Acne
What Is Acne?
Acne is the medical term for pimples.
It is more likely to occur in young people in their teens to thirties, but in what is called neonatal acne, it can also be seen in babies from two weeks to two or three months of age due to the influence of hormones. Acne takes forms such as whiteheads (pores plugged with a keratin plug), blackheads (oxidized sebum), red pimples (inflamed), and yellow pimples (filled with pus). It can also be accompanied by seborrheic dermatitis, a sebum-related irritation, with redness (erythema).
Factors in the Development of Acne
First, we explain how acne forms.
Acne begins with the clogging of a pore.
The skin has a mechanism called keratinization, in which the cells at the bottom of the epidermis gradually thin out, lose their nuclei, are pushed upward, and finally slough off. The outermost layer inside the pore is called the outer root sheath, which undergoes keratinization just like ordinary epidermis. The entrance of the pore is also ordinary epidermis, so it keratinizes too. As a result, keratin is constantly sloughed off and accumulates. Also, near the entrance of the pore there is a structure called the sebaceous gland, which secretes sebum.
In other words, inside the pore the keratin layer sloughs off and sebum comes out, and these two mix and harden, forming what is called a keratin plug that clogs the pore. When this happens, the sebum that should emerge onto the skin’s surface to protect it is blocked and stays in the pore, and the mass of the keratin plug grows larger. Because keratinization occurs as long as you are alive, keratin keeps accumulating.
Also, when the resident bacterium C. acnes proliferates it causes inflammation, and when the triglycerides in sebum are broken down to form free fatty acids, these also cause inflammation. Because white blood cells come out to eliminate the bacteria, pus can also form.
Important factors that make acne more likely include increased sebum secretion due to hormonal balance, proliferation of C. acnes, and abnormal keratinization caused by the irritation of free fatty acids. In addition, factors such as genetic predisposition, age, diet, stress, cosmetics, and washing habits become intricately intertwined.
Treatments for Acne
Skincare
As explained above, to prevent acne it is important to wash the face thoroughly so the pores do not clog. You need to pay attention to the cleanser you use, how you wash, and the frequency. It may also be better to choose cosmetics that are less likely to clog the pores.
Cosmetics that have been verified to be less likely to form keratin plugs, through what is called a non-comedogenic test, are sold. However, in my personal opinion, non-comedogenic testing does not seem to be done in a standardized way, so I think it is best to judge by how a product actually feels in use.
Topical therapy
Adapalene gel
Differin® (adapalene) gel is a vitamin A derivative and a medication used for facial acne. It acts to normalize keratinization.
Once a day after washing your face at night, apply it broadly over the areas prone to acne. It can take about three months for the effect to appear, but conversely, if it has not started working after three months of correct application, we consider stopping it.
As a side effect, which is the flip side of its effect, the skin peels and stings. Continuing to apply it while moisturizing well for a few weeks often leads to the skin getting used to it, but it is not uncommon to have to give up using it because the skin becomes bright red and swollen. It cannot be used by children under 12 or those who may be pregnant.
Benzoyl peroxide gel, lotion, and wash gel
Bepio® (benzoyl peroxide) gel and lotion are medications used for acne. In addition to exfoliating keratin, they have an antibacterial action against C. acnes and Staphylococcus aureus.
Once a day, apply it broadly over the areas prone to acne. As a side effect, which is the flip side of its effect, the skin peels and stings, so it is important to use it while moisturizing.
For people who cannot use the gel or lotion due to side effects, Bepio® wash gel has appeared. Although its concentration is twice that of the gel or lotion, it is designed to be less irritating by adopting a “short-contact method” in which it is washed off 5 to 10 minutes after application. It has a bleaching effect, so care is needed because it can remove color if it gets on hair or clothing. It cannot be used by children under 12 or those who may be pregnant.
Adapalene / benzoyl peroxide gel
Epiduo® (adapalene / benzoyl peroxide) gel is a medication that contains the ingredients of both the previously mentioned Differin® gel and Bepio® gel. It can be tried when acne still appears even with adapalene or benzoyl peroxide.
Apply it once a day after washing your face at night. It is recommended for both whiteheads and red pimples.
