Disclaimer: I am not a medical doctor, so please advise your physician for actual acne treatment and medical intervention. The information below is created for reading purposes only, so it cannot be considered as medical advice or scientific review.

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Now I have dry skin so I am more interested in hydration, brightening, and firming but believe it or not, my high-school time, I mean my sweet 16 was a persistent fight against acne. I had moderate level of cystic acne and blackheads and I tried everything available at that time - Skincare, dermatology and even some traditional Asian medicine, (which taste horrific to be honest.) Well, with the combination of my religious skincare routine and regular visit to dermatology clinic, now I don’t have same problem anymore. Probably, aging is a considerable contributor, to be honest. Anyway I will share all my knowledge on acne from cosmetic to the some invasive medical intervention options.

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                <healthy skin>                                   <acne skin>

Acne is generally caused by the clogged pores by sebum or dead skin cell. So practically, when we hear the word “acne” we only think about the pimples, but actually it is a broader term implying the conditions caused by the same mechanism such as blackhead, whitehead, pimple and cysts. Generally, excessive sebum production or high proliferation of oil glands can worsen the acne condition. The dominant growth of P. Acne bacteria is also a contributing factor and hormone imbalance caused by higher concentration of testosterone or other sex hormones is a very significant factor as well. Even though the exact mechanism of the hormonal effect on acne is a complicated issue, but there are numerous researches assuring causal relationship between hormonal change and acne. I mean, we can see testosterone injection or premenstrual hormonal change cause frequent acne breakout, right?

So now we are good for the basic info. Now, let’s take a look on some practical advices on acne care.

1. Daily and easy – Cosmetics

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I know most of you already know three key ingredients – BHA, Teatree and Centella Asiatica. As I have written before, BHA is a very effective ingredient for unclogging the pores and removing the keratin layers. So, it removes two major causes of acneoil and excessive keratin layer. However it is not a completely irritation free ingredient, so please be careful if you have sensitive skin. Anyway, in my humble opinion, I think BHA is the best ingredient to fight the acne that can be used in cosmetics. It's exfoliating and oil controlling property is a must for acne care as we all know.

Teatree is used in many calming and anti-breakout masks and products. Teatree oil contains various terpenes in composition, it has weak anti-septic property. Even though it cannot be used as a substitute for conventional anti-bacterial drugs, it may be helpful for the light case of p.acne induced condition. Centella Asiatica is a new rising star in acne treatment. There are quite a few researches proving the anti-inflammatory property of the centella asiatica. Especially, titrated extraction of centella asiatica is more potent and demonstrated more effective would healing and anti-inflammatory property. So, centella asiatica is NOT a treatment for the p.acne or oil-induced acne breakout, rather it is an aftercare & soothing ingredient to minimize acne scar and promote healing.

 

2. More Intensive Approach – Benzoyl peroxide / Azelaic Acid

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I am sure many of you already know about this. It is used to treat the mild to moderate acne, especially for the acne that caused by p.acne bacteria. Benzoyl peroxide is free radical forming chemical that effectively kills the bacterial cell on the skin. It is not (at least in my knowledge) a conventional antibiotic, so it does not induce the antibiotic resistance. It is not allowed to use this in cosmetic in South Korea, so you cannot find this ingredient in K-beauty products. In the United States, it is used in many cosmetics or OTC products, in the brands such as Neutrogena and Paula’s Choice. It is a very effective antibacterial chemical and works well in p.acne induced skin conditions but it causes irritations for sensitive skin as well. But definitely it is a great option for moderate acnes especially used on spots. Recent researches suggest the anti-inflammatory & comedolytic property of BPO.

Azelaic acid is naturally occurring long-chain di-carboxylic acid. Even though the mechanism is poorly understood, numerous researches have demonstrated effectiveness of azelaic acid on acnes. Azelaic acid has antibacterial and anti-inflammatory property so it has shown skin condition improvement both on comedonal acne and inflammatory acne. Interestingly, azelaic acid is a tyrosinase inhibitor, so it inhibits the synthesis of melanin, consequently it is suggested to be used a brightening ingredient, as an substitute for hydroquinone. I do not understand the reason, but not many Korean cosmetic manufacturers use this ingredient. As many other effective antibacterial chemicals, it may cause irritation and it may cause dry patches sometimes. However, it is definitely another excellent acne treatment option along with BPO. Non-Korean based brands such as the Ordinary, Paula’s Choice and Murad has some products with azelaic acid with various concentrations.

