Fiance / Acne request

[bmilcs]

My girlfriend has periodic break outs and I was curious what products you recommend for treatment. We saw a commercial the other day for a Proactiv alternative that began with an X I believe -- it was created by Proactiv -- an all in one acne product.

What works?

 

[Luc]

A dermatologist is probably the best person to diagnose what's going on.

FWIW, what you eat can help or not. As an example, drinking soft drinks feed those pimples quite a lot. Changing what you eat might have a direct impact. For an unknown reason, I can't eat white bread but wholemeal is fine. As soon as you know those little things, it helps.

If it's an actual product that you are looking for, products with benzoyl peroxide seem to get rid of those pimples quicker... YMMV

 

[Prof. Moriarty]

Go to a dermatologist.

The pill can help with breakouts (obviously a women only treatment). Aside that getting rid of the actual acne a combination of salicylic acid and benzoyl peroxide works well.

Also putting a towel on your pillow, and changing it daily is meant to help.

 

[KCee]

I think everyone is different, but for me the following make a difference: salicylic acid, benzoyl peroxide, drinking lots of water and changing, at least my pillowcase, twice a week.

 

[ShaveYourSoul]

Look into Tend Skin and even the homemade recipe for it. I use the homemade version twice a day and it really helps control my acne.

 

[DBdL]

Hi bmilcs,

First one must understand that the development of acne is multifactorial in which genetics plays a key role and there is an interplay of essentially 4 factors:
1) Epidermal hyperproliferation leading to a plugging of the follicle.
2) Excess sebum production (mainly genetic however overaggressive cleaning of the face can exacerbate the situation)
3) Presence and activity of a commensal bacteria P. acnes (Propionibacterium)
4) Inflammation (Primary or secondary phenomenon??? Still under debate)

Thus the first part seems to be purely genetic in which androgen hormones (IE testosterone family) have been implicated in the overproduction of the epidermis near the hair follicle creating the dreaded comedone (AKA plugged hair follicle). Note that blackheads are in fact oxidized debris within the open pore. A whitehead on the other hand is a closed pore.

So the idea of cleaning the face is to help remove debris and oil. Salicylic Acid (a type of Beta Hydroxy Acid or BHA) helps to remove some of the cells by basically "ungluing" them and allowing the debris to come out. Since it is related to aspirin it also has some light anti-inflammatory properties which is a bonus (4th factor remember). You may have also heard of AHA's (Alpha Hydroxy Acid) which is from fruit or milk sugars (examples: glycolic acid and lactic acid). They work in a similar way to help exfoliate the skin.

The difference between BHA and AHA is their solubility in oil. BHA is oil soluble and thus better for acne prone skin while AHA is water soluble and better for thick sun damaged skin. The typical concentration for BHA should be anywhere between 1-2%. Try to start with slightly lower concentrations due to the fact that it can sensitize skin to the sun and actually cause damage; use of sunscreen is recommended. Also note that cleansers with BHA have little effect due to the fact that they do not have enough time to properly penetrate deep enough into the pore before being rinsed away. One idea is to leave the cleanser on the skin for a few minutes. That being said a moisturizer with BHA is still the best idea due to it being on the skin for a long period of time.

Scrubs are another method however they have some major drawbacks. For one they are nowhere near as efficient as a chemical exfoliant. Furthermore the scrubbing action itself cannot really get into the pore and thus has minimal effect in really helping to unclog blocked pores. They still have a use as a weekly or every 10 day light treatment to help reduce the skin debris even further. Keep in mind that there is no need to scrub hard, allow the particles to do the work.

Since the 3rd factor is a bacterium the use of benzoyl peroxide is advised. Concentrations rage from 2.5% to 10%; studies have shown that 5-10% have much better outcomes however 2.5% is better tolerated. It is an antiseptic thus it will help kill the bacterium responsible for the problem. One of the main issues is initial dryness but becomes much more tolerable after 10 days or so. Although 5-10% concentrations have better outcomes it is advised to start with 2.5% and slowly increase the concentration to a comfortable level.

Note that as previously stated over cleaning the face can actually lead to increased sebum production. It is hypothesized that the sebum is there to help protect the skin. It acts by helping to block water evaporation from the skin and also act as a barrier against microorganisms etc. Thus when the skin is assaulted there is an increase in sebum production. Thus we were taught to first start of with a very light facial cleansing regimen with daily moisturizing hopefully with salicylic acid (very important due to the fact that healthy skin is happy skin). Remove all cleansing solutions for a month or so and then see the results. Thus the patient is advised to clean their face with simple water (morning/night). Very difficult for so many patients because they feel greasy but in many the greasiness does subside considerably after 3 weeks. If there is still an overly greasy face then a facial cleanser is added. It should be as non-aggressive as possible and hopefully no alcohol. Since as stated before BHA's have little effect in cleansers it is advised to use a cleanser with benzoyl peroxide; again leave on skin for a few minutes to allow for greater action. There are also creams that contain benzoyl peroxide (usually gels).

Last but not least a physician (start with family and if need be a dermatologist) can prescribe antibiotic skin regimens (also oral). Keep in mind that the antibiotic treatments usually cause severe sun sensitivity (dapsone is an exception; WARNING can cause skin discoloration if combined with benzoyl peroxide). This is usually reserved for moderately severe cases and finally retinoic acid is used for persistent/severe acne (so many side effects).

Thus my recommendation is first start with a very light facial cleaning regimen with just plain water for 4 weeks (remember that all of the action is deep within the dermis and will take time to see the results) and a good moisturizer with some BHA and AHA (help with acne and wrinkles in the long run respectively). If there is improvement continue for another 2-4 weeks with the light regimen. If there was no improvement in the first 4 weeks then begin adding a light facial cleanser (BHA/AHA an option but make sure to keep the cleanser on the face for a few minutes before rinsing off) once daily and if need be twice daily but always wait approximately 4-6 weeks before making any changes Thus 4-6 weeks of trial and review of progress between changes.

