will even tell you the real cause of your problem. All you have to do is take the time to read it.

What is Acne?

       The hair follicle is the part of the skin where hair grows. It is attached to the sebaceous gland (oil gland) , which produces sebum that lubricates the hair and prevents the skin from becoming dry. The opening at the surface of the skin, with the attached hair is known as the skin pore. Big pores are associated with big oil glands that produce higher amounts of oil. The oil glands are triggered to produce oil by being exposed to male hormones called androgens. Females also produce androgens at lower quantities via the ovaries or adrenal glands. During puberty, there is a surge of sex hormones and androgens causing the oil glands to pump more oil.

       Acne is a condition of the skin that is caused by excessive oil secretion of the sebaceous glands (oil glands) and the excess production of keratin inside the hair follicles (hyperkertinization). These two conditions cause dead skin cells and excess oil to be trapped inside the pores, this results in pore clogging and the formation of a comedo. Trapped sebum and dead skin cells in the pore are the major food source of the acne-causing bacteria known as Propionibacterium Acnes. The availability of more sebum makes the population of the bacteria grow.

       When the clogged pores are fully closed the comedo has a whitish appearance on the skin surface and is called a whitehead. When the clogged pores are partially opened it is called a blackhead. The partially opened pore allows the slow drainage of sebum, bacteria and dead skin cells on the surface. Blackheads have the characteristic dark color because of the reaction of melanin to oxygen in the surrounding air. 

Once the bacterial population inside the pore increases at a critical level, the pores become infected often producing pus and breaking out. This type of lesion is called pustule, pimple or zit. It is similar to a whitehead but it has a red base and a yellowish center when you view it from the top.

Severe acne has the following lesions:

acne lesions
Photo Credit: ACNE.ORG

Nodules: 

Basically, these are pimples which are bigger than 5mm. They can be painful and grows as large bumps beneath the skin surface. Scarring is very common with this type of lesion. These lesions last for several months.

Cysts: 

These are painful sac-like, pus-filled lesions that may cause scarring. It is similar to a nodule but it is pus-filled and they usually have a diameter of 5mm or more. Do not squeeze cysts as they may cause scarring.

Macule: 

Also known as pseudo scars because they somewhat look like a scar but unlike “true scars” they leave no permanent scar or mark. They are temporary flat, light red or pink spots that have been left from a previously healed lesion. They may last from several days to a few weeks. Sometimes they are raised slightly from the surface of the skin.  

References:

1. http://dermnetnz.org/acne/acne-causes.html “Causes of acne” (Last updated 08 Aug 2007)
2. http://www.acneguide.ca/basics/acne/what_causes_acne.html “What Causes Acne?”(Last modified: Friday, 16-Feb-2007”)
3. http://www.nlm.nih.gov/medlineplus/acne.html “Acne” (Topic last reviewed: 13 September 2007)

What are the causes of acne?

1. Genetics

If your parents have acne during their teenage years, then you have a higher chance of getting acne. You may also inherit an overactive oil gland from your parents or grandparents.

2. Hormones

High amounts of hormones stimulate the oil glands to produce more oil and sebum. High amounts of sebum lead to pore clogging. High levels of sex hormones are expected during puberty. During menstrual cycles hormonal activity is also high.

3. Anabolic Steroids

They are used by body builders to increase muscle mass. The use of anabolic steroids increases the hormone testosterone which is also converted to dihydrotestosterone. Dihydrotestosterone causes the oil glands to pump more oil.

4. Medication containing halogens (iodides, bromides, chlorides), lithium,barbiturates or androgens

5. Exposure to high levels halogenated aromatic compounds (chlorinated dioxins and dibenzofurans)

A good example of a victim of this type of ACNE also known as Chloracne is the Ukrainian president Viktor Yushchenko.

References:

1. http://dermnetnz.org/acne/acne-causes.html “Causes of acne” (Last updated 08 Aug 2007)
2. http://www.acneguide.ca/basics/acne/what_causes_acne.html “What Causes Acne?”(Last modified: Friday, 16-Feb-2007”)
3. http://www.nlm.nih.gov/medlineplus/acne.html “Acne” (Topic last reviewed: 13 September 2007)

What you need to know about Acne Treatment

       Acne may have several causes but when it comes to acne treatment we can summarize them into at least 3 categories (antibacterials, pore unblockers, oil reducers). Most acne treatment products are using what we know as “monotherapy”. Monotherapy is an acne treatment procedure utilizing only one anti-acne treatment product. This single anti-acne treatment product may function as an antibacterial agent, keratolytic agent or both. The best acne treatment product or acne medication should be able to kill acne-causing bacteria, prevent the formation of comedo or pore blockage and reduce the sebum output of the oil glands.

       The best acne treatment product should also be able to reduce skin irritation, accelerate skin repair and moisturize the skin. Since there is no single anti-acne treatment product or procedure that can address all the major causes of acne, the only option that dermatologists have is to combine them in a synergistic way. This acne treatment method is known as multi-therapy acne treatment. Multi-therapy acne treatment is better than monotherapy acne treatment because it utilize the synergistic effect of several anti-acne products. Multi-therapy acne treatment also includes bioactive ingredients that are designed to accelerate skin repair, moisturize the skin and reduce skin irritation.

1. Antibacterial: 

The main purpose of this acne medicine is to reduce the population of acne-causing bacteria known as Propionibacterium Acnes. This bacteria cause redness and inflammation of the oil glands; in more advanced cases they cause the formation of pus. If left untreated, bacterial infection can cause damage to the dermis, which would leave depressed scars. Antibacterial can be taken orally or applied topically. Topically applied antibacterial has the least amount of side effects and is generally safer to use. Oral antibiotics are reserved for moderate to severe acne because of its side effects to the internal organs and the issue of “bacterial resistance”.