 

3. Classical Serious Intervention – Tretinoin

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Tretinoin (Retin-A) or isotretinoin (Accutane) is the last option for extremely severe acne and they are strongly controlled with prescription only option. I won’t mention the extensive list of side effect of the tretinoin or isotretinoin, but it is a serious medication that should be used in close observation of physician, since there are frequent report of side-effect of the lymphatic system, skin and musco- skeletal system. Despite of its long history of use, the mechanism is not fully understood. But it is thought to accelerate the cell-cycle and to induce apoptosis (programmed cell death.) As a result, keratin layer is quickly replaced and pores are quickly cleansed out. But as I mentioned above, it has severe side effects if not used properly. In my experience, it makes the skin extremely dry and causes dry patch. The worst part that it may cause chapped and cracked lips for considerably prolonged time.

There are some off-label use of tretinoin ointment for the anti-aging care, since it is a much more potent form than retinol or retinyl palmitate. (If you are interested, consult with your physician.)

 

4. More invasive but effective, Medical Intervention

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Medical Grade Peeling: As you could see, this is a chemical removal of keratin layer with different depth. It does help for acne and acne scar, and they are relatively cheaper than other techniques. It requires several peeling session for sustained result, and it does have some down-time. Salicylic acid (BHA) is known to be more effective for acnes, than other peels. Jessner, Obagi Blue peel or Cosmelan can be considered as substitute. Please consult your dermatologist for advice.

Photo-Dynamic Therpy (PDT): PDT also can be considered for acne treatment option. A physician applies photo-sensitizer (most of the time ALA) on the skin and LED source (Levulan) or IPL is used as photon source. It does work in my experience, but many physicians report that first or second treatment of PDT may cause even more acne because it directly targets sebaceous gland. Again, consult with your dermatologist for this option. Some people use PDT as a substitute treatment to Accutane.

Fractional Layer: Fractional layer is a after-care laser to treat the acne scarring. It practically induces small dot-like burns on the skin with the column shape (adermal necrotic columns). When the skin heals those burns, the skin texture is dramatically improved. It hurts a lot, but it works on some people.

Reference

Park JH1, Choi JY2, Son DJ3, Park EK4, Song MJ5, Hellström M6, Hong JT7. Anti-Inflammatory Effect of Titrated Extract of Centella asiatica in Phthalic Anhydride-Induced Allergic Dermatitis Animal Model.

Ratz-Łyko A1, Arct J1, Pytkowska K1. Moisturizing and Antiinflammatory Properties of Cosmetic Formulations Containing Centella asiatica Extract.

Liu RH1, Smith MK, Basta SA, Farmer ER.Azelaic acid in the treatment of papulopustular rosacea: a systematic review of randomized controlled trials.

Gold MH, Goldberg DJ, Nestor MS.Current treatments of acne: Medications, lights, lasers, and a novel 650-μs 1064-nm Nd: YAG laser.

Ochi H1, Tan L, Tan WP, Goh CL., Treatment of Facial Acne Scarring With Fractional Carbon Dioxide Laser in Asians, a Retrospective Analysis of Efficacy and Complications.

Kontochristopoulos G, Platsidaki E. Chemical peels in active acne and acne scars. Clinical dermatology. 2017 Mar - Apr;35(2):179-182. doi: 10.1016/j.clindermatol.2016.10.011. Epub 2016 Oct 27.

Wiznia LE, Stevenson ML, Nagler AR. Laser treatments of active acne. Lasers Med Sci. 2017 Aug 4. doi: 10.1007/s10103-017- 2294-7. [Epub ahead of print] Review. PubMed PMID: 28776112.

Hoffman LK, Del Rosso JQ, Kircik LH. The Efficacy and Safety of Azelaic Acid 15% Foam in the Treatment of Truncal Acne Vulgaris. J Drugs Dermatol. 2017 Jun 1;16(6):534-538. PubMed PMID: 28686770.

Kosmadaki M, Katsambas A. Topical treatments for acne. Clin Dermatol. 2017 Mar - Apr;35(2):173-178. doi: 10.1016/j.clindermatol.2016.10.010. Epub 2016 Oct 27. PubMed PMID: 28274355.