Everything you need to know about Acne

Teen Healthy Body – Body/Skin Care – Acne

Acne 101

Written by Jennifer Choi, M.D.

Zits, pimples, breakouts, whatever you call it, it always seems to pop up when you least expect it! Do not panic, there are common ways to treat acne, and most likely, you are not the only one experiencing it.

Acne is a medical skin condition that is caused by clogged pores and inflammation around hair follicles. It commonly consists of pimples, of which there are several types: whiteheads, blackheads, red bumps, and sometimes even large, deep nodules or cysts.

This condition is mostly caused by sebaceous glands, which are oil glands. Everyone has oil glands but what is unique is how much individually we produce. Other factors that contribute to acne are hormones, menstruation, genetics, bacteria, makeup, and sometimes even diet. Acne is very common and if you are a preteen or teen, you most likely have experienced some acne, or will at some point.

As we grow into young adults and enter into the stages of puberty, our sebaceous glands really start to kick into gear. Oils combined with changing and fluctuating hormones can be the perfect storm for acne. This may present as zits/pimples and bumps above or below the skin on your face, chest, back, neck, and even your shoulders and arms.

If you get a pimple here or there, you may wonder if this is considered acne. Acne is when pimples become recurrent and persistent. People with acne often develop frequent breakouts and usually develop several pimples at a time.

What age should I start a skincare routine?

Just like brushing your teeth and combing your hair, taking care of your skin is good for your health and your self-esteem at any age. When you are younger, taking care of your skin may be just as easy as bathing or showering daily, washing off your face with a cool splash in the sink, and applying moisturizer when your skin is dry. You can also care for your skin at any age by protecting yourself from the sun.

As you enter your preteen and teen years you will notice increased oil production of your skin and may start to see some clogged pores or breakouts. At that time, a good twice-daily skin care routine can be a skin-saver! It only takes a few minutes but taking the time to care for your skin can help prevent lots of skin issues and help you look and feel your best.

Simple Skin Care Routine

A skin care regimen does not have to be complicated. In fact, the simpler the better. The best skin care routine is one that you can stick to on a consistent basis.

In the morning:
  1. Wash your face in the morning. If you’ve washed your face the night before, all you need is a splash of water. If you feel like your skin has already become oily overnight, then wash with a gentle cleanser.
  2. Use an over-the-counter or prescription spot treatment containing ingredients like salicylic acid, benzoyl peroxide, or antibiotics on any active pimples. If your skin feels dry, apply a non-comedogenic (another term for a product that won’t block your pores) facial moisturizer.
  3. As the last step, apply a non-comedogenic (non-pore clogging) facial sunscreen or use a moisturizer with SPF.
At night:
  1. Cleanse/wash your face. Use either a gentle hydrating cleanser or a facial cleanser containing ingredients like low-strength benzoyl peroxide or salicylic acid. If you have worn makeup that day, remove the makeup first using a cleansing balm or makeup remover, such as micellar water.
  2. Use an over-the-counter or prescription spot treatment containing ingredients like salicylic acid, benzoyl peroxide, or antibiotics on any active pimples.
  3. If you are acne-prone, apply topical retinol or retinoid over the areas of your face that get acne. This topical treatment helps to soothe the skin at the microscopic level and can both treat and prevent acne. If you are starting a retinoid for the first time, only apply it 2-3 times a week at first and slowly increase it to nightly. Use only a pea-sized amount for the entire face.
  4. If your skin feels dry, then apply a non-comedogenic (non-pore clogging) facial moisturizer.
Weekly (1-3 times a week):

You can consider using a gentle exfoliating wash or serum containing ingredients like alpha-hydroxy acids or beta-hydroxy acids, such as lactic acid or glycolic acid. This can help keep your skin smooth and prevent or treat blackheads. However, do not overdo it. If your skin becomes too dry, the skin barrier can get damaged and acne can worsen. If at any time, your skin feels very dry and flaky, then stop all treatments except for a gentle hydrating cleanser and moisturizer.

Types of Acne

First, it can be helpful to try and narrow down what kind of breakouts are happening and some possible contributors to acne to help appropriately treat it.

Whiteheads
Whiteheads form from a buildup of dead skin cells mixing with oils that clog the pores.

Blackheads
Blackheads also form from the buildup of dead skin cells mixing with oils that clog the pores. These differ from whiteheads as the surface appears dark or black.

Papules
Papules are simply pimples that do not form a whitehead or opening. They appear as small red or pink bumps that can be inflamed.

Pustules
Pustules have a white or even yellow-colored head containing pus. These lesions can be painful and sometimes itchy.

Nodules
Nodules are larger and deeper papules that form hard firm bumps on or under the skin. These are frequently painful and can last for weeks to months before they go away.

Combo acne
It is common to have a mixture of all of these acne lesions combined and the best way to treat your unique condition is to see a skin care professional.

Acne Scarring

It is normal to get some acne as a preteen or teen but if there are more than ten inflammatory lesions at a time or deep painful nodules, you may need to see a dermatologist for treatment. These deep nodules have the potential to scar, so if you start seeing marks left on your skin from acne, it may be an indication that you need some help taking care of your skin.

Considerations

For people with darker skin types, acne can frequently lead to dark spots called hyperpigmentation after the acne lesion heals. This is not the same as scarring, which is defined by damage to the middle layer of the skin, called the dermis. With hyperpigmentation, there is no actual damage to the skin, but rather an increase in pigment in the superficial layer of the skin. Hyperpigmentation can last for weeks to months. For people with hyperpigmentation, serums containing ingredients like azelaic acid, kojic acid, or vitamin C can be helpful in slowly lightening those areas. These serums can be applied either in the morning or at night before any moisturizers. Do not be dismayed that this darker discoloration is permanent. While they may last for weeks to months, they eventually tend to fade over time. Daily sunscreen use throughout the entire year is crucial in allowing hyperpigmentation to improve.

For people with lighter skin types, acne can lead to persistently red or pink marks after the acne lesion heals. This is referred to as post-inflammatory erythema. This redness also is not permanent and tends to fade over time. In this scenario as well, daily sunscreen use throughout the year is very important.

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