June is Acne Awareness Month.

To all who suffer from acne, know that you are not alone. Acne affects a majority of the population – an estimated 80% or more.

Acne is a frustrating and complex skin disease.

There is no quick and easy treatment to clear the issue.

Its impact reaches beyond physical appearances.

Basically, acne can be socially and psychologically devastating for many who suffer from this skin issue.

Treating acne as early as possible and as aggressively as possible offers the best chance of scar prevention and relief from lasting emotional burdens.

To help understand the complexity of this skin disease, it is important to start with the basics.


Acne is an inflammatory skin disorder of the pilosebaceous units of the skin. In other words, the pore and everything in it isn’t working properly.

The pilosebaceous unit consists of the pore, hair follicle (the part of hair just underneath the skin surface), hair shaft (visible part of the hair above the skin surface), sebaceous glands and little muscles attached to the hair follicles called arrector pili muscles.

When all parts of the pilosebaceous unit are functioning properly, the passage is clear for sebum (oil) to travel up the hair follicle onto skin’s surface, keeping skin clear, moisturized and healthy. When there is an obstruction to the process or abnormality in the unit, acne erupts.

Acne occurs when dead skin cells and sebum clump together to form a plug. Inflammation occurs when bacteria builds up around the plug. Read more about the birth of a pimple.


Grade I – Non-Inflammatory Comedonal Acne

The plugs discussed above are classified as non-inflammatory comedonal acne. Basically, they are white heads and blackheads.

Grade II + Grade III – Inflammatory Acne

Inflammatory acne occurs when bacteria causes the plug to become inflamed, presenting as red (erythematous) papules and pustules. Grade II is the mildest form of inflammatory acne.

Grade III presents with more widespread and intense numbers of papules and pustules than Grade II.

Grade IV – Severe Inflammatory Acne/ Cystic Acne

Cystic acne develops when the inflamed plugs become infected, forming cysts, nodules and potentially scarring breakouts.

Hormonal Acne

Hormonal acne usually affects the lowers face, generally presenting as papules and deep cysts.


Treatments are chosen and combined to target as many factors as possible contributing to the acne issue.

  • Topical medications promoting cell turnover to clear and unplug pores, such as retinoids and lytics
  • Topical antibiotics and other medications to reduce inflammation and destroy acne causing bacteria
  • Oral medications, such as isotretinoin, antibiotics, contraceptives, spironolatone
  • Lasers. chemical peels, light therapy

Read more about acne treatments.

BASIC TIPS regarding acne treatments:

  • Apply topical medications over all affected areas as directed, in the amount directed. Using more than prescribed of a topical medication likely will cause adverse reactions of varying kinds, such as sensitivity, irritation, etc.

To illustrate: If you are prescribed oral meds and instructed to take one a day for two weeks, you hopefully will not take five pills thinking it will work faster because it won’t. Also, it is highly likely you will have to deal with some pretty serious adverse reactions.

The same attention needs to be applied to topical medications. If instructed to use a pea-sized amount for the entire face, do not use a quarter-sized amount.

Less is more. Less is more. Less is more.

  • Be patient and compliant with medications and treatments. Nothing works overnight. As a matter of fact, it can take up to eight weeks for products to visibly start working. In that eight weeks, skin can clear, purge, clear again, peel, etc. Stick with it!

Of course, excessive irritation or sensitivity needs immediate attention. Call your dermatologist asap.

  • Follow-up appointments are very important! Oftentimes, medications must be adjusted or changed.

More advice:

  • If you have tried over the counter products without success, STOP! Cut to the chase and call your dermatologist.
  • If you are a skin picker, STOP! Not only will the agony of having acne be prolonged by spreading acne causing bacteria on the surface and between the layers of skin, but also, the chance of creating scars skyrockets every time you pick at your skin. (BTW, scrubbing skin can also spread acne causing bacteria.)

Skin picking (aka dermatillomania, excoriation disorder) is quite common, and it is not as easy to stop as many may think.

A few excellent resources regarding dermatillomia:

TLC Foundation



REMEMBER: You are not alone in this journey to clear skin. There are resources to help you. We are here to help you.