The Identification of Acne Lesions

This is a whitehead or a closed comedone. Whiteheads develop when sebum is overproduced beneath a microcomedo, which is basically a clogged pore (or hair follicle). Sebum is important because it keeps your skin and hair moisturized in dry climates, but it's also full of fats and proteins, those things upon which most living things feed; it's an Old Country Buffet for bacteria. Whiteheads, by definition, are not infected, which is why it's important not to touch them, pop them, or molest them in any way.

This is a blackhead or an open comedone. Blackheads develop when a whitehead or a clogged pore finally opens and releases most of that sebaceous garbage onto your skin. I say "most" because what's left in your pore is dead skin cells, expired fats, and melanin (the stuff that makes your skin look good when you tan). Now, this isn't necessarily a bad thing. One of two things can happen here: either your body naturally flushes out the leftovers, or bacteria show up for a free lunch--causing an infection.

This is a papule. Some people mistake these for whiteheads. You see, whiteheads aren't technically infections--they're just white and bloated, with nothing left to do but burst. Papules are what happens when a whitehead or a blackhead finally does become infected. They're slightly larger, sometimes pink, and painful to the touch. This can happen either because your immune system isn't strong enough to fight off the bacteria or because you've been poking and prodding that whitehead and you've ruptured the pore (or hair follicle) beneath the surface of your skin. Once this happens, it's considered an acne lesion.

This is a nodule. At this point, your acne lesions are so infected that you risk the chance of acne scarring. Nodular or cystic acne is one of the more serious types of acne. Once your dermatologist sees nodules, they're going to start bringing in some of the topical antibiotics and more aggressive retinoids to do the heavy lifting because your body isn't doing its job. If you think you might be suffering from nodular acne, you should consult a dermatologist immediately. If you'd like more information about cystic acne treatment strategies, you should read "How to Get Rid of Cystic Acne." It will help you and your dermatologist generate a treatment plan together.

What Causes Acne Vulgaris?

How to Get Rid of Acne at Home

1. Start getting rid of acne at home by refusing to put oils on your skin. As if the multitude of causes you can't control aren't bad enough, if you wear makeup, you're putting chemicals on your skin (namely synthetic oils) that aren't regulated by the FDA; no one knows what's in those products. This advice doesn't really apply to most of the male population; I say "most" because, if you've ever been to a drag show, you know that that kind of work demands an oil-based makeup!
2. If you're serious about getting rid of acne, you'll start using a synthetic detergent face wash. Cetaphil is a good example of just such a face wash. Synthetic face washes are better than traditional soaps because they have a pH closer to that of your skin (pH of 5.5 to 6.5)--just enough solvent power to help wash away the oils and dead skin that are clogging your poor, beleaguered pores. More recommendations? Try Dove Sensitive Skin Bar. That one is actually recommended by dermatologists.
3. If you want to take acne treatment at home to excess, then grab a bottle of antibacterial soap. Triclosan and chlorhexidine-based soaps are the weapon of choice, if you choose to go that route. This isn't actually recommended by doctors. I should mention that. There have been studies done that suggest it may help manage acne vulgaris in certain instances, but it's a last resort--like killing zombies with a rusty shovel instead of a shotgun.
4. Another common, non-prescription treatment to get rid of acne would be benzoyl peroxide. Benzoyl peroxide has been the mainstay of domestic acne treatment regimens since before I was born. That was a long time ago--a fact made glaringly obvious by my inability to relate to anything I see on MTV today. But the point is, benzoyl peroxide (2.5% concentration in most cases) helps the skin slough off layers more quickly, reducing blockage and bacteria levels at the same time. There's a reason it's still on the shelves.
5. Whatever you do, don't scrub your face like you're guilty of murder. The oils and skin that are causing the buildup and blockage of your pores are easily washed away with gentle massaging and a very mild synthetic detergent. Your dermatologist should be very adamant about this point: anything done to irritate your skin, even the slightest bit of damage, is going to make your acne worse. Remember: nothing beats warm water, a mild solvent, and the slightest touch. Anything else is like rubbing your face with rock salt.

Medical Treatments for Acne

So, if home remedies for acne aren't working for you, then it might be time to escalate your treatment plan. The following section discusses the use of topical retinoids, topical antimicrobials, azelaid acid, and oral antibiotics. For the sake of brevity, we won't get into too much detail in this article. I'm just going to outline the basics of treatment plans that most dermatologists are using today, and I'll discuss the mechanisms behind the most common medical treatments.

Now, when you're dealing with an acne treatment plan, you have to understand that there are roughly four things that lead to the appearance of acne lesions:

1. your skin's inability to slough dead cells out of your hair follicles,
2. overproduction of sebum (natural oils),
3. P. acnes (the bacteria responsible for most follicular infections),
4. and inflamed tissue surrounding your pores.

Knowing this, it should be understood that current medical treatments are focused on stopping all four (or any combination of) these symptoms from occurring.

Topical retinoids are usually the first choice of medications to get rid of acne. Retinoids like tretinoin, Adapalene, and tazarotene are derived from Vitamin A. They are used to accelerate your skin's natural ability to slough dead skin cells, decreasing the chance of occlusion (medical fancy-talk for clogging) of your pores. This is done at a cellular level by affecting the DNA of the cells on the surface of your skin, "tricking" them into shedding and regenerating themselves more quickly. On top of that, they have properties that also inhibit the inflammation associated with acne lesions. They're available in both gel and ointment form. People with oily skin are usually given the gels because they tend to dry the skin.

Topical antimicrobials are usually the second choice of medications used to get rid of acne. Antimicrobials are exactly what you think they are: they kill microbes (i.e. bacteria, P. acnes). Turns out I already suggested a very common antimicrobial, benzoyl peroxide. There are so many topical antimicrobial ointments and gels out there that it's hard to keep track of them all. The mechanism of action is simple: kill the P. acnes bacteria that are causing the inflammation (a result of infection) to reduce the number of acne lesions. More examples of common antimicrobial ointments are clindamycin, dapsone, and erythromycin.

The third and least prescribed choice of acne treatments are oral antibiotics. This form of treatment is generally reserved for very serious cases of nodular (cystic) acne, acne conglobata, and acne fulminans. Like topical antimicrobials, oral antibiotics work by targeting the P. acnes bacteria, and examples of these medications include azithromycin, doxycycline, and tetracycline. Except in serious cases of acne where topical antimicrobials are ineffective, oral antibiotics are losing favor among dermatologists because of increased instances of antibiotic resistance.

Note: many of the newer topical medications are a combination of both retinoids and antimicrobials, and it has been suggested by recent studies that formulas containing both benzoyl peroxide and adapalene are the most tolerated combinations on the market. If you'd like more information, you can read more about it in our acne medications section.