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Everybody Hates Acne

Don’t we all equally hate pimples? This week we’re breaking down ACNE!! We discuss the causes of acne, various treatments (those that do and those that don’t work), our personal tips and experiences with acne. If you haven't listened go back and check out this weeks episode. Here are some show notes to catch you up to speed:

What is acne?

- Common locations include: face, back, neck, chest and upper arms

Risk factors: menstrual cycle, greasy products, stress, excessive sweating, pregnancy, milk consumption

4 main causes: excess oil production, hair follicles clogged by oil and dead skin cells, bacteria, as well as excess androgens

Pathophysiology: obstruction of the pilosebaceous unit forms comedones which can occur due to increased production of sebum (leaking from comedones into dermis), colonization with P. acnes (stimulating cells that are proinflammatory), abnormal desquamation and accumulation of keratinocytes

- Associated conditions: PCOS, Cushing's, Congenital Adrenal Hyperplasia

Inflammatory lesions include erythematous papules, pustules, cysts or nodules

- Papules = small red, tender bumps

- Pimples or Pustules = papules with pus at the tips

- Cystic lesions = painful, pus-filled lumps beneath the surface of the skin

- Nodules = large, solid, painful lumps beneath the surface of the skin

Noninflammatory lesions: dilated hair follicles fill with keratin, sebum and bacteria

- open comedones are blackheads and closed comedones are whiteheads

Differential Diagnosis include: Rosacea, Folliculitis, Hidradenitis Suppurativa



- Approach: acne type, scarring, side effects and compliance with medication

Mild Inflammatory Acne

- First line: Benzoyl Peroxide (topical vs wash)

- Other topical options: Salicylic Acid (topical vs wash), Azelaic Acid (most effective, best if used with topical antibiotics)

- AHA's and BHA's: works as a skin exfoliant by decreasing inflammation, even out your skin tone, decrease the appearance of pores and improving overall skin texture. Alpha hydroxy acids are water soluble, peel away the surface of your skin. Beta hydroxy acids are oil soluble, get into your pores deeper than the alpha hydroxy acids and remove dead skin cells as well as, excess sebum. The takeaway, AHA for mild hyperpigmentation and BHA for those with acne and sun damage.

- Dapsone: 5% gel, used in adult women with acne

Mild non-comedonal Acne

- Topical antibiotics: clindamycin, erythromycin

usually not used alone but in conjunction with benzoyl peroxide or a topical retinoid

Mild to Moderate non-comedonal or comedonal Acne

- Topical Retinoin includes: adapalene, tazarotene and the one most commonly known as, T-retinoin. These work by preventing plugging of the hair follicles

- Systemic or Oral Medications

- should not be used long term or as mono-therapy

- Oral antibiotics: doxycycline, tetracycline, minocycline

Moderate to Severe Acne (i.e: cystic acne or scarring)

- Isoretinoin

- Contraindication: in pregnancy (teratogenic to fetuses and can cause cleft palate and cardiac abnormalities

- requires pregnancy testing prior to initiating

- associated with an increased risk of depression, birth defects and ulcerative colitis

Severe Acne or Refractory Acne

Hormonal therapy:

- OCPs: combined estrogen-progestin


- Spironolactone: blocks the effect of androgen hormones on the sebaceous glands

Complications of acne: permanent acne scarring and cosmetic disfigurement

Other treatment options:

1. Chemical peels: salicylic acid, glycolic acid or retinoic acid, they come in different strengths

2. Laser, Photodynamic, and Light therapy: intense beam of light used to treat scarring

3. Laser resurfacing therapy: brief pulses of high energy light vaporizing thin sections of the skin (superficial scars)

4. Soft tissue fillers: (Juvederm, Radiesse) injected directly into your acne scars meant to plump and smooth out acne scars

5. Dermabrasion: surgical sanding or planing of the outer layer of skin on acne scars

6. Microdermabrasion: a special machine applies tiny rough particles to remove the uppermost layer of skin from acne scars

7. Dermaplaning: physical form of exfoliation via scalpel, similar to dermabrasion, meant to remove dead skin cells

8. Excision and Punch grafting: small instrument to either cut the skin (excise) and sew up the site where the acne scar was or puncture a hole that matches to the size of the scar, remove the scar and plug it via a skin graft that is usually taken from behind the ear to fill the wound.

9. Fat transfers: Also known as, micro-lipo injection or autologous fat transplantation where you take your own fat and place on depressed scars to even-out the skin tone

10. Facial Extractions: by hand vs via machine

What we're loving: The Hydrafacial works in three steps: cleanse and peel, extracts and hydrates, fuses and protects

11. Steroid injections: inject directly into your skin, rapid improvement in pimple size and decreases pain

Other things to note:

- Do not pick your face use these instead:

RAEL Acne Healing Patch

COSRX Acne Pimple Master Patch

- Avoid Dairy

- Avoid excess sweating, if you do sweat a lot make sure you shower often!

- Wear SPF and avoid excess sun exposure

- Play with different products, you will never know what works for you unless you try it on yourself!

Here's something we love to use:

Mario Badescu Drying Lotion

Secret Tip: Use a new Q-tip every time you use this! (Don't dip with the same side you already used)

- Use water based, oil-free and noncomedogenic products

- Avoid greasy items (greasy cosmetic products!)

- Don't forget to gently exfoliate but not daily

- Can also try tea tree oil, probiotics, brewer's yeast and fish oil

- Clean anything that directly touches your phone, like that you know that cellphone you use all day? yeah it's clogging your pores!

- Greasy food and chocolate on their own do not cause acne

- Wash your face! Do not sleep with your makeup, trust us it adds up!

It's not all bad news, oily skin ages slower so take care of it!

Secret Tips:

- Pillowcase: change them every 4 days

(quick tip: sleep on one side for 2 days and flip to the other side for another 2 days) - Adelynn

- Towels: purchase a bunch of small face towels use one side for day and one side for the evening. Wash them every couple of days.

- Clean your makeup brushes often, this depends on how often you wear makeup for example if you wear makeup daily cleaning the brushes should be incorporated into your weekly Sunday routine!

Check this one out:

Cinema Secrets Makeup Brush Cleaner

- opt for a silk pillowcase: great for both your face and your hair!

Some of the ones we love:

Slip Silk Pillowcases

For a cheaper alternative: Zimasilk 100% Mulberry Silk

That's all for this week, don't forget to leave us feedback, rate, review, subscribe and send in your questions so we can continue to improve as well as, provide you high quality content!

Disclaimer: The Content on our podcast/website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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