Don’t Scrub
I remember when I first got acne. I tried to scrub it away by using a washcloth several times a day and rubbing as hard as I could. This resulted in what were probably hundreds of tiny pimples, on my forehead and hairline especially. It didn’t take me long to realize that harsh scrubbing was getting me nowhere.

I have never seen a scientific study specifically attempting to gauge how physical irritation of the skin can cause acne, however. It’s abundantly clear that it does, both from my own personal experience, and the experience of hundreds of thousands of us on acne.org. If you’re not convinced, just wear a face mask for a sport and you will see how hard it is to keep this area clear.

In a recent article published in the journal Dermatology, authors observe three female patients who presented with severe inflammatory acne “due to the association of two factors: facial friction with cosmetic agents.” These young women were rubbing their faces in a “compulsory manner” with their cosmetics.

The authors conclude: “Because cosmetic face friction as a cosmetic care becomes more and more fashionable, dermatologists should be aware of this severe clinical condition, which can occur in patients without a person history of acne.”

Hey, at least this is something. It would be cool to see some sort of controlled clinical trial performed on the effects of physical irritation alone on the severity of acne in the future. In the meantime, if you want to clear up your skin, stay gentle!

References:

  • Seneschal J, et al. “Exogenous inflammatory acne due to combined application of cosmetic and facial rubbing.” Dermatology. 2012; 224(3): 221-3.

Acne ScarsI recently finished pouring through the last 2 years of acne scar research and have updated the scars page. It’s an evolving field. Here’s what I found:

Lasers are becoming more and more the go-to treatment for acne scarring. Fractional lasers, which treat only a fraction of the skin at once, are also becoming more popular for their ability to reduce side effects while still producing results.

Scientists are incorporating radiofrequency devices along with lasers and data is promising, while not earthshattering, that radiofrequency could help a bit.

Scar revision specialists have treated scars with fat injections for years with lots of success. However, recently, they are trying what they call autologous fibroblasts, which are cultured connective tissue cells from the person’s own body. This is also showing lots of promise.

Despite the advances, a person embarking on scar revision should not expect miracles, but should instead expect improvement. As always, data is showing that a combination of treatments (i.e. laser combined with subcision and augmentation) produces the best outcomes especially in more severe scarring. According to an article in the journal Dermatologic Surgery, “Severe grades of scarring often require a combination of filling agents for volume deficit, injectable agents for hypertrophic disease, neurotoxins to effect movement, and fractionated and ablative resurfacing for surface changes.”

Lastly, there appears to be vast confusion amongst dermatologists in the classification of acne scars. This highlights the need to carefully select a scar revision expert who is dedicated to and experienced in this specific area of surgery. If you decide to embark upon acne scar revision, do your homework and make sure you go with someone who specializes in acne scars.

Helpful links:
Acne.org Scar Forum: join in the discussion
Acne.org Scar Gallery: share your pictures

References:

  • Leheta TM, Abdel Hay RM, El Garem YF. “Deep peeling using phenol versus percutaneous collagen induction combined with trichloroacetic acid 20% in atrophic post-acne scars; a randomized controlled trial.” The Journal of Dermatologic Treatment. 2014; 25(2): 130-6.
  • Nirmal B, et al. “Efficacy and safety of Erbium-doped Yttrium Aluminium Garnet fractional resurfacing laser for treatment of facial acne scars.” Indian Journal of Dermatology. 2013; 79(2): 193-8.
  • Al-Dhalimi MA, Arnoos AA. “Subcision for treatment of rolling acne scars in Iraqi patients: a clinical study.” Journal of Cosmetic Dermatology. 2012; 11(2): 144-50.
  • Manuskiatti W, et al. “Comparison of fractional erbium-doped yttrium aluminum garnet and carbon dioxide lasers in resurfacing of atrophic acne scars in Asians.” Dermatologic Surgery. 2013; 39(1 Pt 1): 111-20.
  • Sardana K, et al. “Histological validity and clinical evidence for use of fractional lasers for acne scars.” Journal of Cutaneous and Aesthetic Surgery. 2012; 5(2): 75-90.
  • Bencini PL, et al. “Nonablative fractional photothermolysis for acne scars: clinical and in vivo microscopic documentation of treatment efficacy.” Dermatologic Therapy. 2012; 25(5): 463-7.
  • Maluki AH, Mohammad FH. “Treatment of atrophic facial scars of acne vulgaris by Q-Switched Nd:YAG (Neodymium: Yttrium-Aluminum-Garnet) laser 1064 nm wavelength.” Journal of Cosmetic and Laser Therapy. 2012; 14(5): 224-33.
  • Hedelund L, et al. “Fractional CO2 laser resurfacing for atrophic acne scars: a randomized controlled trial with blinded response evaluation.” Lasers in Surgery and Medicine. 2012; 44(6): 447-52.
  • Qian H, et al. “Treatment of acne scarring with fractional CO2 laser.” Journal of Cosmetic and Laser Therapy. 2012; 14(4): 162-5.
  • Huang L. “A new modality for fractional CO2 laser resurfacing for acne scars in Asians.” Lasers in Medical Science. 2013; 28(2): 627-32.
  • Kimura U, et al. “Biophysical evaluation of fractional laser skin resurfacing with an Er: YSGG laser device in Japanese skin.” The Journal of Drugs in Dermatology. 2012; 11(5): 637-42.
  • Cho SI, et al. “Evaluation of the clnical efficacy of fractional radiofrequency microneedle treatment in acne scars and large facial pores.” Dermatologic Surgery. 2012; 38(7 Pt 1): 1017-24.
  • Ong MW, Bashir SJ. “Fractional laser resurfacing for acne scars: a review.” British Journal of Dermatology. 2012; 166(6): 1160-9.
  • Wada T, et al. “Efficacy and safety of a low-energy double-pass 1450-nm diode laser for the treatment of acne scars.” Photomedicine and Laser Surgery. 2012: 30(2): 107-11.
  • Azzam OA, et al. “Fractional CO(2) laser treatment vs autologous fat transfer in the treatment of acne scars: a comparative study.” The Journal of Drugs in Dermatology. 2013; 12(1): e7-e13.
  • Lorenc ZP. “Techniques for the optimization of facial and non-facial volumization with injectable poly-l-lactic acid.” Aesthetic Plastic Surgery. 2012; 36(5): 1222-9.
  • Halachmi S, Amitai DB, Lapidoth M. “Treatment of acne scars with hyaluronic Acid: an improved approach.” The Journal of Drugs in Dermatology. 2013; 12(7): 3121-3.
  • Goodman GJ. “Treating scars: addressing surface, volume, and movement to expedite optimal results. Part 2: more-severe grades of scarring.” Dermatologic Surgery. 2012; 38(8): 1310-21.
  • Tenna S, et al. “Combined use of fractional CO2 laser and radiofrequency waves to treat acne scars: a pilot study on 15 patients.” Journal of Cosmetic and Laser Therapy. 2012; 14(4): 166-71.
  • Zhang Z, et al. “Comparison of a fractional microplasma radio frequency technology and carbon dioxide fractional laser for the treatment of atrophic acne scars: a randomized split-face clinical study.” Dermatologic Surgery. 2013; 39(4): 559-66.
  • Leheta TM, et al. “Do combined alternating sessions of 1540 nm nonablative fractional laser and percutaneous collagen induction with trichloroacetic acid 20% show better results than each individual modality in the treatment of atrophic acne scars? A randomized controlled trial.” The Journal of Dermatologic Treatment. 2014; 25(2): 137-41.
  • Lee SJ, et al. “Ablative non-fractional lasers for atrophic facial acne scars: a new modality of erbium:YAG laser resurfacing in Asians.” Lasers in Medical Science. 2014; 29(2): 615-9.
  • Shah S, Alam M. “Laser resurfacing pearls.” Seminars in Plastic Surgery. 2012; 26(3): 131-6.
  • Preissig J, Hamilton K, Markus R. “Current Laser Resurfacing Technologies: A Review that Delves Beneath the Surface.” Seminars in Plastic Surgery. 2012; 26(3): 109-16.
  • Mohammed G. “Randomized clinical trial of CO2 laser pinpoint irradiation technique with/without needling for ice pick acne scars.” Journal of Cosmetic and Laser Therapy. 2013; 15(3): 177-82.
  • Finlay AT, et al. “Classification of acne scars is difficult even for acne experts.” Journal of the European Academy of Dermatology and Venereology. 2013; 27(3): 391-93.
  • Kwok T, Rao J. “Laser management of acne scarring.” Skin Therapy Letter. 2012; 17(2): 4-6.
  • Sobanko JF, Alster TS. “Management of acne scarring, part I: a comparative review of laser surgical approaches.” American Journal of Clinical Dermatology. 2012; 13(5): 319-30.
  • Levy LL, Zeichner JA. “Management of acne scarring, part II: a comparative review of non-laser-based, nominally invasive approaches.” American Journal of Clinical Dermatology. 2012; 13(5): 331-40.
  • Munavalli GS, et al. “Successful treatment of depressed, distensible acne scars using autologous fibroblasts: a multi-site, prospective, double blind, placebo-controlled clinical trial.” Dermatologic Surgery. 2013; 39(8): 1226-36.