Examples:

  • Benzoyl Peroxide (Topical)
  • Azelaic Acid (Topical)
  • Topical and Oral Antibiotics

2. Keratolytic/Comedolytic: 

These are acne medications that open up blocked pores and prevent them from being clogged; they open up the pores by encouraging the skin to peel. Peeling removes trapped sebum and dead skin cells inside the pores. In acne prone skin, there is an excess production of keratin that causes the pores to become blocked with dead skin cells and trapped sebum. Trapped sebum encourages the growth of acne-causing bacteria because sebum is their main source of nourishment. It is therefore necessary for an effective acne treatment strategy to always keep the pores free from blockage.

Examples:

Alpha-Hydroxy Acid Family (Glycolic Acid, Lactic Acid)
Beta-Hydroxy Acid Family (Salicylic Acid)
Retinoids (Retinoic Acid, Adapalene, Retinol Palmitate)
Sulfur

3. Anti-Androgens: 

Oral anti-androgens are effective in suppressing the male hormone, which causes the oil gland to produce more oil. The problem with oral anti-androgens is that it can only be used by females. It cannot be used by males for the purpose of just treating acne because it can cause the reversal of male secondary sex characteristics. Anti-androgens are used only by males under medical supervision and in certain conditions such as in treating hypersexuality, prostate enlargement and male pattern baldness. Currently, there are no topical anti-androgens that are as effective as oral anti-androgens.

Examples:

Spironolactone (Aldactone, Spiritone)
Cyproterone acetate (Androcur, Climen, Diane 35, Ginette 35)
Flutamide (Eulexin), nilutamide (Anandron, Nilandron)
Finasteride (Proscar, Propecia)

4. Sebosuppresive agents: 

These are acne medications that reduce the production of sebum in the oil glands. The most effective sebosuppresive agent is oral isotretinoin. Oral isotretinoin makes the size of the small glands smaller thus they produce less oil. However, oral isotretinoin is reported to produce very nasty side effects including liver damage, depression, tendonitis and blood sugar problems. Since oral isotretinoin is a bit dangerous, it is only prescribed as a last line treatment for severe acne.

Example of oral sebosuppresive agent:
Oral Isotretinoin (Accutane)

       There are topical sebosuppresive agents that are safer compared to oral sebusuppresive agents but they are very modest in reducing the amount of facial oil. Zinc Oxide and Copper Peptide seems to block 5-Alpha Reductase. 5-Alpha Reductase is an enzyme responsible for converting testosterone to dihydrotesterone, the hormone responsible for triggering the oil glands to produce more oil. Isolutrol is an extract from the bile of sharks and is also aimed at reducing the oil secretion of the oil glands. However, the results of the studies using Isolutrol to reduce facial oiliness are mixed. Some studies say that it can reduce facial oiliness while others say that it is not effective. Topical niacinamide one study demonstrated some ability to reduce facial oiliness.

Example of topical sebosuppresive agents:
(Zinc Oxide, Copper Peptide, Isolutrol, Topical Niacinamide)

References:

1. Combination azelaic acid therapy for acne vulgaris. J Am Acad Dermatol. 2000 Aug;43(2 Pt 3):S47-50.
2. Acne therapy with topical benzoyl peroxide, antibiotics and azelaic acid, J Dtsch Dermatol Ges. 2006 Apr;4(4):293-300.
3. Topical therapy for acne. Am Fam Physician. 2000 Jan 15;61(2):357-66.
4. A randomized, double-blind, multicenter, parallel group study to compare relative efficacies of the topical gels 3% erythromycin/5% benzoyl peroxide and 0.025% tretinoin/erythromycin 4% in the treatment of moderate acne vulgaris of the face. J Cutan Med Surg. 2003 Jan-Feb;7(1):31-7. Epub 2002 Oct 9.
5. Study results of benzoyl peroxide 5%/clindamycin 1% topical gel, adapalene 0.1% gel, and use in combination for acne vulgaris. J Drugs Dermatol. 2007 Jun;6(6):616-22.
6. Efficacy and safety of azelaic acid and glycolic acid combination therapy compared with tretinoin therapy for acne.Clin Ther. 1998 Jul-Aug;20(4):711-21.
7. The comparative efficacy of benzoyl peroxide 5%/erythromycin 3% gel and erythromycin 4%/zinc 1.2% solution in the treatment of acne vulgaris. Br J Dermatol. 1997 Feb;136(2):235-8.

Standard Acne Treatment

Acne Treatment with Benzoyl Peroxide

       This is probably the most common OTC acne treatment. Benzoyl peroxide is an oxidizing agent that is applied on the skin and absorbed by the pores. Benzoyl peroxide creates free radicals inside the pores which kills the bacteria that cause acne. Benzoyl peroxide also promotes the drying of sebum and encourages the shedding of skin cells to avoid pore blockage. It is best to use the benzoyl peroxide 2.5% gel against the 5% benzoyl peroxide gel because it is less irritating and has the same effectiveness as with the 5% gel. Benzoyl Peroxide does not induce bacterial resistance so it is also good for long term use. Since benzoyl peroxide is an oxidizing agent, this acne medication can bleach your hair and your clothes.

Precautions and Side Effects:

Do not use benzoyl peroxide without consulting your doctor if you are pregnant or could become pregnant during acne treatment. This acne medication is not intended to be used on children.

Benzoyl Peroxide causes stinging sensation in the skin, light peeling of the skin and redness of the skin. People with very sensitive skin may experience flaking and scabbing.

Effectiveness:

       The 2.5% benzoyl peroxide formulation was more effective than its vehicle and equivalent to the 5% and 10% concentrations in reducing the number of inflammatory lesions (papules and pustules). Desquamation, erythema, and symptoms of burning with the 2.5% gel were less frequent than with the 10% preparation but equivalent to the 5% gel. The 2.5% formulation also significantly reduced Propionibacterium acnes and the percentage of free fatty acids in the surface lipids after 2 weeks of topical application.

