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)

1. Exfoliation

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.

2. Bacteria

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;(.

3. 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.

4. Redness

To calm the inflammatory, red stage of acne, focus on reducing both bacteria and irritation while protecting the skin barrier. Gentle cleansing twice daily with a non‑stripping cleanser helps remove excess oil and debris without over‑drying. Targeted actives like benzoyl peroxide (for P. acnes bacteria) and a retinoid such as adapalene (to normalize cell turnover and prevent new clogs) are core treatments, used in thin layers to minimize irritation. Supporting ingredients like niacinamide and azelaic acid can reduce redness and inflammation while being relatively well‑tolerated. Avoid picking, scrubbing, or using multiple harsh products at once, since this worsens redness and can increase scarring risk. For more severe or persistent inflamed acne, prescription topical or oral medications from a dermatologist are often needed to control inflammation and prevent long‑term marks.

5. Sebum (Oil)

Sebaceous glands produce sebum and are influenced by androgens like testosterone. This can lead to oilier skin and acne during life stages with higher androgen levels, such as puberty and certain phases of the menstrual cycle. In women, hormonal changes like stopping birth control, pregnancy, and perimenopause can increase acne. Conditions like PCOS, with elevated androgen activity, also contribute to persistent acne. In young boys, increased testosterone and athletic activities can exacerbate oiliness and acne due to factors like sweat and friction. Managing these issues involves regular cleansing, using non-comedogenic products, and medical treatments to reduce inflammation and adjust androgen effects.