Acne is caused by two main influences:

• Family History – Those with a strong family history of acne, and in particular scarring acne, seem to get more acne.
• Hormones – Hormones rise with the onset of puberty and acne is the first sign of adolescence. Furthermore, hormones fluctuate with menstrual cycles and are heavily influenced by stress. This explains why those who under more stress (e.g. upcoming examinations) tend to flare of acne.
• Additional Causes
  • Those people who take anabolic steroids get more acne.
  • Those with a hormone imbalance (e.g. PCOS) develop more acne.
  • Certain birth control methods such as progestin only (e.g. Depo-Provera or Mirena IUD) can make acne worse.
  • Acne can be triggered by mechanical occlusion such as hats, headbands, chin straps, occlusive clothing, as well as heavy makeup.
  • Certain medications such as lithium can also trigger acne

There are multiple different types of acne lesions. The earliest lesion is known as a comodone (more commonly referred to as “blackheads and whiteheads”). These are the basic form of acne in which oil and skin cells clog the pores. Papules and pustules (i.e., “zits”) represent the body’s inflammation towards the overgrowth of C. Acnes bacteria within the pores. Cysts and nodules refer to inflammation associated with ruptured pores and carry a higher risk of potential scarring. In general, it is easier to calm down the inflammatory lesions quicker than it is to unclog the pores. – It takes months to unclog the pores.

No. It is impossible to scrub open your clogged pores. In fact, the more you scrub, the worse the acne may become. It is best to avoid cleansers with grapefruit pits, beads, and other harsh chemicals. It is frustrating that it takes months to unclog pores. The best way to accomplish this is through exfoliating cleansers, retinoids (i.e., Acne Duo Plus™, Retin-A™, adapalene, tazorotene etc.), and chemical peels. It is critical to remember that you must apply a non-comodogenic moisturizer to minimize irritation.

Wash your face every morning, every evening, and after exercise.

1. Use a mild cleanser that won’t clog your pores. (The label may say “won’t clog pores” or “non-comedogenic”). Harsh scrubs with grapefruit pits and beads should be avoided.
2. Do not use astringents, alcohol, or witch hazel.
3. If you have very oily skin, then a cleanser with salicylic acid (i.e., Neutrogena oil free acne wash) may be useful. But keep in mind that that salicylic can dry out your skin and produce irritation. Using a facial moisturizer afterwards is a must, even if you have oily skin.

Examples of commonly recommended cleansers:

For Combination skin: 

• Neutrogena transparent facial bar
• CSD glycolic acid wash

For Sensitive skin

• Neutrogena ultra-gentle hydrating cleanser (for sensitive skin)
• Dove sensitive skin bar (for sensitive skin)
• Cetaphil daily facial cleanser (for sensitive skin)

   For Oily Skin:

• Salicylic acid wash (Neutrogena oil free acne wash)

Glycolic acid is a gentle facial cleanser used for the treatment of acne. Alpha-hydroxy acids provide exfoliation, and their low pH helps reduce P. acnes levels on the skin. Glycolic acid is well-suited for use by individuals with dry skin because the hydroxy acids act as humectants (i.e., draw water into the skin). In addition, the exfoliating activity of glycolic acid improves the penetration of other acne medications into the skin. Glycolic acid wash is available for purchase at Craig Singer MD Dermatology.

Several moisturizers are available for purchase over the counter. (The label may say “won’t clog pores” or “non-comedogenic”). Some people prefer one over another. Some people find that certain moisturizers sting or irritate their skin. It may take some trial and error to figure out what you like best. Dr. Singer’s personal preference is for a moisturizer called Theraplex Hydro lotion™ sold on Amazon. However, many other over-the-counter moisturizers are more than adequate. These include Neutrogena Hydro boost™, Cetaphil moisturizer™ and Cerave moisturizing cream™.

Apply your acne medications first and then apply the moisturizer second, on top of your acne medications. On rare occasion, if a topical retinoid medication is producing irritation, you may be instructed to apply the moisturizer before the topical retinoid.