All About Acne
What is Acne ?
The tendency to develop acne and related blemishes is hereditary. People who suffer from acne-prone skin inherit 2 major factors: the tendency to retain cells (cell buildup) known medically as “retention hyperkeratosis”, and overactive sebaceous oil glands in the skin. As cells buildup in the skin, they are coated by oil (sebum) secreted by the overactive glands. This causes a type of “sludge” which blocks pores (follicles), cutting off oxygen from the bottom of the follicle.
Acne bacteria, called propionibacterium acnes are anaerobic, which means they cannot survive in the presence of oxygen. Even though these bacteria exist normally in every pore on every person, acne does not manifest itself in most people because oxygen is penetrating the follicle, keeping bacterial growth in check. When a blockage occurs in the follicle however, oxygen cannot penetrate as easily, which sets the stage for development of acne blemishes.
Acne bacteria feed off fatty acids that they process from the abundance of sebaceous oil secreted by the oil glands. This causes more inflammation, resulting in swelling that further blocks the follicle.
The signal that triggers oil production is sent by hormones called androgens. These are male hormones, but are present in both men and women. Androgens, such as testosterone, are what cause pores to enlarge and acne problems to start at puberty. They also cause women to sometimes develop acne problems and hair growth at menopause, and especially those pesky pre-menstrual breakouts! These premenstrual flares are theorized to be caused by sudden surges of oil triggered by androgens in the bloodstream. These surges inflame the follicles causing sudden acne flares, most often in the chin and jaw line areas. They can also be caused by the kind of fight-or-flight stress women experience in their jobs, since women produce testosterone in their adrenal glands; an adrenalin rush can cause the same oil surge as PMS. In chronic cases, these flares can be managed with hormonal therapy from a gynecologist or an endocrinologist (hormone specialist physician), since there is a good likelihood there is an imbalance present. In most cases, however, they can be treated and controlled with proper skin care.
Although there is still no real cure for acne, acne-prone skin can be managed by controlling cell buildup and managing the oil secreted by the glands. Because this is a never-ending cycle, people with acne-prone skin must be forever vigilant in controlling the buildup that begins the development of blemishes. The beginning of this process in the follicle results in the formation of a microcomedo, a small “sludge” within the follicle that cannot be seen by the person. It is only in the later stages does this “sludge” results in a blackhead (open comedo), whitehead (closed comedo) or a pimple. The trick in managing acne-prone skin is the squelching of the development of the microcomedo!
Treatment of Acne
It’s very important for the skin care consumer to know that there are 4 grades of acne. Grades 3 and 4, where there are more than just a few pimples and quite a bit of infection (think “pizza-face”), are the purview of doctors. Grades 1 and 2, marked by varying degrees of blackheads, whiteheads and a smaller severity of pimples with and without white heads on them, are not necessarily medically related. If you have anywhere from a few blackheads, to blackheads with three or four small pimples, to a few blackheads in the t-zone area with one or two large, even painful, “undergrounders” in the chin area, you most likely have grade 1 or grade 2 acne.
Going to a doctor for breakout problems like those seen in grades 1 and 2 acne is like going to a podiatrist for a pedicure. It is totally unnecessary to use medication for acne that is not infectious, highly inflamed or cystic. Antibiotics can cause systemic problems in the long run and over-drying and sensitivity in the short run. But with all the claims, choices, fancy marketing and products out there, the question remains, how does one get rid of annoying breakouts that should have been left behind with adolescence ?
Mild to moderate acne for most people is more a problem of pore clogging than anything else. Bacteria is most often a secondary issue, as it really only becomes a problem when a pore is clogged, or swollen, shut. As long as oxygen can enter the pore, bacteria is kept under control (except in cases of cystic acne). Therefore, whether the problem is pore-clogging ingredients, dead skin cell build-up, or irritation inside a pore, if the pores are kept clear and flowing, acne will not be a problem.