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golden serpent fernA recent article in the journal Alternative and Complementary Therapies discusses herbal sunscreens and sun protectants. Of specific interest is an herb called golden serpent fern (Phlebodium aureum). Several studies have been performed, and an extract from the plant, when taken orally, appears to help protect the skin from damage. In one particularly intriguing clinical trial, people were able to stay in the sun almost 3 times as long with golden serpent fern than without. According to the authors of the article, “The data on golden serpent fern extracts look very promising for counteracting negative effects of UV exposure in healthy people wishing to avoid sunburn…”

I think it would be great to have something oral that could help protect against the sun. This would limit the amount of stuff people need to put on their skin, thus eliminating potential breakouts. The only problems is I cannot find a single place anywhere online to buy golden serpent fern.

Two questions:

1) Have any of you tried golden serpent fern? If so, did it work?
2) Any ideas on where I can get my hands on some?

References:

  • Yarnell E and Abascal K. “Herbal Sunscreens and Ultraviolet Protectants.” Alternative and Complementary Therapies. 2012; 18(3): 141-144.

aczoneA smattering of members of acne.org have tried Dapsone, a prescription anti-inflammatory medication which is best known as an oral medication for treating leprosy but is also prescribed topically in 5% concentration by the brand name Aczone. When taken orally, Dapsone comes with a host of worrying side effects, but when administered topically for acne, patients tend to suffer very few side effects. That is all well and good, but from the research that is coming in, it doesn’t seem to work very well, at least in the short term. Two studies have been performed recently on topical Dapsone. The first was a 12 week study which reported a 39% reduction in inflammatory acne. This is obviously not ultra-impressive, but when you consider that the placebo group experienced a 32% reduction, it becomes even less earth shattering. The second study was also a 12 week study which reported a 49% reduction in women and a 34% reduction in men. This is somewhat better news for women but the medication was still unable to even cut acne symptoms in half.

Longer term therapy: I spoke to a dermatologist a few years back who likes to prescribe Dapsone to her patients and claims that results only come after about the 3 month (12 week) mark. Therefore, I would like to see a study performed for a longer period of time.

Combination therapy: While Dapsone alone may not provide for sufficient clearing of acne, it may be prescribed alongside other drugs such as benzoyl peroxide or topical retinoids.

Have any of you guys taken Dapsone for longer than 3 months? How did it go?

References:

  • Tan J. “Dapsone 5% Gel – A New Option in Topical Therapy for Acne.” Skin Therapy Letter. 2012; 17(8): 1-3.

I wanted to let you guys know where I’m headed with The Regimen and getting it out to the world and hear any feedback you have.

Sobering reality #1: Not enough people know about The Regimen. Yes, there are tons of people on Acne.org, and yes, probably at least a million people have tried it…probably quite a bit more, since I started sharing it in 1996. However, there are 300 million people in the US alone, and 7 billion around the world. So we’ve reached only a tiny fraction of people. This I think is a shame since The Regimen actually works when most other stuff doesn’t.

