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The four common causes of acne, and five steps to treat it

Posted on November 15, 2016 at 3:30 PM

Acne is mainly caused by 4 factors: sebum, hormones, an immune response, and bacteria.


Sebum is produced by sebaceous glands in the skin; it is a waxy substance that helps keep the skin and hair shafts moisturized. When sebum is being produced faster than it can leave the sebaceous gland, the gland gets plugged up and forms a blackhead (also called an open comedone). When the skin is dry, it produces more sebum. This is why over-washing your face, especially with harsh soaps, can actually CAUSE acne. Sebaceous glands can sometimes get plugged by dirt, oil, and sweat, so my first recommendation to help prevent acne is to wash your face once or twice a day (depending on how naturally oily your skin is), and to follow up with a gentle moisturizer.


Hormones such as testosterone and progesterone stimulate the sebaceous glands to produce more sebum. Steroid medications such as prednisone, and other medications such as dilantin, lithium, and isoniazid can have the same effect. If you feel a medication is causing you to have acne, speak to your doctor about it before stopping the medication. Cortisol is a steroid that is naturally produced in your body in response to stress, which is why acne flare-ups tend to occur in times of stress. Meditating daily is one great way to help reduce your cortisol level.


An immune response occurs when pressure increases in the sebaceous gland or blackhead quickly, and the trapped sebum bursts into the surrounding tissue. This can happen when a pimple forms suddenly, or when the outlet/surface of the blackhead is blocked. White blood cells come to remove the sebum that doesn’t belong there, and when white blood cells die they form pus. This is what forms a whitehead (also called a closed comedone, pustule, or boil). When the inflammation is very severe, they can form cysts (also called cystic acne), which can leave scars. Medicated face washes that contain benzoyl peroxide or salicylic acid break down the sebum plug to prevent inflammation. When washing with gentle soap and following up with moisturizer doesn’t do enough, the next step is to try one of these medicated face washes. Benzoyl peroxide can lighten your skin and hair (e.g. eyebrows) because it is a kind of bleach, and both medications can make you more sensitive to the sun, so remember to wear sunscreen if you are using these medicated face washes.


A bacteria called Propionobacterium acnes lives on the skin and can trigger inflammation in the sebum. When benzoyl peroxide and/or salicylic acid aren’t helping enough, the next step is to ask your doctor about a face wash or cream that contains an antibiotic or an oral antibiotic pill. Another medication that kills P. acnes is isotretinoin; this medication cannot be used if you are pregnant because it causes birth defects, and most doctors will make female patients take birth control pills if they are using isotretinoin. It is a very strong medication only reserved for severe cases. Antibiotics and isotretinoin are only available by prescription. Clorhexidine is an antiseptic that you can buy over the counter that kills skin bacteria, and is not as drying as other anti-bacterial soaps. It needs to be used twice daily to work. All anti-bacterial treatments need to be used for several weeks before your skin will clear up, and should be used in conjunction with medicated face washes for optimal effect.


Many people feel that eating certain foods (such as fried foods or chocolate) can worsen their acne, but this has not been proven in studies. It is believed that if you have greasy foods and then touch your face, the excess oil on your face CAN be a trigger for acne, but it’s not eating them that is the problem. One other correlation is that people tend to crave greasy foods and chocolate when they are stressed, and the stress increasing their cortisol is actually what is causing more acne.


In summary, here are my recommendations for acne. If one doesn’t work, continue on to the next step. And remember, if you already have acne, it can take 4-6 weeks for your skin to clear up, so don’t give up after a few days!

1. Try to decrease your level of stress by meditating or doing something else relaxing daily.

2. Wash your face once or twice daily with a gentle, unscented soap. After washing, gently pat your face dry and use a gentle moisturizer. Use only water-based cosmetics.

3. Use a medicated face wash that contains either benzoyl peroxide or salicylic acid.

4. Use a clorhexidine face wash twice a day, or ask your doctor about starting an antibiotic treatment (either a face wash, cream, or oral pill).

5. Ask your doctor for a referral to a dermatologist, who can prescribe isotretinoin.


If you have any questions, you can always call Doctor At Your Door at 720-418-1705.

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