Factors that Cause and Affect Acne Development

Acne is a common skin condition that occurs in many individuals. It occurs when hair follicles
become stopped up with oil and dead skin cells. This causes whiteheads, blackheads or
pimples. Although acne tends to be most common in teenagers it can affect people of all ages.

Acne is caused by four main factors.

1. Abnormal follicular keratinocyte hyperproliferation – leads to the formation of a follicular
   plug
2. Increased sebum production within sebaceous follicles
3. Proliferations of microorganisms in the retained sebum
4. Inflammation

Genetics may also play a role in the development of acne and the effectiveness of certain
treatment regimens. There are a couple different types of acne, and these include acne
rosacea, acne vulgaris and hormonal acne.

Signs and symptoms of acne include:

• Whiteheads which are closed and plugged pores
• Blackheads which are open plugged pores and small red bumps

Pimples are also common with pus at the tip which sometimes cause lumps and are painful.
Also, it can be large, solid lumps under the skin that do not break the surface. They commonly
appear on the face, but it can also be found on the chest, back, shoulders and forehead.

Contributing Factors & those at risk:

Certain things can trigger or make acne worse. These include but are not limited to hormonal
changes, medications, diet and stress. Genetics can also play a role in acne, if both parents
had acne, then their children are likely to get acne at some point during their life.

Holistic Treatments:

There are several treatment options for acne. Cleansing soaps and washes can be utilized to
help manage acne. However, strong cleansers, cheap washes, and exfoliating can lead to
further irritation of the skin, which may worsen acne. Moisturizers are often used in people with

acne who tend to have oily skin due to an overproduction of oil (sebum), and don’t typically
need additional moisturizer. Some people have the tendency to pick at the skin damages to
follicles and causes inflammation, which increases the likelihood of developing more acne.
Popping a pimple breaks the skin, which promotes bacterial infection. In terms of sunscreen and
makeup, oil free products are best for people with acne. Sunscreen is very important because
sunburn causes skin to swell, leading to blocked pores and more acne. Use only what is
necessary; too much product can block pores and worsen acne.

Diet plays a huge role in the development and prevention of acne. It is important to try to avoid
high glycemic foods and to try to increase the amount of low glycemic foods in the diet. Below is
a chart outlining high and low glycemic food options.

Physical activity also plays a huge role in controlling acne. Physical activity reduces blood sugar
levels leading to lower androgen levels and in return decreases oil production. Outdoor exercise
can also be beneficial as UV radiation has anti-inflammatory effects that reduces acne.
However, you must shower right after working out in order to reduce acne breakouts.

Treatments:

There are several options of topical treatment for acne. The commonly used OTC products
include azelaic acid and benzoyl peroxide. Sometimes patients will use chemical peels,
corticosteroids, dapsone, hydrogen peroxide, niacinamide, sodium sulfacetamide, sulfur and
triclosan products.

There are certain benefits to utilizing topical treatments in acne management. The direct
application to the skin limits the number of drugs that get into the blood, which reduces the side
effects. The basic types of topical treatments can come in a variety of forms including cream,
gel, lotion, solution and washes.

Retinoids are prescription only and are very effective at treating acne. Unfortunately, these can
cause sensitivity to sunlight and should be used at night to avoid the effects seen during the
day. Retinoids are not recommended for use during pregnancy.

The gold standard for treating acne is Isotretinoin. This is the most effective drug available for
treating acne that is unresponsive to other therapy. However, this can only be prescribed by a
specialist like a dermatologist. This medication works by reducing sebum production and it is
an anti-inflammatory. However, patients who are of childbearing age must be monitored monthly
via blood work or pregnancy tests to ensure the patient is not pregnant. Serious birth defects
can occur if a patient becomes pregnant while using retinoids. Another possible systemic oral
option for treating acne is Dapsone. Dapsone works to decrease the inflammation that causes
the cysts, skin redness and nodules in acne.

Most used products for treating acne are oral antibiotics. These are typically taken once or twice
daily and are most effective when combined with benzoyl peroxide or a retinoid. Antibiotics are
usually used for patients who have popular, nodular, pustular and cystic acne. Unfortunately,
utilizing antibiotics it can take weeks or months to show improvement. Below is a chart that
outlines the type of antibiotic and the correlating dosage.

For some patients, hormonal acne plays a huge role in their symptoms. For these patients,
women can utilize birth control. Birth control can be combined with antibiotics or topical retinoids
to show improvement. Usually, improvement is seen within 3 months or sometimes more. The
active ingredients in birth control that are attributed to improvements in acne include:

• Cyproterone acetate, Desogestrel, Dienogest, Drospirenone, and Jestodene.

Compounded medication offered at Homestead Community Pharmacy:

Topical Steroids:

• Base: Petrolatum, Cerave, Lipid Barrier Cream
• Triamcinolone 0.1% + Niacinamide 4%
• Hydrocortisone 2.5% + Niacinamide 4%
• Clobetasol 0.05% + Niacinamide 4%

Acne:

• Tretinoin (0.025%, 0.05%, 0.1%) + Niacinamide 4%
• Tretinoin (0.025%, 0.05%, 0.1%) + Azelaic Acid 8%
• Clindamycin 1% + Benzoyl Peroxide 2.5%
• Clindamycin 1% + Tretinoin 0.025% + Niacinamide 4%
• Clindamycin 1% + Tretinoin 0.025% + Niacinamide 4% + Spironolactone 2% (For Females Only)

Reach out to your local doctor or pharmacist for more information.

Adverse Effects of Treatments:

For the majority of the topical OTC products utilized in acne, the side effects are mild and
involve irritation or dryness to the skin. For isotretinoin the most concerning side effect involves
high triglycerides and muscle pain. Occasionally patients can experience abdominal pain or high
cholesterol as well.

References:

1. https://www.racgp.org.au/afp/2017/december/acne-in-adolescents/
2. https://cdn-bneoicczbswi.netdna-ssl.com/wp-content/uploads/2017/11/SCHEMA-
   SEBOCYTES-version-EN-final-bis-1.jpg
3. https://thelifesquare.com/wp-content/uploads/2016/03/types-of-acne.jpg
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6273829/
5. https://www.acne.org