Elimination of the use of comedogenic (pore-clogging) cosmetics and skin care is imperative to help problem skin. Many fats used in cosmetics, particularly moisturizers and treatment products, foundations, powder, and blush, help to contribute to the pore-clogging process. Use of the right products recommended by the right professional can make the difference between years of trial and error or maybe even unnecessary medications, and a regimen that can finally control your breakouts and give you beautiful skin.
Here are a few guidelines that can help you deal with mild to moderate breakout problems :
1)You must cleanse your skin twice a day! Your skin should feel clean and comfortable after washing. If it feels a little slippery and not very clean, your cleanser is not adequate. If it feels tight or dry, the pH is too high and your skin will try to balance itself by overproducing oil ! This is one major cause of excess blackheads.
2)An alcohol free, balancing toner must be used after cleansing every time to prevent excess oil production and to augment the hydrating aspects of your moisturizer. This is especially true if your cleanser is foaming rather than a lotion type.
3)An anti-oxidant hydrating serum will help speed healing of acne lesions (watch use of anti-oxidants though when you have a tendency toward many large blackheads, because sometimes blackheads with very oily skin can be increased by anti-oxidant serums).
4)For exfoliation, the use of Alpha Hydroxy Acids (AHA’s) or Beta Hydroxy Acids (BHA’s) is wonderful for unclogging pores and keeping them unclogged (if you are allergic to citrus, aspirin or dairy, these acids might not be appropriate – there are alternatives such as enzymes or mild scrubs). DO NOT USE APRICOT SCRUB!! Scratchy scrubs cause microscopic tears in the skin, which are repaired by oil and dead skin cells, resulting in small white heads, or milia. It can also cause small red breakouts from irritation. If your breakouts are very minor, use a creamy scrub that contains small round beads, or crushed pumice, instead of crushed pits.
5)Benzoyl Peroxide (BPO) not only kills bacteria inside pores by exposing these anaerobic bacteria to oxygen, but it also “flushes-out” pores with mild exfoliation, and dries up excess oil. However, BPO’s are not meant for long-term use! Even when it’s only a 2.5% concentration, which is the only percentage that should be used on most faces, it can be over-drying over too long a period of time. If used for too long after the initial breakout has cleared up, BPO can backfire and cause too much dryness resulting in oxygen not getting into pores to kill growing bacteria, along with irritation from its oxygenating nature that can lead to inflamed pores resulting in those nasty “undergrounders”. Use a BPO for a few days on blemishes only, then switch to every other night when the breakout begins to clear up, then take a break entirely from it until you break out again (if you break out again). It’s also a great idea to use a BPO under a clay mask on breakout areas or individual blemishes every night until the breakout goes away. As soon as it starts to clear up, stop the procedure. Let the skin heal the rest itself. Be aware, many people are allergic to BPO.
6)DO NOT use any moisturizer that is not approved by a licensed skin care professional who knows ingredients! 90% of the moisturizers out there are the main cause of the breakouts you experience. You must use a non-comedogenic (that means non-clogging) moisturizer that adds water to the skin, even if you are oily – remember, the more hydrated your skin is, the more pliable it is, the more pliable it is, the more it’s able to release it’s excess oil that otherwise would get solid from lack of water, which results in more blackheads. So, a hydrating SPF in the morning, and a hydrating lotion at night will help your skin get rid of your blackhead problem as well has help it to function properly.
7)Consider the products your boyfriend or husband may be using, especially if he has a beard or goatee.
8)If your breakout is more severe along the hairline or the “side burns”, it’s very likely that a hair styling product or leave-in conditioner is causing the problem. Pomades and mousses are especially clogging, and gels can be as well. Hairspray is a problem if too much is directed at the front of the head. Either way, styling your hair either before washing, or running a cotton pad with toner along the hairline after styling and once in the middle of the day, can help. Of course, the most effective solution is either to stop using the offending product, or keep it as far away from your hairline and upper cheeks as possible. But remember, even if you only apply it to the ends of your hair, it can still get onto your skin if you ever sleep on your hair or when hair brushes against your skin on a windy day. It only takes a few molecules of a clogging ingredient to clog a pore! You might also want to consider that you’re not washing your face properly. You’d be surprised how many people don’t know how to clean their face !