(Source: Comparing 2.5%, 5%, and 10% benzoyl peroxide on inflammatory acne vulgaris.Mills OH Jr, Kligman AM, Pochi P, Comite H.)

       A water based 5% benzoyl peroxide gel (Benzac® W5) was compared with topical 1% clindamycin phosphate solution (Cleocin T®) in the treatment of acne vulgaris using a randomized, investigator blind study design. Lesion counts were significantly reduced in both treatment groups over the 12-week study period; however, the reduction of total lesions produced by benzoyl peroxide gel was significantly greater than that produced by clindamycin phosphate (P< 0.05). Clindamycin phosphate had a milder effect on the skin surface in terms of peeling and drying than the benzoyl peroxide gel.

(Source: L.J. SWINYER, M.D. BAKER, THALIA A. SWINYER, O.H. MILLS Jr (1988) A comparative study of benzoyl peroxide and clindamycin phosphate for treating acne vulgaris British Journal of Dermatology 119 (5), 615–622.)

Product Information:

Benzoyl Peroxide is available in gel or cream form at 2.5%, 5% and 10% concentration. The cream or gel is topically applied on the skin.

(Brand Names: Benoxyl®, Benzac®, Desquam® , Fostex®, Oxy 10®, PanOxyl®)

Reviews and Comments:

“I find benzoyl peroxide very effective in controlling acne breakouts especially if you use the 5% gel as spot treatment. I used this acne medication to counteract the breakouts caused by topical retinyl palmitate use. My only comment against it, is the way it made may skin slightly red and inflamed”.

References:

1. http://physchem.ox.ac.uk/MSDS/BE/benzoyl_peroxide.html Safety data for benzoyl peroxide (updated September 2003)
2. http://dermnetnz.org/treatments/benzoyl-peroxide.html Benzoyl peroxide Benzoyl Peroxide( updated December 2006 )
3. http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a603021.html Benzoyl Peroxide( updated 10/01/2003)

Acne Treatment using Topical Antibiotics

       Topical antibiotic is applied at the top of the skin; it is absorbed by the pores where the bacteria that cause acne live. Upon absorption, the population of the acne-causing bacteria is reduced significantly thus reducing the pimple redness and inflammation. Topical antibiotic is used as an alternative to oral or systemic antibiotics to avoid the bad side effects of oral or systemic antibiotic. Topical antibiotic is safer than oral antibiotics because it does not affect internal tissues and organs. The common side effect of topical antibiotic is just skin irritation and in some cases photosensitivity. Skin irritation can be reduced by using topical niacinamide or topical copper peptide. Avoid using topical corticosteroid when reducing skin irritation caused by topical antibiotics.

        Although topical antibiotic is effective against acne, the disadvantage of this acne treatment medication is “bacterial resistance”. Bacterial resistance is a condition where an antibiotic loses its germ killing power because the bacteria had already adapted to the germ killing ability of the specific antibiotic. The longer you use one type of antibiotic, the higher is the chance of bacterial resistance. This means that topical antibiotic therapy is only effective for several months if you use only one type of anti-acne antibiotics. An effective way to avoid bacterial resistance is to change the type of topical antibiotic you are using from time to time. For example, use topical clindamycin for the first 2 months and then use topical erythromycin for the next two months.

Precautions:

       Consult your doctor before using any oral or topical antibiotics if you are pregnant or if you have renal insufficiency. This acne treatment medication is not intentended to be used on children.    

Acne Treatment with Topical Clindamycin

It is commonly used to treat acne because it is more effective than topical erythromycin and tetracycline. Topical clindamycin is available as Clindamycin Phosphate at 1% concentration in gel, solution or lotion form. Topical clindamycin is applied twice daily on affected areas. You may encounter skin irritation with the use of this acne medication.

(Brand Names: Clinac® solution, Dalacin T® gel, lotion, solution, Topicil® solution & Duac® Once Daily gel)

Acne Treatment with Topical Erythromycin

Topical erythromycin is available at 2 to 4% concentration with or without 1.2% zinc acetate. Zinc acetate enhances the effectiveness of topical erythromycin. Topical erythromycin is applied on the face twice daily on affected areas.

(Brand Names: Stiemycin® solution, Eryacne® gel,A/T/S, Erycette, T-Stat)

Acne Treatment with Topical Tetracycline

Topical tetracycline is not used very often in acne treatment. Some people may have allergic reactions to topical erythromycin because it contains sodium bisulfite which is a sulfa derivative. Topical tetracycline may also cause the skin to turn yellow.

Acne Treatment with Topical Metronidazole

Used often in acne that is caused by rosacea. Topical metronidazole is available at 0.75% concentration in gel form.

References:

1. Expert Opin Pharmacother. 2007 Oct;8(15):2625-64. Topical clindamycin in the management of acne vulgaris. Guay DR. ; University of Minnesota, College of Pharmacy, Department of Experimental and Clinical Pharmacology, Weaver-Densford Hall 7-148, 308 Harvard Street SE, Minneapolis, MN, 55455, USA.
2. Drugs. 2004;64(21):2389-97. Topical antibacterial therapy for acne vulgaris. Dreno B.Department of Dermatology, Hotel Dieu, Nantes, France.
3. Cutis. 2001 Feb;67(2 Suppl):5-7. Are 2 combined antimicrobial mechanisms better than 1 for the treatment of acne vulgaris? Clinical and antimicrobial results of a topical combination product containing 1% clindamycin and 5% benzoyl peroxide. Introduction. Leyden J. Department of Dermatology, University of Pennsylvania Medical School, Philadelphia, USA.
4. Cutis. 2004 Jun;73(6 Suppl):6-10. Antibiotic resistance in the topical treatment of acne vulgaris. Leyden JJ. Skin Study Center, Broomall, Pennsylvania, USA.