Irritation is more likely than when using adapalene or benzoyl peroxide alone, so care is needed to use it while moisturizing well.
Clindamycin / benzoyl peroxide combination gel
Duac® (clindamycin / benzoyl peroxide) combination gel is a medication that contains the ingredients of both Bepio® gel and the antibiotic Dalacin®.
Apply it once a day.
It too can cause irritation. Note that because there are reports that mixing benzoyl peroxide with tretinoin breaks down the tretinoin, those who have been prescribed tretinoin as a self-pay treatment should avoid applying them to the same area.
Antibiotics (clindamycin, nadifloxacin, ozenoxacin)
Dalacin® (clindamycin) gel/lotion, Acuatim® (nadifloxacin) cream, and Zebiax® (ozenoxacin) lotion have all been confirmed effective for red pimples. However, they are not effective against whiteheads.
Zebiax® lotion is applied once a day, and the others twice a day.
Azelaic acid cream (self-pay)
Azelaic acid is an ingredient found in grains such as wheat and rye and in yeast. It has actions including suppressing abnormal keratinization, antibacterial activity, suppressing sebum secretion, and anti-inflammatory effects, and overseas studies have shown its effectiveness against whiteheads and red pimples. Combination therapy with oral minocycline and topical antibacterials has also been shown to be useful.
Side effects include itching, redness, and a stinging sensation, but they tend to be mild.
See the price of azelaic acid cream
Oral therapy
Antibiotics
There are many types of antibiotics, but those considered to work well for acne are Vibramycin® (doxycycline), Minomycin® (minocycline), and Farom® (faropenem). Doxycycline and minocycline in particular are considered to have not only a bactericidal action but also an anti-inflammatory action.
Oral medication is recommended when inflammation is strong, but because long-term use leads to resistant bacteria, oral antibacterials should be given for up to three months, with the effect assessed at 6 to 8 weeks to decide whether to continue. It is best to use them in combination while diligently using drugs such as benzoyl peroxide and adapalene. Side effects vary by drug, but doxycycline and minocycline frequently cause nausea and dizziness.
Kampo (Japanese herbal medicine)
Keigai-rengyo-to, Seijo-bofu-to, and Jumi-haidoku-to are considered treatments that may be tried when other treatments do not work. They are used selectively: Jumi-haidoku-to for early acne with scattered small red and yellow pimples, Seijo-bofu-to for oily skin with strongly inflamed red pimples, and Keigai-rengyo-to for chronic cases with large boils.
Isotretinoin (self-pay)
A vitamin A derivative, this medication suppresses sebum secretion and speeds up the turnover of the keratin layer. Because it has many side effects, it is considered for prescription only for those whose acne does not clear despite ample other treatment.
As for side effects, first, as the flip side of its effect, the skin becomes dry. Because it is an oral drug, the whole body dries out, with peeling, itching, and chapped lips. The nasal mucosa and eyes can also become dry.
Also, isotretinoin is teratogenic. If taken during pregnancy, the rate of birth defects in the baby becomes very high, at 20 to 35%. (Birth defects have a natural occurrence rate of 2 to 3% even without taking the drug.) Therefore, contraception is necessary for both men and women. Women must use contraception for one month before starting, during use, and for six months after use. Pregnant and breastfeeding women also cannot take it. Men must use contraception during use and for one month after use.
Also, because it may stop bone growth, those in their growth period cannot take it. For adolescent acne, other treatments must be used. It is also said to sometimes cause depressive symptoms. Because abnormalities in liver function and lipids can occur, taking it while undergoing blood tests is recommended.
Aesthetic procedures
Peeling (self-pay)
This aims to reduce acne by improving clogged pores with chemical peeling using AHAs (alpha hydroxy acids) such as glycolic acid and lactic acid, or BHAs (beta hydroxy acids) such as salicylic acid.
Our clinic uses salicylic acid in macrogol. As a side effect, irritation symptoms from the solution can occur. Also, people with aspirin-induced asthma or aspirin allergy cannot receive the treatment, because salicylic acid is structurally similar to aspirin and symptoms can occur.
*For Mesona-J and the treatment of acne scars, please see the aesthetic dermatology pages.