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A Guide To Managing Acne

  • Acne is a common skin condition in which hair follicles get clogged, forming various bumps on and/or under the skin often on the face, chest and back.
  • Acne is not a serious health concern but can be uncomfortable and often affects self esteem.
  • Over-the-counter treatments can be effective for mild acne. Prescription medications may be necessary for moderate to severe acne.

What is Acne?

Acne, a common skin condition affecting almost 90% of people at some point in their lives, occurs when hair follicles on the skin become clogged with dead skin cells and oils. It is most prevalent during puberty due to hormonal changes but can affect individuals of all ages, including babies and the elderly.

While acne is often associated with red bumps on the face and back, its appearance can vary. Some common types of acne include:

  • Whiteheads: Small, white bumps on the skin caused by clogged follicles without a clear opening.
  • Blackheads: Small black spots on the skin resulting from clogged follicles that are open to the air, causing the oils to darken.
  • Papules: Small pink bumps on the skin accompanied by inflammation and tenderness.
  • Pustules: Pink-based bumps with a white or yellow top, indicating inflammation and the presence of pus.
  • Nodules: Deeper, flatter pink spots that are often painful and located beneath the skin's surface.
  • Cysts: Similar to nodules, these deep lesions are filled with pus and have a softer texture.

Causes of Acne

There are many causes of acne, though they are all related to increased production of oil, dead skin, and bacteria on the skin and in the pores.

Hormonal changes

One of the primary causes of acne is hormonal fluctuations. During puberty, increased production of sex hormones (androgens) can lead to excessive oil production, clogged pores, and acne. Hormonal changes during pregnancy or due to hormonal disorders can also contribute to acne development.

Genetic factors

Family history plays a role in acne susceptibility. If your parents had acne, there's a higher likelihood that you may experience it too. Genetic predispositions can influence factors such as oil production and skin sensitivity, making individuals more prone to acne.


Certain medications have been associated with acne development or worsening of existing acne. Examples include corticosteroids, anti-seizure medications, and lithium. If you suspect that a medication is contributing to your acne, consult with your healthcare provider for potential alternatives or solutions.

What causes acne?

There are 4 leading causes of acne:

  • Bacteria (P. acnes)
  • Inflammation
  • Excess oil (sebum) production
  • Hair follicles clogged by oil and dead skin cells

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Medication Options for Acne

The treatment of acne depends on the underlying cause and the severity of the condition. Addressing the root cause, such as medication-induced acne, may involve modifying the medication regimen. However, when the cause cannot be directly addressed, acne treatment is typically based on its severity, which is classified into four grades:

  • Mild Acne: Characterized primarily by the presence of blackheads and whiteheads, with only a few papules or pustules.
  • Moderate Acne: Mainly consists of papules and pustules, with a higher frequency and intensity compared to mild acne.
  • Moderately Severe Acne: In this stage, there are numerous papules and pustules, and possibly a few nodules. Acne may spread to other areas of the body, such as the chest and back.
  • Severe Acne: This stage involves a significant number of large pustules, nodules, and cysts. It is the most severe form of acne and may cause extensive inflammation and scarring.

Acne treatments typically require a few weeks to show noticeable results. There are seven main medication categories commonly used to treat acne. The choice of treatment depends on the severity of the acne. Here are the different options available:

  • Topical Exfoliants: These products contain sulfur or salicylic acid. They work by breaking down blackheads, whiteheads, and reduce dead skin cells.
  • Topical Antibacterials: Topical antibacterials such as antibiotics, dapsone and/or benzoyl peroxide work to kill bacteria on the skin’s surface. They also help to reduce inflammation and therefore are most effective for inflamed acne.
  • Topical Retinoids: Topical retinoids, such as adapalene and tazarotene, are the most effective topical therapies for acne. They work to prevent the formation of acne as well as reduce inflammation and scarring.
  • Oral Antibiotics: Oral antibiotics, such as minocycline and tetracycline, work to reduce inflammation and destroy bacteria that may be causing acne. Oral antibiotics are stronger than topical forms and are therefore a choice in more severe acne or if treatment with topicals has failed.
  • Oral Hormonal Birth Control: Women with hormonally-caused acne may benefit from hormonal birth control pills. These medications reduce androgen levels, leading to decreased oil production and prevention of acne.
  • Oral Anti-Androgen Medications: Anti-androgen medications like spironolactone reduce androgen production, thereby decreasing oil production in the skin. They can be used in both men and women.
  • Oral Retinoids: Isotretinoin, an aggressive oral retinoid, is highly effective in treating severe and stubborn acne. However, it comes with notable side effects and is not suitable for certain populations, such as pregnant women or those planning pregnancy.

It's essential to remember that while these risk factors raise the possibility that someone may acquire celiac disease, they don't guarantee that they will. Without these risk factors, celiac disease is still possible to develop, and not everyone who has these risk factors will also develop it.

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