Acne Treatment with Salicylic Acid

       Salicylic acid occurs naturally in Willow Trees and Wintergreen Trees. It is used traditionally as an anti-fungal agent for the treatment of warts and corns. For the treatment of acne, Salicylic acid doesn’t help much in killing those acne-causing bacteria. Salicylic acid only helps in exfoliating the skin. Exfoliation makes the skin peel at a faster rate which unblocks the pores of the skin.

Open pores reduce the growth of acne-causing bacteria by starving them with trapped sebum. Since salicylic is oil soluble, it can penetrate deeper into the skin compared to Alpha-Hydroxy Acids. This makes Salicylic acid more effective in treating oily skin with lots of whiteheads, blackheads and acne breakouts. For people with dry skin, Salicylic is not recommended not unless you use a good moisturizer like Panthenol or Hyaluronic acid. Salicylic acid usually makes your skin dry 2 to 3 days after initial application; it is then followed by mild to moderate peeling of the skin. After the peeling or shedding of the skin is completed, a smoother and younger skin is fully exposed.

Precautions and Side Effects:

Do not use salicylic acid without consulting your doctor if you are pregnant or could become pregnant during acne treatment. This acne medication is not intended to be used on children.

Topical salicylic acid may produce burning sensation after application especially at higher concentrations. Some may experience redness, swelling, itching and sun sensitivity. Higher concentrations may burn the skin.

Effectiveness:

       Beta-Hydroxy Acid works best at concentrations of 1% to 2% with an acidity level of pH 3. As the pH increases or their acidity decreases, the effectivity of beta-hydroxy acids decline.

(Source: Cosmetic Dermatology, October 2001, pages 15–18).

       Both inflammatory and non-inflammatory acne lesion counts were decreased in proportion to the duration of treatment. The side effects were tolerable in most cases, and all patients were pleased with their peel results. Stratum corneum hydration, skin surface lipid, skin pH, and transepidermal water loss were unchanged from baseline levels.

(Source: Ho-Sup Lee MD, Il-Hwan Kim MD (2003) Salicylic Acid Peels for the Treatment of Acne Vulgaris in Asian Patients Dermatologic Surgery 29 (12), 1196–1199.)

Product Information:

Salicylic acid is available in cream, lotion, gel and topical solution form at 0.51% to 3% concentration. Salicylic acid works best in concentrations of 1 to 2%. (Brand Names: Diprosalic®,Duofilm®,Coco-Scalp®,Neutrogena®)

Reviews and Comments:

“I find salicylic acid too drying on the skin even at 0.5% concentration when used daily. The good thing about it is that this acne medication can make your skin glow after exfoliation. A good moisturizer is needed if you want to use this acne product.”

References:

1. Desai A, Moy LS. The role of -hydroxy acids in the treatment of photoaging. Photoaging. Marcel Dekker, 2004: 117-140.
2. http://www.mayoclinic.com/health/drug-information/DR601247 ( updated 2007)
3. SALICYLIC ACID – A Plant Hormone Hayat, S.; Ahmad, A. (Eds.) 2007, XV, 401 p., Hardcover ISBN: 978-1-4020-5183-8
4. http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a607072.html (Last Revised – 11/01/2007 American Society of Health-System Pharmacists, Inc. Disclaimer )

Acne Treatment with Sulfur

       Sulfur is an element which exists as yellow powder or solid crystals near volcanic or hot spring areas. Sulfur posses an antibacterial, antifungal and keratolytic properties. Its antibacterial and keratolytic property is especially important to acne treatment. Although sulfur can kill acne-causing bacteria, sulfur is best noted for its keratolytic property. Sulfur makes the skin peel which helps unblock clogged pores. The peeling of the skin is thought to be caused by hydrogen sulfide which breaks down keratin. Hydrogen sulfide is the result of the reaction between the cysteine on skin cells and sulfur. Sulfur is best combined with topical Zinc Oxide because if its ability enhance wound healing and its anti-inflammatory property.

Precautions and Side Effects:

Do not use topical sulfur without consulting your doctor if you are pregnant or could become pregnant during acne treatment. This acne medication is not intended to be used by children.

Sulfur may cause itching, burning, stinging, tingling sensation, redness or dryness of the skin. Skin dryness is the most common side effect of sulfur.

Effectiveness:

       Sulfur has antifungal, antibacterial, and keratolytic activity. In the past, its use was widespread in dermatological disorders such as acne vulgaris, rosacea, seborrheic dermatitis, dandruff, pityriasis versicolor, scabies, and warts. Adverse events associated with topically applied sulfur are rare and mainly involve mild application site reactions. Sulfur, used alone or in combination with agents such as sodium sulfacetamide or salicylic acid, has demonstrated efficacy in the treatment of many dermatological conditions.

(Source: The use of sulfur in dermatology, Gupta AK, Nicol K. Division of Dermatology, Department of Medicine, Sunnybrook And Women’s College Health Science Center, University of Toronto, Toronto, Ontario, Canada. agupta@execulink.com)

10% topical sulfur is comparable to the performance of oral tetracycline.

(Source: Journal of Drugs in Dermatology | Date: 7/1/2004 | Author: Gupta, Aditya K.; Nicol, Karyn)

Product Information:

Available as Lotion, Liquid, Cream, Soap, Ointment, Gel, Shampoo. (Brand Names: Liquimat, Sastid Soap, Sulfoam, Sulfo-Lo,Sulmasque, Sulpho-Lac, Sul-Ray Aloe Vera Acne,Thylox Acne Treatment, Zapzyt Cleansing)

Reviews and Comments:

Sulfur is also affective in preventing acne breakouts if you use it at least twice a day. I used sulfur soap twice daily but I find it too drying on the skin. I quit using sulfur because I was not able to find a good moisturizer and I don’t want to use petroleum jelly as a moisturizer.”

