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If you were to ask most people who have acne what causes their skin to break out, you might get answers on the lines of "eating fried food," or "my hormones," or "oily skin," or "acne bacteria," and all of those answers would be right. Really getting acne under control, however, always requires a multipronged program that you follow faithfully over a period of several weeks to several months or even longer.
What Really Causes Acne?
Acne is an inflammatory disease of the skin. The inflammation that causes acne, however, is generated by the immune system when it detects acne bacteria in large numbers living in the pores of the skin. And those acne bacteria don't multiply to large enough numbers to get the attention of the immune system unless they are trapped inside pores in the skin, which in turn aren't clogged unless there is some combination of excessive production of skin oils and the accumulation of dead skin cells in their linings.
Combination Treatments for Acne
Dermatologists used to prescribe single treatments for acne and hope for the best. Nowadays prescribing just one medication or just one kind of skin restorative acne vulgaris treatment is relatively rare. And acne products themselves are beginning to reflect this understanding of how to achieve clear skin. For example:
- The retinoid medication adapalene, which is marketed under the trade name Differin, is a kinder, gentler version of the retinoid medications Roaccutane and Retin-A. Differin stimulates the growth of the skin underneath cysts and blocked pores so that they open from the inside out. Differin and drugs like it are sometimes the only way to restore a smooth contour to the skin without surgery. But once new growth in the skin is stimulated by Differin, acne bacteria find new pores to infect. New medications combine both adapalene and the bactericide benzoyl peroxide to prevent newly smooth skin from promptly popping out in new acne blemishes.
- Germ-killing benzoyl peroxide kills Propionibacterium acnes, the microbe that causes mild to moderate common acne. However, in the process of killing acne bacteria over about 48 hours, it also dries out the skin. Even though the recommendation seems obvious now, it is just now becoming common for dermatologists to recommend that their patients who use benzoyl peroxide also use a moisturizer.
- The rich golden tones of Asian skin types and the dark brown tones of African skin hold their own healing secret, the skin pigment melanin. The skin quenches inflammation with melanin, and these skin types heal from acne relatively fast. However, when there is a lot of inflammation, the skin produces a lot of melanin, and that excess melanin can cause long-lasting brown or black blotches that can be a bigger cosmetic problem than the acne they replace. Dermatologists are beginning to realize that sunscreen and skin lighteners may be essential to healing acne on Asian and African skin types.