9)You must be very careful about the foundation, powders, bronzers and blush you use. Unfortunately when dealing with acne-prone skin, one product that contains inflaming or clogging emollients can often spoil the whole routine. Be very careful not to spoil a good skin care program with makeup that is oily or irritating! And, “Oil-free” does not necessarily mean that the foundation is free of all emollients that can cause or aggravate flares! Bronzer is notorious for causing breakouts, especially pressed. Most blushes also can cause problems because of the cheap red and yellow dyes that are used. If you are breaking out along your cheeks, it’s not because of your blush brush – that is a myth started by a very sweet and well meaning makeup artist (my he rest in peace) who knew makeup very well, but didn’t know skin. The cause is the dyes in the blush. Buy only from a licensed Esthetician or look for pure mineral makeup. Some hypoallergenic lines are quite good, but Mark Lees Skin Care makeup is the only line I know of that guarantees their makeup will not cause breakouts due to clogging and is available in the salon (I didn’t include the makeup line on the web site because it’s difficult to see color that way).
Some Myths About Acne:
•There is no scientifically proven connection between the food that you eat and your breakouts. Oily foods do not contribute oil to the skin, and if you are convinced that you break out whenever you eat chocolate (or anything else), just ask yourself this question; when are you most likely to eat chocolate? (answer: before your period, and any time you’re under stress!) And when do you tend to break out most of the time?? See ? Having said that, there is a theory that there may be a connection between breakouts and the consumption of iodine (such as in shellfish, seaweed and/or kelp supplements, and iodized salt which is in just about everything) but it’s just a theory. If you think this may apply to you, try cutting these out for two weeks and see if your skin clears up.
•Sun exposure does not get rid of acne breakouts! A tan only camouflages a breakout, and even if the UV rays do clear up a problem short term, do you really want to damage your skin to that extent to clear up a breakout when there are so many other, safer ways to do it ?
•The skin does not have to be dried up with alcohol in order to clear up a breakout.
•Facials and good skin care can compliment a dermatologist’s care. If your dermatologist tells you that facials or estheticians make problems worse, sorry to say, your doctor is very old school and is not up to date on the latest developments in skin health and care. You may want to switch doctors.
•Facials do not cause “toxins” to come up to the surface causing breakouts. The skin simply does not work that way. When a breakout occurs after a facial, it’s usually because pores are traumatized by extraction that is too rough and oil subsequently spills into pores causing irritation and swelling. BPO (Benzoyl Peroxide) can take care of that. Other times a breakout after a facial can occur from allergic reaction or sensitivity. Most often it’s a matter of cheap, pore-irritating products being used by estheticians who have not studied problem skin or ingredients. Be sure to get your facials at a reputable skin care salon that specializes in problem skin by a licensed skin care professional who understands acne-causing ingredients, and who knows how to prevent problems as well as advise you on what to use at home.
Follow this tried and true skin care routine for acne skin :
1)Cleanse with a foaming cleanser that doesn’t make your skin tight or dry after rinsing. You may want to try a few samples before you purchase, to make sure what’s right for your skin.
2)Use a toner that will address your problem based on the amount of oil your skin produces – if you tend to get shiny or greasy before noon and you have breakouts, use a toner with salicylic acid, if not use an alcohol-free toner with a spray.
3)Apply an acne fighting treatment lotion or liquid with BPO, Salicylic Acid or Sulfur and Resorcinol.
4)Exfoliate with an AHA or BHA gel to unclog pores and break up excess oil.
5)Apply a hydrating SPF in the morning, and a hydrating lotion at night.
6)Once or twice a week, use a clay mask to clear up skin and keep it clear.
Professional help
Regular facials can help acne-prone and oily skin, but only if they are performed by a competent, well-trained esthetician. Not all facials are great for acne. Many “anti-aging” facial treatments may be loaded with oils or irritants that can aggravate a flare-up. However, if you get a facial from an esthetician trained in problem skin, it is possible to get a great “anti-aging” facial designed just for problem skin that is perfectly effective and just as results-oriented, without all the goopy mess.