References:

1. http://www.medicinenet.com/zinc_oxide-topical/article.htm “Zinc Oxide”( Last Editorial Review: 3/2/2005)
2. http://www.zincsulfur.com/Info.html “2001-2007 DAK Pharmaceuticals”

Acne Treatment with Azelaic Acid

       Azelaic acid is a naturally occurring substance produced by Pityrosporum ovale, a type of yeast that lives normally on the skin. Azelaic acid is toxic to the bacteria that causes acne and thus inhibits their growth. When you reduce the population of the bacteria that lives on the pores, you also reduce the inflammation and redness commonly associated with acne. The good thing about Azelaic acid is that it does not cause bacterial resistance and you can use it for very long periods of time.

Azelaic acid is also a keratolytic/comedolytic agent. This action helps unclog blocked pores by encouraging mild shedding of skin cells and it also normalizes the disordered growth of keratin which is a contributing factor in pore blockage. The end result is a reduction in the formation of comedos such whiteheads and blackheads. Azelaic acid also lightens the brown marks or brown spots ( hyperpigmentation ) left by acne. This may be useful for people with darker skin complexion.

Precautions and Side Effects:

Do not use azelaic acid without consulting your doctor if you are pregnant or could become pregnant during acne treatment. This acne medication is not intended to be used on children.

The only side effect presented by Azelaic Acid is the burning and stinging sensation that is felt almost immediately after its topical application. This feeling usually subsides after a few minutes. Some people with very sensitive skin may experience redness and dryness of the skin which can be reduce by using topical niacinamide, topical B5 or hyaluronic acid.

Effectiveness:

       Azelaic acid (15%) gel was as effective as 5% benzoyl peroxide gel and clindamycin

(Source: Iraji F, Sadeghinia A, Shahmoradi Z, Siadat AH, Jooya A. Efficacy of topical azelaic acid gel in the treatment of mild-moderate acne vulgaris. Indian J Dermatol Venereol Leprol 2007;73:94-6)

       Azelaic acid in 20% cream and 15% gel formulations appears to be effective in the treatment of papulopustular rosacea, particularly in regard to decreases in mean inflammatory lesion count and erythema severity. Compared with metronidazole, azelaic acid appears to be an equally effective, if not better, treatment option.

(Source: Arch Dermatol. 2006 Aug;142(8):1047-52. Liu RH, Smith MK, Basta SA, Farmer ER. Department of Dermatology, Eastern Virginia Medical School, Norfolk, VA, USA.)

Product Information:

Commercial Azelaic acid is usually available in 20% cream or gel formulation that is topically applied on the skin at least twice daily. (Brand names: Azelex®, Skinoren®)

Reviews and Comments:

“I would prefer Azelaic Acid over topical antibiotics because it can be used for very long periods of time. It is also preferable to Benzoyl Peroxide since Azelaic Acid has milder side effects. I find Benzoyl Peroxide too drying to the skin and somewhat makes my skin tender and swollen the following day after topical application. The only downside of Azelaic Acid is of course the cost. This acne medication is more expensive than Benzoyl Peroxide.”

References:

1. http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a603020.html ( Last update – 10/01/2003 American Society of Health-System Pharmacists, Inc. )
2. Br J Dermatol 1988 Nov;119(5):627-632 Inhibition of 5 alpha-reductase activity in human skin by zinc and azelaic acid. 3. Stamatiadis D, Bulteau-Portois MC, Mowszowicz I , Laboratoire de Biochimie B, Hopital Necker-Enfants-Malades, Paris, France.
3. http://www.raztec.com/azelaic.html (last update 2001)
4. http://www.rxlist.com/cgi/generic/azelex.htm (updated 2007) Azelex

Acne Treatment with Glycolic Acid Peels

       Glycolic acid belongs to the Alpha-Hydroxy Acid family. They can be isolated from sugarcane, sugar beets and pineapple. Glycolic acid is applied topically on the skin to dissolve and weaken the glue that binds the dead skin cells together. This results in the peeling of the outer skin layer which is composed of dead skin cells and the exposure of younger skin cells underneath. The young skin cells have smoother appearance and more even coloration. The peeling of old skin cells helps unblock clogged pores thus reducing the formation of whiteheads and blackheads. Since glycolic acid is water soluble, it may not be able to penetrate very oily skin. It is best used in treating acne where blackhead is not an issue.

Precautions and Side Effects:

Glycolic Acid can be used by pregnant women and is safe during pregnancy. This acne treatment product is not intended to be used on children.

The most common side effect of glycolic acid peel is skin irritation. Your skin may turn red and at high concentrations it may even burn the skin.
Effectiveness:

Effectiveness:

       Glycolic acid chemical peels are an effective treatment for all types of acne, inducing rapid improvement and restoration to normal looking skin.

(Source: L. Atzori, M.A. Brundu, A. Orru, P. Biggio (1999) Glycolic acid peeling in the treatment of acne Journal of the European Academy of Dermatology and Venereology 12 (2), 119–122.)

The glycolic acid and salicylic acid peels had been equally efficient. The salicylic acid peel had sustained effectiveness and fewer unintended effects. alpha- and beta-Hydroxy acid peels each provides a profitable adjunctive remedy of facial pimples vulgaris.

(Source: Comparison of alpha- and beta-Hydroxy Acid Chemical Peels in the Treatment of Mild to Moderately Severe Facial Acne Vulgaris.Kessler E, Flanagan K, Chia C, Rogers C, Anna Glaser D. Saint Louis University School of Medicine, St Louis, Missouri, USA.)

Product Information:

5% Glycolic Acid is used on dry, dehydrated, and normal skin.
10% Glycolic Acid is used on oily skin.

