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Acne is one of the most common problems that prompt people to seek the help of a dermatologist. Teenagers are not the only ones affected by this disfiguring skin condition. Up to 30% of diagnosed cases occur in people over the age of 25. Some are forced to deal with breakouts in their forties, fifties and even beyond. It's not a pretty picture. Fortunately, there are treatments that can help manage this common skin condition.

What Causes Acne?

Overproduction of sebum is a primary cause of acne. Sebum is an oily substance produced by the sebaceous glands on the skin. Sebum production is affected by hormone fluctuations, offering a partial explanation as to why the condition is more prevalent among teenagers.

Inside hair follicles on the surface of the skin, cells are continually turning over. New cells are produced while others die and slough off. When dead skin cells are not able to slough off at a healthy rate, they can stick together and clog pore walls. Bacteria can take up residence in the blocked pores and feed on the sebum. This triggers an inflammatory response, leading to red pustules and papules. In severe cases, the hair follicle can rupture and release its contents. When this happens, scarring can result.


When blocked pores, also known as comedones, become inflamed, red bumps or papules can form. People with acne usually also have comedones in the form of blackheads and whiteheads.

Blackheads are comedones that open to the surface of the skin and are filled with a waxy substance that is a mix of keratin (a skin protein) and sebum. As this waxy substance mixes with oxygen on the skin's surface, it darkens to a black color.

Whiteheads are filled with the same substance but are closed off so that they are not exposed to oxygen. For this reason, they appear white in color.


There is a variety of approaches to treating acne. Many dermatologists recommend prescription-strength topical retinoids such as Retin-A in order to open up and clear clogged pores. Retinoids can clear blemishes and prevent new lesions from forming. Outbreaks may increase when first starting retinoids, but most people experience significant improvement over time. Some people experience significant irritation from the use of retinoids.

There are also over-the-counter products containing ingredients that help dissolve pore clogging sebum and eliminate dead skin cells that clog pores and cause breakouts. Such products include alpha hydroxy acids, also known as AHAs, and the beta hydroxy acid salicylic acid. Salicylic acid found in some over the counter skin care products seems to be more effective than AHAs for unclogging pores. It also sloughs away superficial dead skin cells and reduces inflammation.

Salicylic acid products should be used continually in order to maintain clear skin. They can cause burning and skin irritation in sensitive types. Over the counter salicylic acid products usually have strengths between 0.5% and 2% with higher strengths carrying an increased risk for irritation.

Another way to prevent breakouts is to kill acne causing bacteria. Topical benzoyl peroxide works by oxygenating the follicle, thereby killing bacteria. Because of possible contraindications, benzyol peroxide should not be layered with retinoids. Most dermatologist recommend using benzoyl peroxide in the morning and retinoids in the evening when using both treatments.

Benzoyl peroxide is available in over the counter concentrations from 2.5 to 10%. It's best to start with lower concentrations to reduce skin irritation. Some dermatologists also prescribe topical or oral antibiotics to reduce the number of bacteria. Antibiotics also help by reducing inflammation. There are many potential side effects that can occur from using oral antibiotics including stomach upset and sensitivity to sun light.

Most people respond to a combination of acne therapies rather than just one.
Sulfur is another ingredient that can be effective in treating acne. Sulfur helps eliminate dead skin cells in order to clear pores. It also has antibacterial benefits and reduces oil production. While sulfur can reduce redness and irritation in some, others may experience dryness.

Facial peels made from alpha hydroxy and beta hydroxy acids can be effective at eliminating dead skin cells and excess sebum. Over the counter products can be found in lower concentrations while higher concentrations must be administered in a dermatologist's office. Blue light therapy has been shown to be effective at reducing acne causing bacteria while red light therapy can help promote healing. Over the counter systems are now available for home use with professional treatments available in spas and dermatologists' offices.

The Bottom Line?

Acne is a frustrating condition, but there are multiple treatment options that can help. Most people respond to a combination of therapies rather than just one. Thanks to new treatments, more people are managing the condition and enjoying clear skin.