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 the dermis), colonization with P. acnes (stimulating cells that are pro-inflammatory), 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:

Chemical peels

Salicylic acid, glycolic acid or retinoic acid. They come in different strengths.

Laser, Photodynamic, and Light therapy:

An intense beam of light used to treat scarring

Laser resurfacing therapy:

Brief pulses of high energy light vaporizing thin sections of the skin (superficial scars)

Soft tissue fillers:

(Juvederm, Radiesse) injected directly into your acne scars meant to plump and smooth out acne scars


surgical sanding or planing of the outer layer of skin on acne scars


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


Physical form of exfoliation via scalpel, similar to dermabrasion, meant to remove dead skin cells

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.

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

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

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: