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Acne, or Cystic Acne, is a complex disease that can be treated with many different medications.  There is no cure for acne, but treatments do help and can prevent permanent scarring.

Acne (Cystic Acne)


What causes acne?

There are three components to acne; each has its own basic treatments.

The first component is a build up of skin that is treated with a class of medications called comedolytics. These treat the white heads and black heads. Medications in this class include salicylic acid, glycolic acid, and retinoids such as differin, retin A and tazorac. This component is difficult to treat and requires at least a four month commitment to make improvements.

The second component is bacteria or inflammation, these are the red bumps called papules, pustules (the ones with the pus bump on top), or cysts (large painful ones under the skin). These lesions are what dermatologists call inflammatory lesions. These are treated with the retinoids mentioned above, but usually need an additional medication such as a topical benzoyl peroxide, topical antibiotic, or an antibiotic pill. Both the pills and the topical medications are anti-inflammatory and antibacterial. If there are large cysts, injections of these cysts with an anti-inflammatory medication in the office may be offered to try to avoid scarring and help the lesion resolve faster.

The third component is oil production. This is from the oil glands located in the skin. Oil production is determined mostly by hormones, which is why acne is usually worse in adolescence. This is also why medications such as birth control pills may help acne in some people. Another medication that is used to treat severe acne is isotretinoin (used to be called ACCUTANE). This medication alters the oil production in skin, but there are risks and strict guidelines that must be followed if you are a candidate for this medication.

Acne is NOT a disease caused by dirt, diet, gender, or behavior. It may worsen with stress, infection, heat, friction, sweating, poor hygiene and certain medications. In females it may flare around the menstrual cycle.

Important points:

Food probably plays very little role in acne. However, if you believe that a certain food worsens your acne, you should avoid that food.

Use only “oil-free” or “non-comedogenic” products on the face. Avoid oil containing products including coconut, cherry pit etc. There is still controversy over mineral oil, but in general Dr. Jennifer Janiga recommends avoiding those products in acne prone skin.

Squeezing pimples may actually worsen them by releasing the contents into the undersurface of the skin.

What lotion and cleansers can I use that will not make my acne worse?

Mild Cleansers: Cetaphil facial cleanser, Neutrogena cleansers, Aveeno, Aquanil, Purpose

Lotions: Cetaphil lotion with or without sunscreen, Purpose, Aquanil, Aveeno, DML, Neutrogena

What medications will be given to me for my acne?

There are many different medications used for acne treatment. Usually Dr. Jennifer Janiga will start with one of the topical medications like Retin A or topical antibiotics before moving to medications that you would have to take by mouth. Each person’s treatment is individualized to the type of acne and type of skin that they have.

How do I apply my medications for my acne?

Retintoids:  Retin A, tretinoin, Tazorac, Differin: Wash face with one of the gentle cleansers above, allow to dry for at least 15 minutes, then apply pea sized amount to whole face avoiding skin around eyes and mouth. If you are too dry from this medication use a moisturizer and try using it every other day. Do not wax or use hair removal products while using retinoids; you should stop the medications at least one week before hand.   Some people may notice a worsening of their acne for two to four weeks after starting these medications, this is normal and will subside.

Benzoyl Peroxide (BP): Apply to a dry face. The wash and the creams will bleach cotton fabrics so use white towels for your shower and wash off completely if using the washes to minimize this effect. For creams and gels take care not to get it on your clothes or bedding.

Isotretinoin: A vitamin A derivative that is reserved for severe acne that has not responded to other therapy. If you are interested in this medication please ask for an IPLEDGE handout and visit www.ipledgeprogram.com for more information.

Appointment length varies and depends on severity of condition or other contributing factors, but is usually not more than 15-30 minutes.

Jennifer J. Janiga, MD, FAAD

Dr. Janiga enjoys taking care of both adults and children. Her extensive training and years of experience in medical dermatology, lasers, and cosmetic procedures allows her to treat her patients with the comprehensive attention they deserve.

Dr. Janiga listens attentively to what patients have to say, and works with them in planning the right course of action on an individual basis. Honest talk, humility and a fresh perspective paired with years of experience and education all contribute to the effectiveness of her straightforward care.