Pennsylvania Centre for Dermatology


What is Acne?

Acne is a condition involving the hair follicle and oil gland.  Acne is most commonly located in areas where oil glands are the largest and most numerous (T-zone, chest, shoulders, back). In individuals that develop acne, there is a spike in oil production from their oil glands. This causes a type of bacteria that is normally found on the skin, Propionibacterium acnes (p.acnes), to proliferate. In addition to this, dead skin cells that line the follicle shed into the follicle. The follicle then becomes blocked and from this, blackheads, whiteheads, inflammatory papules/pustules, cysts/nodules develop.

What is the cause of acne? The cause of acne is multi-factorial.

  1. Hormones:  The main cause of acne is hormones-particularly testosterone. Many women notice an increase in their acne a week to ten days before the start of their menstrual cycle.  This is the time when estrogen is at its lowest. Testosterone levels stay fairly constant throughout the month, so as estrogen drops testosterone is relatively higher. Testosterone triggers the oil gland to produce oil/sebum which then causes propionibacterium acnes (p.acnes) to proliferate.  During puberty, Testosterone is especially unbalanced in teens. producing the same sort of effect.  
  2. Food:  In addition to hormones, some studies show that food items that are high in sugar and simple carbohydrates can exacerbate acne. These foods spike blood sugar which causes your body to produce insulin which increases oil production which then leads to acne.  In addition to foods high in sugar and simple carbohydrates, dairy products may exacerbate acne. More research is needed, but it may be that the growth factors and hormones naturally found in milk somehow act as acne triggers.

  3. Stress:  Scientists don’t know exactly how stress worsens acne. They do know that cells that produce oil/sebum have receptors for stress hormones so as stress hormones rise, so does oil production and acne.

  4. Lifestyle Factors like wearing a sports helmet, working out and not washing directly afterwards, and friction from rubbing while working out can exacerbate acne

  5. Skincare Habits:  The following skincare habits can further exacerbate acne: over-cleansing skin, using face scrubs too often, switching skincare routines too often, sleeping in makeup, not cleansing makeup brushes, using masks too often. popping/manipulating acne pimples.

The Acne 2 Rules of Thumb

“Patience is a Virtue”:  It can take 6-8 weeks to start to see improvement with your skin. It is important to follow instructions very closely and stay patient with the process. If your skin or body does not agree with a particular treatment, it is best to contact your provider to get their advice before changing the regimen on your own.

“Less Is More”: When it comes to treating acne, the less you do to your skin, the better your skin will be. Many of our patients find themselves buying a product here and there and then before they know it, they have a small drugstore in their home. They end up using too many products which can irritate and over-strip the natural oil from the skin. Keep it simple. Stick to a basic routine that does not irritate your skin.

Frequently Asked Questions

What type of cleanser should I use on my face?

It is best to use a mild, non-detergent cleanser just once to twice a day.  Unless otherwise indicated by your provider, avoid cleaners with beads/scrubs, salicylic acid and benzoyl peroxide. Do not use a washcloth to cleanse the skin.  Use fingertips in a gentle circular motion.

There are so many toners out there. Are they worth using?

What ingredients in toners should I be looking for?  It is best to avoid alcohol-based toners. Instead, opt for exfoliating toners or hydrating/refreshing toners. Apple Cider Vinegar and Witch Hazel are not a good choice for toners.

Is it recommended to exfoliate the skin?  

It is typically not recommended to use exfoliating scrubs. If you do wish to use them, limit usage to once to twice a week. In general, it is best to instead use chemical exfoliants such as toners with alpha hydroxy acids (glycolic and lactic) and beta-hydroxy acids (salicylic).

What type of moisturizer should I use?  

Choose moisturizers that are oil-free/non-comedogenic. Coconut Oil is not a good moisturizer as it is comedogenic (pore-clogging). It is also important to choose a moisturizer with SPF of 30+ in it for the daytime.  Many people believe that drying out the skin is the best way to treat acne lesions, but the opposite is true. When the skin is overdried it tries to make up for it by producing even more oil to compensate for the lack of moisture on the skin’s surface, a phenomena called “rebound oil production.”  Avoiding a moisturizer if you have oily skin can actually have the opposite effect than the one you are going for. Applying an oil-free moisturizer before and after your prescription acne medications can cut down on irritation and redness.

Do IUDs make your acne worse?  

There are two different types of IUDs: Hormonal (Mirena, Lileta, Skyla, Kyleena) and Non-Hormonal/Copper (Paragaurd). If you are predisposed to hormonal acne, any of the hormonal IUDs may cause breakouts.  This is because the hormonal IUD uses progestin to prevent pregnancy, which can create an imbalance that leads to worse acne breakouts.  The progestin in hormonal IUDs has some androgenic properties that stimulate your skin’s oil glands and exacerbate acne.

Does it really matter if I squeeze my pimples?

Try not to squeeze, scratch, pick or rub pimples. Trauma can produce scarring, promote infections and actually exacerbate acne.

Will sun exposure help clear up my complexion?  

A suntan will not help your acne in the long term. While a tan may temporarily camouflage discoloration from old acne breakouts and can sometimes dry up excess oil on the skin, these effects are only temporary and the risk of direct sun exposure outweighs the benefits of a temporary suntan.