Dean Erickson asked:


In deciding on the best acne medication, it is first necessary to consider its causes. There are several types of acne that vary in intensity and difficulty of treatment, but all appear to have the same cause.

Although the cause of acne is not fully understood, it is believed to occur when the sebaceous glands increase their production of the oily sebum, which appears to be promoted by hormonal activity.  Sebum mixes with dead skin cells to block the pores in the skin and this mass become infected with bacteria. Your body’s immune system reacts to cause inflammation and the formation of pus, the detritus of white blood cells that have been active in destroying the bacteria.

Basically, that is what acne is. It has nothing to do with fatty food or chocolate, but the cleaner your skin, the less likely you will be to build up skin bacteria. However, you cannot catch it from somebody else, and stress and hormonal changes during the menstrual cycle can make it worse.

So how does this knowledge help us to treat acne, and devise an effective acne medication?  Let’s have a closer look at the belief that acne is caused by a combination of dead skin cells, sebum and bacteria, and the knowledge that hormonal changes can make it worse. In fact acne begins after puberty, when hormones are raging through young bodies: hence the phenomenon of teenage acne.

Sebum and Hormones

The production of sebum increases in line with the generation of certain hormones. During the menstrual cycle, the production of androgens in women increases at certain times. The activity of these androgens (e.g. testosterone) is believed to be responsible for acne, so if their production could be reduced, then the incidence of acne should be likewise reduced. Androgens promote acne by increasing the rate of production of oily sebum by the sebaceous glands in the skin. This gives some women a natural healthy glow, while others are provided with a sticky oil slick that mixes with dead skin cells to block up skin pores.

It has been found that many women respond well to an acne medication formulated from a combination of an anti-androgen such as spironolactone or cyproterone acetate, and an oral contraceptive containing an estrogen and progestin. This results in a reduction in breakouts due to a reduction in the production of sebum. There may be side-effects such as breast tenderness or nausea, but these normally last for only the first month or so of acne treatment.

Another possible way to treat acne to reduce sebum production is isotretinoin (trade name Accutane), that reduces the rate of sebum production and makes it less sticky. This is an effective prescription acne medication for sever cystic acne vulgaris, and also for acne rosacea.  Chemically it is a retinoid, a form of Vitamin A.  Both of these treatments are on prescription only, so what can you do before you see your doctor?

Dead Skin Cells

One way to prevent the build of dead cells on your skin that mixes with the sebum to block your pores is to wash with an exfoliating scrub.  Obviously you need a milder scrub for your face than for the rest of your body, but it is effective in removing dead cells

Another acne medication that achieves this at the cellular level is Vitamin A itself.  This dries the skin and flakes off the dead cells. Another is benzoyl peroxide, found in acne treatments such as Clearasil Max and Proactive. This not only flakes off dead skin cells but also possesses mild antibacterial properties.  However, these acne treatments can also dry up the skin of some people and turn it flaky.

Bacteria

Bacteria are the third factor in acne, and antibiotics are good acne medications. They kill off the bacteria that initiate your immune response that in turn causes the inflammation and pain, and your acne settles down and eventually clears up. You could also use a antibacterial soap with your exfoliating scrub to keep your skin scrupulously clean, but don’t overdo it because sebum possesses protective properties that prevent your skin and hair from drying out and also keep them waterproof. 

These are the three major forms of acne medication, designed to tackle each of the three components of the plug that is blocking your skin pores. Unfortunately the underlying reason for this occurring severely in some people, not all in others and to a greater or lesser extent in even more, is unknown in spite of a great deal of research.

Nevertheless the above mentioned acne medication currently available to you can be effective, although you will likely have to use them for several months before seeing lasting effects.