Growing up with acne in an Asian household meant that everyone’s aunt and uncle had an opinion on how to best deal with acne. Everyone had an herbal tea remedy or a line of Korean cosmetics to recommend. I remember a relative even suggesting I wash my face daily with a purifying liquid from France. It was literally Evian water.
When herbal teas and bottled water cleanses didn’t work, I fell prey to the Proactiv and Neutrogena ads and celebrity marketing. It wasn’t until years later when I finally convinced my mom to let me see a dermatologist that I learned about what actually works and what was just clever marketing. So what’s the latest in acne treatments today? And what does Proactiv actually do?
Over the counter variety
Salicylic acid products: This is seen in a lot of face washes like Clearasil Ultra Rapid Action Daily Face Wash or Biore Pore Unclogging Scrub. This ingredient is anti-inflammatory and comedolytic. Comedolytic means that it helps reduce blemish formation by overturning skin cells so there’s less pore blockage. Products with salicylic acid are meant to help exfoliate your skin and dry out your pimple. Not surprisingly, common side effects include dry skin, skin peeling/flaking, and general skin irritation.
Benzoyl peroxide products: This is more commonly seen in spot treatments or acne creams like Neutrogena Stubborn Acne Spot Gel and Clear & Clear Advantage Acne Control Kit. It has antimicrobial properties, which means it fights off the acne-causing bacteria thriving on your skin, most commonly propionibacterium acnes (see this post), and subsequently reduces your skin’s inflammatory response ergo less pimple formation and redness.
Proactiv: Its main components include benzoyl peroxide and salicylic acid, which really isn’t different from the other drugstore brands mentioned above. But why doesn’t it work for its target demographic? Because chances are, if you’re trying Proactiv, you probably have more than the occasional zit. Topical benzoyl peroxide and salicylic acid only help your skin fight off bacteria and inflammation on the surface or superficial level, but it doesn’t address the underlying inflammation or bacterial proliferation happening beneath the skin’s surface.
Herbal teas, tiger balm face lotions, lotus root cream, etc: Just no.
Topical retinoids: This is the granddaddy of comedolytic medications. Or salicylic acid’s bigger older cousin. Derived from vitamin A, retinoids help reduce comedone formation by normalizing follicular hyperkeratinization (see post). In plain english, it fixes the way acne-prone skin sheds itself, and prevents buildup of dead cells and pimple formation. Bonus fact: Retinoids also help improve old acne scars, and this is the ONLY ingredient shown to help with skin aging (more on anti-aging later)!
Topical antibiotics: These most commonly include erythromycin, clindamycin, and dapsone. Unlike topical antimicrobials (benzoyl peroxide) that fight off bacteria living on the skin’s surface, topical antibiotics actually target proliferating bacteria inside the follicles. Remember what I said about targeting the source of the problem? These agents do just that.
Oral antibiotics: When bacteria become resistant to creams and lotions, there’s oral therapy. Oral medications allow your body to fight off bacteria systemically, and often are used for moderate-severe acne or body acne. Lowering the bacteria in your system also helps topical creams/lotion work better since they’re fighting off fewer and weaker bacteria. However, long-term oral antibiotic use can lead to bacteria resistance and is discouraged.
Oral isotretinoin (commonly known as Accutane): This is the only medication that has been shown to permanently treat acne. Side effects can include birth defects in pregnant women, joint pain, dry skin, elevated liver enzymes, elevated cholesterol, and increased photosensitivity. Therefore, female patients must sign a waiver indicating they are on contraception to prevent pregnancy while on the drug. This is an oral retinoid that shrinks your sebaceous glands so you have less sebum to feed the bacteria in your skin. Often seen as a miracle drug for severe acne, many patients report seeing clear skin within months.
Hormonal agents: Sometimes, it’s actually a hormonal imbalance and not bacterial inflammation that’s causing acne. Androgens like testosterone increase your body’s sebum production, causing more pimple formation. For women who get pimples during their menstrual cycle or women who get acne post-pregnancy, they are often prescribed oral contraceptives to help them regulate their androgen levels.
Other office-based therapies
Intralesional injections: These are for pimples that require an emergency quick fix. Like the ones that erupt days before your prom or wedding. Doctors inject steroids into the pimples so it resolves in 2-3 days.
Laser/light therapy: Lasers have been used to treat acne by causing thermal damage to sebaceous glands, leading to bacterial death. More commonly, lasers have been used to heal acne scars by promoting skin regeneration.