Reviews and Comments:

“I have used 5% Glycolic acid peels one a week and it is considerably less drying than salicylic acid peels”

References:

1. http://www.healthguidance.org/entry/2511/1/Chemical-Skin-Peels-Defined-and-Benefits.html ( By David Maillie last update 5/26/2006 )
2. http://www.healthguidance.org/entry/4650/1/What-You-Need-To-Know-About-Glycolic-Acid.html ( ( By David Maillie last update August 2006 )
3. http://www.skincareguide.ca/articles/
4. Hydroxy acids and retinoids in cosmetics. Clinics in Dermatology, Volume 19, Issue 4, Pages 460-466 M. Ramos-e-Silva
5. Desai A, Moy LS. The role of -hydroxy acids in the treatment of photoaging. Photoaging. Marcel Dekker, 2004: 117-140

Acne Treatment with Lactic Acid Peels

       Lactic acid is an Alpha-Hydroxy acid derived from milk sugars and occurs naturally inside the body. Since lactic acid is a natural substance inside the body, it is less irritating and highly unlikely to cause allergic reactions. Lactic acid has skin hydrating property that attracts and traps moisture in the skin. It is ideal for treating dry skin with acne. Lactic acid also stimulates the synthesis of collagen and elastin fibers in the dermis or deeper layer of the skin. The anti-acne action of Lactic acid relies on its ability to loosen the glue that holds the dead skin cells together. By exfoliating or peeling the skin, the formation of whiteheads and blackheads is reduced.

Precautions and Side Effects:

Lactic Acid can be used by pregnant women and is safe during pregnancy. This acne treatment product is not intended to be used on children.

Mild skin irritation. Higher concentrations of lactic acid peels may burn the skin.

Effectiveness:

       In an open clinical study, efficacy of 5% aqueous solution of lactate for preventing acne was evaluated in 22 patients. Lactate lotion was used topically all over the face twice a day and continued like a cosmetic for 1 year. Systematic antibiotics were given for periods of 4 weeks whenever the disease was severe. The effect of the treatment was evaluated by counting the number of comedones, inflammatory lesions and cysts separately once a month and recording them graphically. The greatest reduction in the lesion counts was achieved in 8-24 weeks for the inflammatory lesions and 8-30 weeks for the comedones.

(Source: Garg T, Ramam M, Pasricha JS, Verma KK.; Department of Dermatology and Venereology, All India Institute of Medical Science, New Delhi, India.)

Product Information:

Lactic acid peel is available in topical serums, creams or gels with varying concentrations.

50% Lactic Acid (pH 2.0) – this formulation is good for wrinkles and mature skin.
40% Lactic Acid (pH 2.2) – this is recommended for first time users of lactic acid peel.
30% Lactic Acid (pH 2.3) – recommended for sensitive skin.

Reviews and Comments:

“Youghurt can also be applied on the face if you want a very mild form of lactic acid peel

References:

1. http://www.healthguidance.org/entry/2511/1/Chemical-Skin-Peels-Defined-and-Benefits.html ( By David Maillie last update 5/26/2006 )
2.. http://www.skincareguide.ca4. Hydroxy acids and retinoids in cosmetics. Clinics in Dermatology, Volume 19, Issue 4, Pages 460-466 M. Ramos-e-Silva
3 . Desai A, Moy LS. The role of -hydroxy acids in the treatment of photoaging. Photoaging. Marcel Dekker, 2004: 117-140.

Blue Light Acne Treatment (Phototherapy)

       Blue light acne treatment is sort of an “optical antibiotic”. Blue light with a wavelength of 405 nanometers to 420 nanometers can kill acne-causing bacteria. Acne-causing bacteria ( Propionibacterium Acnes ) excretes waste products known as Porphyrins. When Porphyrins are exposed to blue light they produce free radicals which eventually kill the bacteria. Blue light acne treatment can only be used to treat mild to moderate acne and it does not do much on severe pustular acne. Commercial blue light acne treatment kits are made up of Light Emitting Diodes or special fluorescent lamps. There are portable blue light kits designed for home use and some products are intended for clinic use only. Eye protection is necessary for this type of acne treatment since high intensity blue light could damage your eyes.

Precautions and Side Effects:

Blue light acne treatment can be used by pregnant women and is safe during pregnancy.This acne treatment procedure is not to used on children.

None. May cause epileptic seizure in susceptible people.

Effectiveness:

In this study we have evaluated the use of blue light (peak at 415 nm) and a mixed blue and red light (peaks at 415 and 660 nm) in the treatment of acne vulgaris. After 12 weeks of active treatment a mean improvement of 76% (95% confidence interval 66-87) in inflammatory lesions was achieved by the combined blue-red light phototherapy. We have found that phototherapy with mixed blue-red light, probably by combining antibacterial and anti-inflammatory action, is an effective means of treating acne vulgaris of mild to moderate severity, with no significant short-term adverse effects.

(Source: P. Papageorgiou, A. Katsambas, A. Chu (2000) Phototherapy with blue (415 nm) and red (660 nm) light in the treatment of acne vulgaris British Journal of Dermatology 142 (5), 973–978. doi:10.1046/j.1365-2133.2000.03481.x)

      Subjects were treated over eight sessions, two per week 3 days apart, alternating between 415 nm blue light (20 minutes/session, 48 J/cm2) and 633 nm red light (20 minutes/session, 96 J/cm2) from a light-emitting diode (LED)-based therapy system. Patients received a mild microdermabrasion before each session. CONCLUSIONS: Combination blue and red LED therapy appears to have excellent potential in the treatment of mild to severe acne. Treatment appears to be both pain- and side effect-free.

(Source: Combination blue (415 nm) and red (633 nm) LED phototherapy in the treatment of mild to severe acne vulgaris.Goldberg DJ, Russell BA. Skin Laser & Surgery Specialists of New York/New Jersey, and Department of Dermatology, Mount Sinai School of Medicine, New York, NY 10022, USA.)

Product Information:

Blue light acne treatment is performed by exposing the affected area to blue light for 15 to 30 minutes. This acne treatment is best done once or twice a week for 8 to 12 weeks.
(Brand Names: Acnelamp, Revitalight)

Reviews and Comments:

“If you have your own blue light acne treatment device, this method could save you a lot of money. No messy stuffs on your face and with very little side effect.”

