Luckily, we do have the incredibly helpful Dr. Adam Friedman, Assistant Professor of Medicine and Director of Dermatologic Research at Montefiore - Albert Einstein College of Medicine, on speed dial. We asked him six questions we had about acne and since we have a feeling your personal squad may also be of the imaginary sort, we figured we’d share his answers.
1. What causes a pimple?
2. What causes a white head or a black head?
The answer to questions 1 and 2 lies on a spectrum. There is not one thing that causes a lesion of acne to form. I liken the formation of a pimple to the onramp of a highway. The highway being the surface of your skin and the onramp being the duct from which sebum, the oily stuff from our sebaceous glands, emerges. If the entrance to the highway gets congested—so if dirt, debris or skin cells block the “pore”—sebum cannot exit the skin and you get traffic backup, this is where you get your white head (a congested pore with skin covering it so the material does not get exposed to oxygen) or a black head (no covering, junk exposed to air, turns black). Bacteria that live on the skin can get trapped in that duct, and they start converting components of sebum to fatty acids, which are pro-inflammatory. The body, in turn, responds to these changes by activating cells and machinery that further break down this unit ultimately causing that nasty, bid red pus-filled pimple.
3. So there’s really no way to predict or control this process?
Now other factors are at play here that can both increase the production of sebum and the rate at which it is produced, such as hormones and foods that are high on the glycemic index. So, if these processes are moving faster, chances are it will be easier for this whole backup to occur. It has also been shown that there may be inflammation in the skin of those persons that get acne even before this all happens, further facilitating the formation of a pimple.
4. I thought acne was only for teenagers. Why am I still dealing with it?
Absolutely not. I probably see more adult women with acne then teenagers because there are more people outside the teenager year spectrum, but also because it is often more worrisome for adult women. This is because of the common misconception that adults should not get acne. Therefore if it does happen, clearly the affected person is to blame. But adult women who get acne likely have hormones called androgens to blame. My first question to these patients is “does it get worse around the time of your period.” The answer is not always yes, as there is never a one size fits all approach to adult acne. Sometimes hormones have nothing to do with it all - this is just one example. But the end all be all is that acne can be a chronic disease just like high blood pressure or diabetes.
5. Is popping pimples really bad for my skin?
Absolutely – already the skin is traumatized by the inflammation, which itself can cause discoloration or scarring. Popping a pimple not only further increases the risk of these events, but one could easily introduce bacteria into the skin, potentially causing a skin infection.
6. How long will it take my acne to clear up?
While the acne treatment infomercials suggest you can clear acne overnight, that is totally incorrect. Acne is a complex process, as mentioned above, involving numerous cell types and structures. Even the strongest medication, isotretinoin, make take a month before you see any real results. I usually tell my patients to be patient (redundancy intended), that they should give any new treatment at least two months to do its thing before re-evaluating. They will probably see results before then, but these medications take time to work and often people get frustrated because a treatment does not cure their acne in 24 hours.
Do you have any other questions about acne for the dermatologist? Ask away in the comments below!