What Causes Acne

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Acne is somewhat like a check engine light in your car.  Not only does it occur at the least opportune moments (right before school starts, before the prom, the morning of a first date), but also there can be multiple causes.
You rush to the drugstore and buy every over-the-counter zit zapper you can find, and two weeks later you are dry and flaky, and still have acne.  This is often because there are multiple causes of acne, and each different cause responds best to different types of medications.

You may leave your dermatologist’s office with several medications for your acne and wonder why you need all of those lotions and potions to get rid of your zits.  Let’s break it down so it makes more sense.

Acne Cause 1: Clogged Pores
The whiteheads and blackheads, otherwise known as comedonal acne, are caused by plugging of the pores.  In order to unplug the pores and prevent this from occurring, we often prescribe a group of medications called retinoids.  The retinoids, which include adapelene, tretinoin, tazarotene are usually applied in a small amount at bedtime and are excellent at clearing the comedones.

Acne Cause 2: Inflammation and Bacteria
Then there are the bright red acne bumps that take up residence on your face and refuse to leave.  This type of acne is due to inflammation that occurs in response to the pore plugging, and due to a bacteria that lives inside your pores.
This inflammatory acne needs medication to calm down the inflammation and clear the bacteria.  The topical benzoyl peroxide and antibiotic treatments are excellent for this type of acne.
Sometimes, the topical treatments just don’t cut it, especially with the stubborn red bumps.  That’s when oral antibiotics can really be helpful.  Not only do they target the bacterial cause, they also calm down the inflammation.

Acne Cause 3: Hormones
Let’s not forget about hormones.  Starting around puberty, hormone levels are fluctuating and the body is responding in many ways, including acne.
In females, the cyclical fluctuations of hormone levels around the time of the menstrual cycle can lead to monthly acne flares, particularly painful red acne bumps along the jaw line.  This is why we may prescribe oral contraceptive pills (OCPs) as an acne treatment.  The OCPs help calm down the hormonal changes that trigger acne and lead to clear skin, all month long.

Putting It All Together for Acne Treatment
That explains the science behind the acne, but the treatment regimen for each patient is truly an art.  Finding the right combination to address each patient’s unique acne can take some time and tinkering.
While one retinoid may be too drying and irritating, another may do the trick.  One antibiotic may cause side effects, while another will be well tolerated.
That’s why communication is so important.  If you don’t like the medications for one reason or another, you won’t use them. And if you don’t use them, they certainly won’t work.  That’s the time to call the office or to come in so we can make changes.
Understanding all of the causes of acne, using the right treatments for each cause, and communicating with your doctor when things aren’t going well will help us get and keep your skin clear.   Together we can keep your skin’s check engine light in check.

Article by
Atlanta Dermatologic Surgeon