It seems that it is still a pretty popular cultural myth that acne is something that happens only to teenagers. It's true, some people are fortunate enough to not have to deal with acne when they are adults, but a lot of adults (myself included) still experience acne.
There is a lot of conflicting information out there about acne prevention and treatments. A lot of websites claiming to have information or resources are just thinly veiled advertisements for a particular product. In this post I attempt to compile helpful information about acne prevention and treatment. Of course, I am not a doctor, so please take my recommendations with the same caution you would use when hearing medical advice from any well-meaning friend.
How Acne Works
Pores are the little holes that are found all over our skin. Our skin secretes oil from the pores. Our skin is also constantly sloughing off little pieces of old skin and replacing them with new skin from beneath.
If the old skin doesn't slough off properly and ends up clogging a pore with some oil behind it, the small grayish plug of dead skin blocking the pore is called a blackhead. If a clogged pore happens to have some bacteria in it, the bacteria can multiply, causing an infection. (It is natural for us to have bacteria on our bodies and usually this doesn't cause us much of a problem -- similar bacteria are also responsible for things like foot odor and body odor.) Our body's immune system reacts to the infection by sending increased blood supply to the area, causing local redness. Also, white cells from the blood devour the bacteria and then die, creating pus in the area of the infection. This red, infected area is a pimple. Hence the redness and pus inside pimples is actually a sign that our body's immune system is working properly to protect us against infection.
But those zits and blackheads still don't look very good! How can we prevent them?
There are two major medications that are widely used in anti-acne products: benzoyl peroxide and salicylic acid. Each of these medications addresses one of fundamental causes of acne.
Benzoyl peroxide is an antibacterial medication that works by killing bacteria that could infect our skin. So when a potential zit is forming, if the bacteria dies, the pore will not get infected and the zit will be prevented. Benzoyl peroxide is the main active ingredient in Proactiv acne prevention products.
Salicylic acid helps the natural process of skin sloughing and helps to avoid clogged pores. So if clogged pores are your problem, salicylic acid containing products, such as many skin cleansers you will find at your local pharmacy, may do the trick for you.
I think most people know that the best way to prevent acne is to wash your skin twice daily with an anti-acne cleanser, following cleansing with a toner (to close pores) and a moisturizer (to keep skin in good shape). But you might not know that almost all the cleansers out there contain one of the two ingredients I just listed above. When shopping for a cleanser, the most important thing is that it contains either salicylic acid or benzoyl peroxide (you should try both to find out which works best for you). In other words, the brand name on the front of the product is probably not as important as the ingredients on the back.
Retinoids help dead skin to slough off better and are often used to treat wrinkles. However, because they can help to prevent blackheads they are also helpful for acne treatment. For example, Neutrogena makes an anti-wrinkle, anti-blemish treatment that contains both retinol and salicylic acid. According to one of my sources (see below) retinols may be more effective than salicylic acid at treating deeper adult blemishes.
Another possible acne prevention you will find in some over-the-counter cleansers is Triclosan. Triclosan is an antibiotic which also helps to kill bacteria on the skin.
Prevention is the first step, but if you're like me you still have occasional breakouts that you want to deal with. Here are some tips that may help you.
Antibacterial treatments: Remember that a pimple is basically a small skin infection. So any treatments that would treat bacterial infections will work on pimples. This includes antibiotic ointment such as Neosporin. You can apply this kind of ointment to help the infection (and therefore the pimple) to go away faster. However, the petroleum in the antibiotic ointment might end up clogging more pores in the area. Perhaps a better option is a spot treatment that is specifically designed for acne, such as a spot treatment containing benzoyl peroxide or salicylic acid. Again, look at the package to find out what the active ingredient is and how much of the active ingredient the treatment contains. These ingredients can be combined with things like makeup to mask the appearance of the blemish or botanicals that are intended to help heal the skin.
Another antiseptic treatment that I have found effective on pimples is udder balm such as Bag Balm. This ointment is sold in cube-shaped tins at pharmacies. It was originally developed to treat infections in cow udders, but also works great on human pimples. Again, use this product sparingly since it is petroleum based. However, it tends to kill bacteria and bring infection to the surface where you can easily deal with it. Tea tree oil and sulfur have also been found to have antimicrobial properties and can therefore be found in some acne treatments.
To deal with acne redness in the meantime, remember that redness is caused by an increase of blood flow to the area of the infection. This is part of the body's natural immune response to an infection. Believe it or not, eye drops such as Visine or similar products are useful for reducing redness of this type, at least temporarily. Eye drops that are designed to reduce redness in eyes will also reduce redness on other areas of the body. You can just apply drops directly to the pimple.
Don't pop it unless you have a good reason. Popping your pimples will usually cause irritation to the skin in the area, meaning that after the pimple has started to heal, redness will still persist because the skin in that area has been damaged. So you should be aware that popping a pimple will probably cause redness and swelling to last longer than if you left it alone.
What if this isn't enough?
If these tips don't work to your satisfaction to get rid of your acne, talk to your doctor. There are prescription treatments, both topical and internal, that are effective at treating acne. These might work by killing bacteria or adjusting your body's hormones. Or it might be that you have a condition that looks similar but requires different treatment, such as rosacea or eczema. But I would like to remind you that the occasional blemish probably won't affect people's view of you. I always say nobody will notice your zit because they are way too busy worrying about whether you are going to notice their zits!
Here are some unbiased sources of information on acne:
WebMD Acne Center
Treatments for Adult Acne
National Institutes of Health