Acne 411

Everybody dreads “blackheads”, acne breakouts, and clogged pores. Technically called comedones, blackheads occur frequently in people with oily skin. They begin as a buildup of dead epidermal skin cells on the walls of the hair follicle. This phenomenon is known as retention hyperkeratosis, a hereditary condition in which the cells do not shed normally, thus forming a “buildup” along the lining of the hair follicle. This buildup is coated with sebum (oil) that solidifies, forming a clump-like mass in the bottom of the follicle (microcomedone). From this beginning, either an open or closed comedone is formed. Additional hereditary factors in acne prone skin are over productive sebaceous (oil) glands and an increase presence of acne causing bacteria (priopionibacterium acnes). Acne bacteria easily break down sebum into fatty acids. These fatty acids are the favorite “food” of acne bacteria. Oxidation causes the black appearance of open comedones as sebum is exposed to oxygen” as opposed to the long running myth that it is dirt and debris that causes the black appearance. Closed comedones can easily become an acne papule or pustule because of the lack of oxygen in the follicle. P acnes bacteria are anaerobic and thrive in an environment void of oxygen.

Acne Treatment Basics
Exfoliate
The control of the microcomedo is the real key to controlling comedone development and, in many cases, comedonal acne. Using exfoliants daily, like alpha and beta hydroxyl acids in a liquid gel, helps remove dead skin cells from the follicles. A mixture of glycolic and salicylic acids helps break loose cell buildup in the follicles, and helps prevent buildup from recurring. The use of professional alpha hydroxyl acids and microdermabrasion can be very helpful in clearing clogged pores, but must be accompanied by a home care exfoliation program. We recommend an initial series of 5 chemical peels with salicylic/mandolin acid immediately followed by a microdermabrasion. The treatments are done every 7-14 days. Once the initial series has been completed we recommend a maintenance chemical peel and microdermabrasion every 8-12 weeks. Because our bodies are constantly producing a layer of dead skin cells, it is very important to understand that ongoing exfoliation is vital in the successful treatment of acne.

Protection from the sun
It is true that many people with notice an improvement with acne initially with sun exposure. However, long term sun exposure (including tanning beds) will have a detrimental effect on acne prone skin. UV radiation from the sun causes a thickening of the top layer of skin (stratum corneum). With that comes a thicker layer of dead skin cells to adhere to the lining of the follicles. Protection from the sun with daily application of an oil-free sunblock (DDF Matte Finish Photo Age Protection 30spf) is a crucial part in controlling acne.

Control of P. Acnes bacteria
There are many treatment options to address this component of acne. As mentioned before, by limiting the fatty acids which the bacteria feed upon we can obtain a greater control over the presence of acne causing bacteria. Other antibacterial agents include: benzyl peroxide, topical antibiotics, arbutinin, salicylic acid, and sulfur face masks. There is also a new treatment (Levulan) available that destroys P. Acnes bacteria and shuts down sebaceous gland activity. The results of recent studies show that the results are comparable to that of a 16 weeks course of Accutane. Studies indicate that the results from this procedure can last up to 16 weeks and possibly longer. It is our belief that no matter what treatment a person chooses it is vital to carefully follow all of the recommendations listed here for long term success in treating acne.

Avoid comedogenic skin care products
Comedogenic products contain oils, certain waxes, fatty acids, and esthers that can penetrate the follicle and caused clogged pores and acne outbreaks. These fatty materials can be present in almost any product, but are most often found in moisturizers, foundations, powders, serums, sunscreens, and blushes. It is important that when you purchase any of these types of skin care products that you choose products that contain non-comedogenic ingredients. We have provided a list of comedogenic skin care products based on their likelihood of causing an acne outbreak. Besides avoiding comedogenic products, a good cleanser containing glycolic and salicylic acids (DDF Blemish Foaming Cleanser or DDF Brightening Cleanser) will help dissipate excess oil and exfoliate dead skin cells. Acne prone skin also needs hydration. When acne prone skin becomes excessively dry the oil glands will increase oil production to compensate for the dryness. We recommend daily or twice daily use of with Skiceutical’s B5 Hydrating Gel or DDF Ultra Lite Oil Free Moisture Dew.

Highly Comedogenic Ingredients
Acetylated lanolin alcohol Linseed oil
Capric/caprylic triglyceride Lanolic acid
decaglyceryl decaoleate Myreth-3 myristate
Isocetyl stearate Myristyl myristate
Isoparaffin C9-11 Octyl palmitate
Isopropyl isostearate Octyl stearate
Isopropyl lanoleate Oelic acid
Isopropyl myristate Oleyl alcohol
Isopropyl palmitate Olive oil
Isostearic acid PPG-2 myristyl propionate
Sweet almond oil

Moderately Comedogenic Ingredients
Coconut oil
Grape Seed Oil
Mink Oil
Myristyl Lactate
Seasame Oil
D & C Pigments

Mildly Comedogenic Ingredients
Avocado Oil
Corn oil
Glyceryl stearate
Lanolin
Lauryl alcohol
Safflower oil

Non-Comedogenic Ingredients
Allantoin
Ceytl palmitate
Cyclomethicone
Glycerin
Iron oxide
isopropyl alcohol
Octyldodecyl stearate
Octyl methoxycinnimate
Panthenol
Polysorbates
SD alcohol
Sorbital
Sodium PCA

A Guide to lifestyle issues for the acne prone
Sleep no less than 8 hours every night on a consistent basis. Physical stress can make it extremely difficult to successfully treat acne.
Wash your clothes in Cheer Free Liquid, Dreft, or Tide Free detergent. Avoid fabric softeners. Do not over-load the laundry machine. If possible, put clothes through an extra rinse cycle and do not forget to rewash any clothing, bedding, towels, etc. that may have been washed in the wrong detergent and/ or fabric softener.
Do not attempt to rub or scrub off dead skin cells with a washcloth or buffing pad. Over-scrubbing causes excessive exfoliation that allows acne medication and alpha/beta hydroxyl acids to overly penetrate, thus causing excessive skin irritation.
Never slack up on your home care routine! Failure to apply your home treatment for too many days in a row can cause new microcomedones to form deep in the pores causing new breakouts, blackheads, and clogged pores to appear later.

Morning Home Care Routine:
1. Wash face with a cleanser that contains ammonium lauryl sulfate, disodium lauryl sulfosuccinate, salicylic acid and glycolic acid.
2. Apply an alpha/beta hydroxyl gel (DDF Glycolic Gel)
3. Apply oil-free sunblock with a SPF 30 or higher
4. Eye creams should be tested for comedogenicity as eye creams tend to drift downward onto the face during the day to acne prone cheeks.
5. If makeup is applied, choose a liquid makeup that is non-comedogenic, but make sure you check the ingredient list before purchasing. Any powder product in a cake form is “pressed” with a form of fatty agent to keep it in a cake form, and should never be used on acne prone skin. Stay away from cream and oil-based makeup.
Evening Home Care Routine
1. Cleanse face with the same cleanser that was used in the morning.
2. Apply sulfur therapeutic mask 3-5 times per week. Leave on for 10 minutes then gently wash off with luke warm water.
3. Apply alpha/beta hydroxyl gel
4. Apply an oil free hydrating moisturizer.