What to know about Acne treatments

The good news about acne treatments is that drugstore remedies have improved a lot over the years. If those don't work, dermatologists have many tools to tackle the problem of pimples, including prescription drugs and even lasers. Below are the answers to common questions about acne.

Why me?
In addition to genetics, fluctuating hormones can be complexion killers. Puberty, pregnancy, going off birth-control pills, and menopause can cause acne to flare. And research shows that stress can cause the body to produce more androgens, hormones that stimulate oil glands.

Another culprit: Some products such as oily sunscreens and greasy hair products contain pore-clogging ingredients that could lead to acne. Breakouts can also be a side effect of drugs, including anticonvulsants, corticosteroids, and sobriety drugs.

If you think a drug is affecting your skin, talk to your doctor about alternatives. Also talk to a doctor if acne is accompanied by other symptoms, such as excessive facial hair, thinning or bald patches on the scalp, and irregular periods. That could indicate a disorder affecting the adrenal glands or ovaries.

Can foods cause acne?
There's little evidence that soda, chocolate, and greasy foods cause breakouts. But some researchers theorize that a diet generally high in those and other carbohydrates and sugars may be bad for your skin, citing a lack of acne in non-westernized societies. Dairy consumption has also been linked to increased acne. "The theory is that hormones in cow's milk could possibly exacerbate acne," says Robert Dellavalle, M.D., Ph.D., associate professor of dermatology at the University of Colorado in Denver.

Is it really so bad to pop a pimple?
Yes, especially if the blemish is inflamed. Squeezing forces infected material deeper into the skin. That can worsen inflammation and increase the chance of scarring. If you have a lot of blemishes, a dermatologist can use sterile instruments and the proper technique to clear them, but there is always a risk of infection or scarring.

And if a large zit threatens to ruin your big day, a doctor can inject it with a small amount of steroid to shrink it more quickly.

Which products help?
Blackheads and whiteheads form when excess skin oil and dead skin cells clog pores. Bacteria can multiply in this oily environment, causing a red and inflamed pimple. Over-the-counter and prescription acne treatments target one or more of those problems.

According to our medical consultants, very effective OTC remedies contain salicylic acid, which helps unclog pores, or benzoyl peroxide, which dissolves dead skin cells and reduces acne-causing bacteria. "Everyone with mild-to-moderate acne should first try these OTC products," Dellavalle says. You might use, for example, a face wash that contains salicylic acid (in a concentration of no more than 2 percent), followed by a 2.5 percent benzoyl peroxide cream.

Birth control pills can also help by reducing excess skin oils. But you may still need to use other products. Although some brands of the pill actually advertise acne-reducing ability, any birth-control pill with a mix of estrogen and progesterone could help. But a progesterone-only pill, sometimes referred to as a mini-pill, can aggravate acne in some women.

What can a doctor do?
If you have deep inflamed lesions, widespread acne, or even milder breakouts that persist after a couple of months of OTC treatment, it's time to call for professional help. Your dermatologist can prescribe a variety of acne treatments, depending on how widespread and severe your skin problem is.

Choices include:

• Topical treatments. Retinoid gels or creams, such as Retin-A, work by cleaning out pores, keeping them from reclogging, and reducing inflammation. (Bonus: They might help diminish wrinkles.) If you have red or swollen spots, your doctor may prescribe a topical antibiotic.
• Antibiotic pills. If acne is moderate to severe and persistent, your doctor may recommend antibiotic pills, usually a form of tetracycline.
• Isotretinoin pills. "This is the big miracle drug for acne," Dellavalle says. "But it also has a high cost and requires careful clinical monitoring." Oral isotretinoin cures acne in about 85 percent of people who take it for about five months. But it's only used for severe cases.
  
• Side effects include nosebleeds, increases in triglycerides, secondary infections, and rarely, a higher risk of ulcerative colitis. A 2005 systematic review found no evidence to support that the drug worsened symptoms of depression.
• Laser and light therapy. These are possible additions to conventional treatments. But they can be expensive and might not be covered by insurance.

Here's what not to do if you tend to break out:

• Don't clean too aggressively. Gently wash your face with a mild cleanser twice a day or after sweating. Scrubbing, as well as astringents, masks, toners, and exfoliating products with scrubbing particles, can irritate your skin and actually make acne worse.
• Don't use greasy hair products. Gels and pomades, for example, can cause acne. Also, style hair away from your face and avoid leave-in products.
• Don't use makeup with oil. Look for "oil-free," "will not clog pores," or "noncomedogenic" on the label.
• Don't tan. Some acne treatments can thin the top layer of your skin, leaving it more vulnerable to damage. And tanning increases your risk of cancer.
• Don't touch your face! Hands can carry oils and germs that aggravate acne. Wipe down the phone and anything else that touches your skin.