Laura J. Martin, MD
For the nearly 50 million Americans affected by acne, the many available medications and treatments can be confusing and overwhelming.
It's easy to make mistakes treating acne or even make it worse, despite the best intentions.
Here, experts list the most common mistakes people make while treating acne. In most cases, a dermatologist can help undo the damage.
Skin reacts slowly to treatment. Even if the acne came on fast, it still requires time to heal. That usually takes between two to six weeks, says Barbara R. Reed, MD, a dermatology professor at the University of Colorado Hospital in Denver.
April W. Armstrong, MD, MPH, assistant professor of dermatology at the University of California Davis Health System, tells WebMD that she advises patients to give a product one month and keep using it if they notice any improvement.
In some cases, the skin can experience minor irritation the first couple of weeks of treatment, says Diane S. Berson, MD, FAAD, assistant clinical professor of dermatology at Weill Medical College of Cornell University, Ithaca.
“It's not an infection, it's an inflammation. It can even get worse before it gets better,” Berson says.
People usually layer on products when they don't get results in the first few days of treatment, Reed tells WebMD.
“What then happens is that they start trying different products, abandoning them very quickly if they do not see results in a day or two. They also add one product to another. Sometimes the products can cause irritation of the skin and add further insult to the owner,” Reed says.
When someone self treats their acne, they may accidentally traumatize their skin. This can make the acne lesions bigger, more likely to pigment, and heal with spots and scars, Berson says.
Scrubbing the skin will actually worsen acne, as it can compromise the skin's protective barrier and can increase irritation, Berson says.
Instead, gently wash with a nonirritating, pH-balanced cleanser to decrease inflammation. It's also important to thoroughly rinse off the cleanser because the residue can be irritating, she says.
“Acne is not from dirt," Reed says. "Many people tend to overwash and overscrub when they get acne. As one of my teachers used to say, 'If acne were from dirt, you would have it on your feet!'
Harsh cleansers, alkaline bar soaps, and alcohol-based products may worsen acne, says Berson, who has consulted for skin care product makers Galderma Stiefel, Proctor & Gamble, and Neutrogena.
Reed says she advises patients to look for “noncomedogenic” or “for acne-prone skin” products. Noncomedogenic products do not contain ingredients that tend to clog pores in people with acne-prone skin.
Certain ingredients found in products such as cosmetics, sunscreen, and moisturizers are more likely to clog pores. They include isopropyl palmitate, isopropyl myristate, butyl stearate, isopropyl isostearate, decyl oleate, isostearyl neopentanoate, isocetyl stearate, myristle myristate, cocoa butter, acetylated lanolin, and D & C red dyes. Products containing oil can clog pores and lead to breakouts.
Popping and picking pimples prolongs healing time and increases the risk of scarring. Infected material can get pushed further into the skin, leading to more swelling and redness.
“People tend to groom the lesions. They examine them very closely several times a day and start imagining that there is something they can stick in the lesion or extract from the lesion. So they pick and the lesion gets worse,” Reed says.
It's time to make an appointment once acne starts taking a toll on self-esteem, becomes painful, causes excessive scarring, or if over-the-counter (OTC) medications aren't clearing it up.
Dermatologists have more tools to treat acne, and can prescribe stronger doses of OTC medications and oral antibiotics. They also offer new technologies, such as light and laser therapy, and chemical peels. However, newer does not necessarily mean better, and these treatments are probably not necessary to treat a patient's acne, Armstong says.
Dermatologists can give prescription medicines that are tailored to the type of acne a person has and also their skin type, Reed says.
It's also possible a patient could have rosacea, which usually requires different treatment than acne. Rosacea is a long-term disease that causes redness and pimples.
Berson says she stresses to patients to use the medication as instructed. Overusage will not help clear the acne, but can cause additional redness and dryness.
Not sticking to a regimen delays any potential improvements.
Half of the battle is consistency. Many people under use because they lose motivation after the first two weeks. They can't expect results overnight, Armstrong says.
Underusing the medication by spot-treating fails to prevent breakouts.
“You need to apply medication to the entire affected area that tends to break out, instead of spot treating. With spot treating, you haven't addressed the area next to it, where another pimple could be brewing, Berson says.
It is best to taper medication usage by using it less and less. For example, if you've been using it twice a day, use it once a day for awhile, then once every other day, then twice a week, and then stop. It often takes acne four to six weeks to return, just like it took it the same amount of time for it to get better, Reed says.
To keep skin blemish-free, most people need to continue usage with at least one acne product. It's possible to cut down to a few times a week if someone is using an OTC medication.
SOURCES:American Academy of Dermatology: “Acne.”American Academy of Dermatology: “Acne Treatment.”American Academy of Dermatology: “7 Acne Skin Care Taboos.”April W. Armstrong, MD, MPH, assistant professor of dermatology; director, Dermatology Clinical Research Unit; director of Teledermatology Program, University of California, Davis Health System.Diane S. Berson, MD, FAAD, assistant clinical professor of dermatology at Weill Medical College of Cornell University, Ithaca. Disclosure: Consultant for Galderma Stiefel, Proctor & Gamble, and Neutrogena.Fulton Jr , J. Journal of the American Academy of Dermatology, January 1984; vol 10: pp 96-105.Kim, R. Dermatology Online Journal. March 2011; vol 17.National Institutes of Health: National Institute of Arthritis and Musculoskeletal and Skin Diseases “Rosacea.”Nemours Foundation: “Tips for Taking Care of Your Skin.”Nguyen, S. CutaneousandOcular Toxicology, 2007, vol 26: pp 287-92.Barbara R. Reed, MD, clinical professor, University of Colorado Hospital, dermatology department; private practice at Denver Skin ClinicAmerican Academy of Dermatology: " Small changes in skin care routine can significantly improve skin affected by acne and rosacea."
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