A doctor’s guide to acne

Aug. 22, 2018

A young woman is show washing her face.


From annoying and inconvenient, to painful and scarring, acne is a challenge for many teens and adults.

“Acne can really lower someone’s self-esteem,” said Dr. Barbara Novotny, a family medicine physician in Steamboat Springs and a member of the medical staff at UCHealth Yampa Valley Medical Center. “I encourage anyone who has acne to seek treatment.”

Below, Novotny explains what acne is, why some people are more prone to get it and how to treat it.

What is acne?

Acne starts with skin pores (also known as follicles), some of which make sebum, an oily substance that lubricates the hair and skin.

The skin is also covered with bacteria, and one type in particular likes to eat sebum. When bacteria enters a pore, a whitehead forms. Next the immune system attacks, causing the pore to burst and become a blackhead.

“When it bursts, the bacteria and pus in that pore seeps into the other pores around it,” Novotny said. “That’s why acne spreads so easily.”

An added challenge for teens is that in puberty, hormones stimulate pores to make more oil and cause hardening of skin follicles, causing pores to close off at the top and trapping bacteria.

Why is acne worse for some people?

About 85 percent of teens deal with acne, but for some, it’s much more than just an annoyance. Scientists believe that genetics play a role in the severity of acne.

“We know that if your parents had acne, you have a three times higher risk of getting acne,” Novotny said.

That may be in part due to a person’s unique immune system. “For people with severe acne, it could be the immune system is having a big response to the bacteria,” Novotny said.

Hormone levels, which can be higher or lower for each individual, also play a role.

Managing acne

The first rule of managing acne is to avoid scrubbing your face hard and picking or popping pimples. “Any type of repetitive trauma, even microtrauma, to the skin where you have acne can cause pores to open and let the bacteria spread,” Novotny said.

Be aware that turtlenecks, bra straps and sports helmets and equipment can rub on the skin and block pores, worsening acne.

Certain foods can have an impact: sugary foods along with the natural hormones in milk may increase severity of acne. However, there isn’t reliable evidence that chocolate is a culprit. Stress doesn’t help, as stress hormones can increase sebum production: one study showed teens’ acne was worse during exams versus summer.

Over-the-counter treatments

Start with a gentle, non-soap facial cleanser, such as Cetaphil or Dove’s sensitive skin bar.

“Those are the best as they’re not super harsh, so they’re not going to cause microtrauma to the skin,” Novotny said.

Products containing benzoyl peroxide work like an antibiotic to reduce bacteria on the skin, while salicylic acids help soften skin and keep pores open so bacteria can’t build up as easily. If using several treatments, Novotny recommends applying one in the morning and the other at night.

Other options include tea tree oil and alpha hydroxy acids, while recent studies suggest there may be benefits of taking vitamin A and D, trying chemical peels and using light or laser therapy.

Prescription medications

“A mainstay of treatment is a topical retinoid, which helps brings down inflammation in the skin and thins the skin to combat hardening,” Novotny said.

Next, topical antibiotics or oral antibiotics can be prescribed. And finally, Accutane may be recommended for the most severe cases.

Don’t hesitate to reach out to your health provider if you or your child is dealing with acne.

“There are a lot of treatment options and we can really help improve things,” Novotny said. “We want our teens to have the best self esteem they can have, and we don’t want acne to lower it.”

This article first appeared in the Steamboat Pilot & Today on Aug. 6, 2018.

About the author

Susan Cunningham lives in the Colorado Rocky Mountains with her husband and two daughters. She enjoys science nearly as much as writing: she’s traveled to the bottom of the ocean via submarine to observe life at hydrothermal vents, camped out on an island of birds to study tern behavior, and now spends time in an office writing and analyzing data. She blogs about writing and science at susancunninghambooks.com.