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Acne 101

People of all ages struggle with acne. But many do not understand HOW to figure out the most effective way to fix their acne. It's not just as simple as popping a pimple;). With so many treatment options, simply strolling down the skincare isle, or using what your friends recommend, seems to miss the mark for many. One easy way to understand all the acne treatment lingo is to break it down into 5 categories: The 5 Steps

  1. Exfoliation (normalizing keratinization)

  2. Eliminating the bacteria (p.acnes bacteria)

  3. Removing the material from the clogged pore

  4. Treating redness (treating inflammatory response)

  5. Decreasing oil (Sebum)


In acne patients, the keratinocytes (skin cells) tend to stick together because of the positive and negative charges, transglutaminase, and the stickiness of sebum (oil). The first step to treating acne is to prevent dead skin cells (keratinocytes) from sticking together. Retinoids (tretinoin/retin-A) do this very well by reducing positive and negative charges that render the cells "sticky" AND by decreasing levels of transglutaminase (enzyme responsible for cross-linking cell membrane of keratinocytes). Chemical peels also help to remove stuck-together dead skin cells. When alpha hydroxy acids and beta hydroxy acids are applied to the skin at high concentations, they detach dead skin cells (keratinocytes) by altering the pH.


Clumped, stuck together skin cells (keratinocytes) block the pore/follicle, creating a "white head", or a "black head" if the pore is open. This clogged pore is a great nutritional source for the p.acnes bacteria, unfortunately. It gravitates to clogged pores! Once the bacteria moves in, it starts digesting and feeding on the sebum/oil in the pore. The use of antibiotics or benzoyl peroxide attacks the bacteria. Common topical antibiotics are clindamycin and erythromycin solution. Benzoyl peroxide kills bacteria by generating reactive oxygen species in the sebaceous follicle (gnarly, right?). **But keep in mind, benzoyl peroxide dose cause free radical formation, which can cause accelerated aging of the skin;(.

Clogged Pore

Clogged pores/hair follicles (comedones) that remain beneath the skin are called white heads, one open to the surface is called a black head. These clogged follicles are full of dead skin cells, oil, and eventually the p.acnes bacteria. Common ways to remove the material in the clogged pore include: retinoids (tretinoin), alpha hydroxy acids (glycolic/lactic acid), and beta hydroxy acids (salicylic acid). Chemical peels (AHA/BHA) are applied to the skin at high concentations to detach dead skin cells (keratinocytes) by altering the pH. Comedone extractions are also used.

Treating Redness (Inflammation)

Once bacteria moves into the pore, the immune system is triggered. It responds with redness and inflammation. Anti-inflammatory solutions, such as salicylic acid, work well for this symptom. In extreme cases of acne (cystic acne), where scarring is a concern, a physician my prescribe oral steroids, or administer intralesional steroids. In office salicylic chemical peels are another great treatment option.

Sebum (Oil)

Sebaceous glands secrete sebum. Topical (tretinoin) and oral retinoids (accutane) decrease sebaceous gland activity. Hormonal stabilization using oral contraceptives (birth control pills) is also a great treatment for women to reduce sebaceous secretions.


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