As of yet there are no good supportive studies indicating a link between diet and acne.

I hope this made sense and it was somewhat helpful.

Cheers,

D

PS: Thanks SalvadorMontenegro, I was not very clear.

 

[DBdL]

Darn it I always seem to be a thread killer lol

 

[bmilcs]

Darn it I always seem to be a thread killer lol

Haha I saw the wall of text while working and said to myself I'll get back to that later tonight.

Soon.

 

[Jack-in-the-Green]

DBdl pretty well covered all the standard treatments, but I'd like to add my continued praise for African Black Soap. Mind you, it works a best for surface acne brought on by too much oil production, as opposed to deep cystic acne that tends to pop up from hormonal fluctuations. From what I hear, Ortho Cyclen and Ortho Tri Cyclen work the best for women whose acne is caused by hormonal fluctuations. A chat with her GP is probably the best course of action.

 

[SalvadorMontenegro]

Darn it I always seem to be a thread killer lol

No. That was a solid contribution. We're all stupefied by your wisdom. The only thing I didn't get was:

Thus my recommendation is first start with a very light facial cleansing regimen for 4 weeks (remember that all of the action is deep within the dermis and will take time to see the results) and a good moisturizer with some BHA and AHA (help with acne and wrinkles in the long run respectively). If there is improvement continue for another 2-4 weeks with the light regimen. If there was no improvement in the first 4 weeks then begin adding a light facial cleanser once daily and gradually increase aggressiveness after at least a 3-4 week trial period and review.

So, if the routine of using a light facial cleanser doesn't work, she should start using a light facial cleanser?

Anyway, I think most systems these days are a combination of a cleanser, an acid (AHA or BHA) and benzoyl peroxide. That's what Proactive is.

I use the Paula's Choice version (it's called CLEAR) sans the benzoyl peroxide, because I don't really need it. The routine works pretty well for me. I've been with it since April.

I would advise against using Pro Active. I haven't ever used it and it may work, but my brother used it and it is an absolute nightmare to try and cancel it. Look up the reviews of the company's customer service. It's amazing.

 

[bmilcs]

Thanks for the responses house!

 

[SalvadorMontenegro]

Edit: I'm illiterate.

 

[Teppanyaki]

When I was younger, I used a combination of benzoyl peroxide and Retin-A. Aside from that, some people use topical antibiotics and hormonal contraceptives.

Benzoyl peroxide is the only thing on that list which is over the counter.

 

[DBdL]

I have heard from a number of patients regarding African Black Soap (Thanks Jack-In-Green). Some absolutely loved it and referred to it as being a saviour as a cleanser. Others however did mention that it caused some pretty awful dryness/redness. Definitely worth a shot in my opinion just to see if there is improvement. As always first start with as light a regimen as possible and gradually increase the dose/aggressiveness of the management. Furthermore as stated before be sure to give the new regimen time (optimum >6 weeks, minimum 4 weeks; it takes time for the deeper dermal layers to "adjust" and of course those new cells migrate to the surface).

As Jack-in-the-Green (damn that's a long one) pointed out OCP (oral contraceptive pills) are commonly used in women; tri-cyclen is a good common one and tri-cyclen lo is better due to low dosage, both are combination hormone treatment (progestin/estrogen combo). Interestingly enough the idea behind this is to help with the androgens (or so they thought) however studies have shown that sufferers of acne actually have normal levels of androgens and individuals who suffer from androgen receptor mutations do not develop acne themselves (Androgen Insensitivity Syndrome). Thus it has been postulated that perhaps it is not so much the levels of androgens but instead the sensitivity of the androgen receptors on the sebaceous glands (produce sebum) that are out of control. Regardless of the debate if she cannot get the acne controlled or it is on the severe side of things, discussion with her physician is always the best plan.

I wish your wife the best of luck, although acne is far from a severe disease it can be disheartening (I know I hated the fact that I had light acne myself, sometimes still get a pimple here and there at the age of 33). Not until my now wife started to nag me to take care of my skin and of course taking the dermatology courses did I not begin to understand certain important factors to always keep in mind. First as stated so many times, issues with skin really are "skin deep" thus learn to wait to see how the skin reacts, use of a moisturizer is critical (happy skin is healthy more rugged skin able to withstand the rigors of life), protect it from the sun and lastly not be as aggressive with cleansing; I would cleans skin twice daily with harsh cleansers, toners and three times a week I would use a scrub. As I changed my concept of skin I saw at first gradual improvements and then monumental improvements resulting in clear skin that is comfortable resulting in dramatically improved shaves (BONUS).

I wish your wife can find that happy resolution as I did.

Cheers,

D

 

[bmilcs]

Thanks for the responses house!

What the heck? Autocorrect had a mind of its own.

 

[bmilcs]

Her acne really is sparse.. Not bad at all. But you know how women can be

 

[DBdL]

Her acne really is sparse.. Not bad at all. But you know how women can be

Yep completely but at the same time I do understand her rather well. Your face is the first thing people notice (ok in general) and stigma regarding acne still exist (unclean); not as common today but still present. Not to mention it really does not look fantastic lol. As I said she should first try to see if she can get it under control on her own but if it seems to be a losing battle, medical help is certainly the way to go.

Best of luck.

D

 

[dieselfuel79]

When I hit 16 I had a bad bout of acne...nothing I tried worked. Went to the family Dr. and he found a resolution. 2 months later, I had clear skin. That was 18 years ago. Have your girlfriend speak to a medical expert.