References:

1. http://www.revitalight.com/consumer_announcements.asp (REVITALIGHT Nancy Trent/Pamela Wadler Trent & Company)
2. http://www.acnelamp.com (Dima-Tech, Inc 2007)

Acne Treatment with Adapalene

       This acne medication is chemically related to Vitamin-A, which belongs to a family of compounds known as Retinoids. The action of Adapalene on the skin is similar to Tretinoin. It promotes the peeling of the skin and renewal of skin cells at a faster rate. Adapalene is less irritating than Tretinoin (Retinoic Acid). This anti-acne product also has some mild anti-inflammatory action and can be used together with benzoyl peroxide. Other retinoids like Tretinoin cannot be used with benzoyl peroxide because it becomes too irritating on the skin.

Precautions and Side Effects:

Do not use adapalene without consulting your doctor if you are pregnant or could become pregnant during acne treatment. This acne medication is not intended to be used on children.
Dryness, redness and mild peeling of the skin.

Effectiveness:

Adapalene gel 0.1% applied once daily was significantly more effective in reducing acne lesions and was better tolerated than tretinoin gel 0.025% in the treatment of acne vulgaris.

(Source: A comparison of the efficacy and safety of adapalene gel 0.1% and tretinoin gel 0.025% in the treatment of acne vulgaris: a multicenter trial.1: J Am Acad Dermatol. 1996 Mar;34(3):482-5)

This study showed that a majority of patients preferred adapalene 0.1% gel over tretinoin 0.025% cream and that it caused significantly less skin irritation.

(Source: Adapalene 0.1% gel for the treatment of acne vulgaris: its superiority compared to tretinoin 0.025% cream in skin tolerance and patient preference.1: Br J Dermatol. 1998 Oct;139 Suppl 52:17-22)

Product Information:

Adapalene is topically applied on the skin. This anti-acne product is available in cream or gel form at 0.1% to 0.3% concentration
(Brand Names: Differin®, Adaferin® )

Reviews and Comments:

Adapalene is milder on the skin but I would have to say that Tretinoin microspheres works better for me”

References:

1. http://www.differin.com ( 2007 Galderma Laboratories, L.P.) Adapelene Gel
2. http://www.fda.gov/cder/foi/label/2000/20748lbl.pdf ( Pharmacokinetics of Adapalene )
3. http://www.galdermausa.com/NewsAndMedia/PressRelease_21.aspx ( FDA Approves Differin® (adapalene) Gel, 0.3% 4. For Acne Fast, Powerful Efficacy For Challenging Acne ( June 20, 2007)
5. Adapalene-Benzoyl Peroxide Combination Effective and Safe for Acne CME News Author: David Douglas CME Author: Hien T. Nghiem, MD November 9, 2007

Acne Treatment with Tretinoin (Retinoic Acid)

      Tretinoin is also known as Retinoic acid which is a derivative of Vitamin-A. Retinoic acid increases the rate of skin cell division. This action generates more new skin cells and the old skin cells are pushed out of the surface of the skin. The overall effect is the mild peeling of the skin that unplugs trapped sebum and dead skin cells on the pore. The mild skin peeling prevents the formation of whiteheads and blackheads. Since the old skin cells are removed by means of peeling, what remains on the face are younger skin cells. This makes the surface of the skin appear smoother and finer. Retinoic acid is also effective in reducing wrinkles and the faces. Retinoic acid acne treatment may take at least 2 months or 6 months of continued use before you notice any significant improvement in the condition of your acne.

Precautions and Side Effects:

Do not use Retinoic without consulting your doctor if you are pregnant or could become pregnant during acne treatment. This acne medication is not intended to be used on children..

       Retinoic acids suppress the production of melanin, which protects us from the harmful effects of ultraviolet radiation coming from the sun. When the surface of the skin has reduced amounts of melanin, it can become easily irritated by the light coming from the sun. If you want to use retinoic as an acne treatment product, make sure that you apply a sun block cream that has a rating of at least SPF 15. During the first 2 weeks of use, your skin may experience redness, dryness, acne breakouts and flaking of the skin. These conditions are expected as your skin adjusts to this acne medicine. The side-effects of retinoic acid acne treatment will subside after a few months. You can use a moisturizer to reduce skin flaking and dryness.

Effectiveness:

       The addition of clindamycin to tretinoin, as in CTG, enhances the comedolytic efficacy of tretinoin in moderate to severe acne of the face, maintaining at the same time its anti-inflammatory efficacy thus accelerating resolution of all types of acne lesions without affecting the safety of response to both components.

(Source: Richter JR, Förström LR, Kiistala UO, Jung EG., Yamanouchi Europe B.V., Medical Department Europe, Leiderdorp, The Netherlands. J Eur Acad Dermatol Venereol. 1998 Nov;11(3):227-33.)

       Both TGM (Tretinoin Gel Microspheres) 0.04% and TGM 0.1% were associated with reductions in lesion counts in these patients with mild to moderate facial acne. Both concentrations were generally well tolerated. The results suggested an early (week 2) incremental benefit for the use of TGM 0.1% in the treatment of inflammatory lesions.

(Source: Berger R, Rizer R, Barba A, Wilson D, Stewart D, Grossman R, Nighland M, Weiss J., Clin Ther. 2007 Jun;29(6):1086-97)

Product Information:

       Tretinoin is available as topical serum, gel and cream at 0.01%, 0.025%, 0.05% concentration. The latest version uses “microspheres” as a carrier; this is a sustained release version of the original topical retinoic acid cream. Tretinoin microspheres deliver retinoic acid in small quantities over longer period of time instead of delivering the full dose in one instance. This makes tretinoin microspheres the least irritating form of retinoic acid.

