The Pitt Prescription: All about acne

I was scrolling through the popular app TikTok the other day when I came upon a video showing “hacks” to get rid of blackheads. As I watched the video, I saw a girl steaming her face to “open her pores” and then using a floss pick to scrape her nose to “get rid of blackheads,” neither of which do anything to help the skin. The video is one of many “hacks” on social media that claim to help with acne. Many of these videos have tips that aren’t actually effective or could even be damaging to your skin. Acne is a complex condition, and its treatment is not as simple as just scraping it off your face.

What is acne?

Acne is a skin condition that can affect people of all ages, but it is typically associated with teens and young adults. It is commonly seen on the face but can also appear on the chest, back, shoulders and neck because these areas have the most oil glands (medically referred to as sebaceous glands). Acne presents as pimples and/or lesions brought on by inflammation of hair follicles and skin glands. In some instances, it can lead to scarring of the skin.

Mild cases of acne produce common pimples known as whiteheads and blackheads. The distinction between them depends on the pore. Whiteheads form when a pore is clogged and the follicle closes around the dirt inside of the pore, whereas blackheads form when the follicle stays open. Pimples are not the only aspect of acne, however. Other marks include papules (small, inflamed and tender bumps), nodules (large, painful bumps deep in the skin) and cysts (deep pus-filled bumps under the surface of the skin).

Causes of acne

There are four main causes associated with acne: excessive oil production, clogged hair follicles, bacteria and an excess of hormones (typically androgens). According to the FDA, there is no way to prevent the formation of acne — it is not caused by bad hygiene, sweating, chocolate or poor diet, despite common belief. However, acne can be triggered or worsened by these factors as well as by hormone imbalances, stress and certain medications (like corticosteroids or birth control).

Risk factors also play a role in acne formation: age, hormones, family history, oily cosmetic use and stress can affect an acne flare-up. Teenagers are most likely to get acne due to puberty and hormonal changes that occur with it. While acne isn’t necessarily genetic, it is more likely that someone will develop acne if both their parents also experienced it. People who use oily cosmetics or have a job where their skin is exposed to grease also have a higher risk of getting clogged pores. Finally, stress can worsen already existing acne, but it does not cause it, which is a commonly spread myth.

Treatment of acne

Acne is not a condition that can be treated by washing the skin with simple soap and water. To properly treat acne, you need medicated soaps or other products aimed specifically towards targeting and treating its causes.

Medical treatments 

If OTC products or home remedies don’t seem to help, more intense treatment options are available. Dermatologists are the skincare experts of the medical world, so if you have persistent moderate to severe acne, you may consider booking an appointment with an expert.

There are different routes that dermatologists take when treating acne. The first is topical treatment (which is used for the majority of cases). Depending on the main cause of the acne, topical medicine may contain antibiotics, a retinoid (like adapalene) or benzoyl peroxide and salicylic acid stronger than available OTC. Different active ingredients target different causes of acne, with some killing bacteria and others targeting over-production of oil.

Common topical products 

Neutrogena Acne Mask – topical benzoyl peroxide (OTC)

Clean & Clear Persa-Gel 10 Acne Medication – maximum OTC strength topical benzoyl peroxide treatment (OTC)

Stridex – topical salicylic acid pads available in 0.5%, 1% or 2% strengths (OTC)

Differin – the brand version of adapalene gel (OTC and prescribed formulations)

Epiduo – a combination topical gel containing adapalene and benzoyl peroxide (prescribed)

Other treatments

In addition to topical treatments, there are oral options available for more severe cases of acne, often involving cysts and nodules. Oral antibiotics like erythromycin and clindamycin, birth control pills (for women) and isotretinoin (Accutane — used as a last resort due to its potential for severe side effects) are common medications prescribed for acne. It is important to note and report any side effects that begin after taking acne medications so your doctor can determine if a different treatment should be pursued.

Another route of treatment is to have a procedure done. These treatments can range from laser therapy to chemical peels or drainages.

Home treatments

There are a lot of “home remedies” out there on the internet that promise miraculous results if you follow their instructions or buy their products. It is important to be aware that there is a lot of false information online, and you should only try home solutions after speaking with a doctor or local pharmacist as all acne is different. 

According to the American Academy of Dermatology, there are some tips that you can safely carry out at home. These tips come from practicing dermatologists and likely will not clear acne completely, but may help reduce it. 

1. Wash your skin at least twice per day, especially after sweating, to remove any dirt or excess oil that could clog pores from the skin.
2. Be gentle when cleansing the skin. Use non-abrasive cleansers and apply with your fingertips because washcloths or sponges can be too harsh. Avoid scrubbing your skin because it may lead to more irritation and inflammation.
3. Avoid touching your face as much as possible to avoid acne flare ups, and do NOT pick or pop your pimples as this may lead to scarring.

Mild acne can be treated with medicated soaps found at many drugstores. Products with benzoyl peroxide or salicylic acid as the active ingredients may clear mild acne anywhere from four to eight weeks after beginning use of the product. These active ingredients may potentially cause excessive drying and redness or irritation of the skin, so it is always best to test them out before using them long term and to learn how to care for your dry skin. 

Another common OTC treatment for acne is adapalene (seen in brands like Differin and Proactiv). It is a topical gel typically applied once daily at bedtime. This treatment is a good solution for controlling acne, but it does not cure it and may take up to 12 weeks to become effective.

While acne is often not a serious or life-threatening condition, it can cause self-esteem issues or discomfort. There are many treatment options available both OTC and prescribed. When looking at OTC solutions, it is always best to refer to a health-care professional, like a pharmacist, before buying a product so you can find the best fit for your individual condition.