(Brand Names: Altinac™; Avita®; RENOVA®; Retin-A™; )
(Tretinoin Microspheres Brand Names: Stieva-A, Retin-A® Micro) Highly Recommended

Reviews and Comments:

“Initially, I used the topical hydro-alcoholic solution form of Tretinoin which would turn my skin red and flaky. It made may skin also feel itchy sometimes and a bit sore. I have a great experience when I switched to Tretinoin microspheres because the flaking was very mild and my skin doesn’t turn red and sore.”

References:

1. http://www.retinamicro.com ( 12 October 2007 )
2. http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682437.html ( Last Revised – 04/03/2000 American Society of Health-System Pharmacists, Inc.)
3. Aditya K Gupta MD, PhD, FRCP(C), Melissa D Gover BSc, William Abramovits MD (2007)
4. Ziana (Clindamycin Phosphate 1.2% and Tretinoin 0.025%)Gel
SKINmed 6 (2), 85–87.
5.Tretinoin: A review of preclinical toxicological studies Marvin Cohen * Scientific Information Services Department, Hoffmann-LaRoche, Inc., Nutley, New Jersey
6. Effects of tretinoin on photodamaged skin. A histologic study
7. J. Bhawan, A. Gonzalez-Serva, K. Nehal, R. Labadie, L. Lufrano, E. G. Thorne and B. A. Gilchrest
Department of Dermatology, Boston (Mass) University School of Medicine 02118.

Acne Treatment with Topical Niacinamide

       Niacinamide is a form of Vitamin-B3 or Niacin. The topical version of Niacinamide is formulated in a water-alcohol base so that it can penetrate the skin more easily. The role of Topical Niacinamide in acne treatment is the reduction of inflammation and redness that occurs in most acne lesions. Niacinamide is an effective topical anti-inflammatory agent that has mild exfoliating action, enabling the skin to shed old skin cells and prevent pore blockage. The mild exfoliating action of niacinamide is attributed in its ability to speed up the differentiation or cell division of keratinocytes. This acne medication also acts as a mild moisturizer that increases the ceramide and free fatty acids in the skin. Topical niacinamide can also mildly reduce the amount of sebum on the oil gland. Some people use topical niacinamide as a very safe skin lightening agent.

Precautions and Side Effects:

Topical Niacinamide can be used by pregnant women and is safe during pregnancy. This acne treatment product is not intended to be used on children.

No adverse side effects. Mild exfoliation, lightening of the skin

Effectiveness:

       Data demonstrate that 4% nicotinamide gel is of comparable efficacy to 1% clindamycin gel in the treatment of acne vulgaris. Because topical clindamycin, like other antimicrobials, is associated with emergence of resistant microorganisms, nicotinamide gel is a desirable alternative treatment for acne vulgaris.

(Source: Shalita AR, Smith JG, Parish LC, Sofman MS, Chalker DK.Department of Dermatology, State University of New York, College of Medicine, Brooklyn, USA.)

       Topical application of niacinamide increases ceramide and free fatty acid levels in the skin, it prevent the skin from losing water content and it stimulates micro-circulation in the dermis.

(Source: British Journal of Dermatology, September 2000, pages 524?531; and Journal of Cosmetic Dermatology, April 2004, page 88)

       2% niacinamide was shown in one small study to be more effective than petrolatum (Vaseline) for reducing water loss from skin and increasing its hydration levels.

(Source: International Journal of Dermatology, March 2005, pages 197-202)

       Fifty subjects applied the 2% niacinamide moisturizer to the face for 4 weeks and 50 subjects used a placebo moisturizer for 4 weeks, with sebum excretion rate (SER) measurements taken at baseline, week 2, and week 4. In addition, 30 Caucasian subjects were enrolled in a randomized split-face study for 6 weeks with SER and casual sebum levels (CSL) measured at baseline, week 3, and week 6. Results : The results of the Japanese study demonstrated that the SER of the two groups was not significantly different at baseline, but the 2% niacinamide treated group demonstrated significantly lowered SER after 2 and 4 weeks of application. The results were somewhat different in the Caucasian study. After 6 weeks of treatment, the CSL was significantly reduced, but the SER was not significantly reduced. Conclusions : Topical 2% niacinamide may be effective in lowering the SER in Japanese individuals and CSL in Caucasian individuals.

(Source: Journal of Cosmetic and Laser Therapy, Volume 8, Number 2, June 2006 , pp. 96-101(6) The effect of 2% niacinamide on facial sebum production,Authors: Draelos, Zoe Diana1; Matsubara, Akira2; Smiles, Kenneth3)

Product Information:

Topical niacinamide is available in cream, lotion or gel form. Niacinamide concentration ranges from 2% to 5% by weight.
(Brand Name: Metazine)

Reviews and Comments:

“Although topical niacinamide does not kill acne-causing bacteria, this acne medicine is a very good adjunct in multi-therapy acne treatment. Topical niacinamide is indeed a good anti-inflammatory and I have used this anti-acne product to treat Seborrheic dermatitis and it works very well in reducing skin lesions.”

References:

1. Sorg O, Antille C, Saurat JH. Retinoids, other topical vitamins, and antioxidants. Photoaging. Marcel Dekker, 2004: 89-115.
2. Chiu A, Kimball AB. Topical vitamins, minerals and botanical ingredients as modulators of environmental and chronological skin damage. Br J Dermatol 2003; 149(4): 681-691.
3. Lupo MP. Antioxidants and vitamins in cosmetics. Clinics in Dermatology 2001; 19:467-473.
4. Using Aldara, copper peptide, and niacinamide for skin care. Aesthetic Surgery Journal, Volume 24, Issue 1, Pages 83-84
J. Carraway

You might think that you need to use prescription medication to get rid of acne, but this is not the case. Many prescription drugs that are used to treat acne are actually not healthy for you in the long run.

Make sure that you don’t risk further damage to your body by taking something like a prescription medicine that will only make your problem worse. If you follow all of the tips in this article, you should have no trouble curing your acne.

Now that you have read this article, you should be able to get rid of acne once and for all. Use the information above to get started on a good acne cure program today.