Sobering reality #2: Most people don’t want to have to learn a bunch of stuff just to do a facial regimen. While anyone who has tried The Regimen knows it works incredibly well and is actually very simple, I think it comes across as too complex when people first encounter it. I am going to try to simplify it. For example, while I do think waiting for your skin to completely dry after cleansing is the best way to go, if you don’t wait the 5-15 minutes, I think The Regimen will still work for you. So I’m going to remove the “5-15 minutes” language from this part of The Regimen. Instead, I’ll just be instructing people to cleanse, wait for their skin to dry, and move right on to Step 2: benzoyl peroxide. I will also be looking at how else I can simplify The Regimen.

Sobering reality #3: Acne.org products are superior to drugstore products. When I started sharing The Regimen, I didn’t make products for it. For the first 8 years of Acne.org I instructed people to use recommended drugstore products. Yes, it is possible to use drugstore products and get clear but it is not nearly as easy. We get people writing to our customer service saying they want to return a product because The Regimen is “not working” for them. Almost every time, these people who want to return a product are not using all 3 Acne.org products on The Regimen. They are using other over-the-counter cleansers, moisturizers, or cream based benzoyl peroxide that just doesn’t work as well as Acne.org products or have comedogenic ingredients. Once we get any of these people using all Acne.org products, they invariably clear up. I can’t help but think our “open-source” Regimen ends up hurting people instead of helping sometimes.
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Where I want to go from here: Ultimately, I’d like to “Apple-ify” The Regimen. When someone buys an Apple iPad, they just start using it. They don’t have to read a manual or watch videos on how to use it. They just press the button and voila. This is how I’d like The Regimen to work. You buy the products and that’s all you have to do. It needs to be patently obvious how to use them. This will require some creativity but I think we can get there.

As a final note, I will probably always have links to alternative products because some people in certain countries can’t even order Acne.org products. It will just be a matter of linking to these alternative products in a way that does not add to any confusion.

I also want to hear you guys weigh in on this before we start making big changes. What do you think?

image-2imageIf you order an Acne.org Cleanser, you will now get the new label design! We changed the names of a few of the products too. Acne.org Cleanser is now called “Gentle Cleanser,” because, really, that’s what it is. Acne.org Treatment will become simply “Benzoyl Peroxide (2.5%),” and our Acne.org AHA+ will become simply “Glycolic Acid (10%).” The names of Acne.org Moisturizer and Jojoba Oil will not change. Overall, we’re going for super straightforward in both the names of our products and the look of the packaging. We also added QR codes to the back of products so people can easily scan and learn exactly how to use them.

Right now only the Cleanser is being sent with the new label, but the other products will slowly start being sent with the new label design in the coming months.

Enjoy! And as always, definitely let me know what you think of it.

NicotinamidesmallNicotinamide (AKA niacinamide or nicotinic amide), a vitamin B3 derivative, may be a welcome adjunct ingredient in an acne sufferer’s arsenal. I say adjunct because it is unlikely to produce adequate levels of clearing on its own, but may help boost otherwise lacking treatment protocols. It has a fairly good track record over the years and two recent studies further corroborate its acne fighting prowess. The first of the two studies compared 5% nicotinamide gel against 2% clindamycin (a topical antibiotic) and found them to be equally effective, with no side effects seen from the nicotinamide gel. The second study pitted 4% nicotinomide against 1% clindamycin. The researchers of this study came to a similar conclusion: “The efficacies of 4% nicotinamide and 1% clindamycin gels are comparable in treating moderate inflammatory facial acne vulgaris.”

Nicotinamide is available over-the-counter but is not found in many products. This may changes as more evidence surfaces showing its efficacy. I am personally going to look into the possibility of adding it into Acne.org products in the coming years.

References:

  • Shahmoradi Z, et al. “Comparison of topical 5% nicotinamid gel versus 2% clindamycin gel in the treatment of the mild-moderate acne vulgaris: A double-blinded randomized clinical trial.” Journal of Research in Medical Sciences. 2013; 18(2): 115–117.
  • Khodaeiani, et al. “Topical 4% nicotinamide vs. 1% clindamycin in moderate inflammatory acne vulgaris.” International Journal of Dermatology. 2013; 52(8): 999-1004.

Oysters for AcneOver the years, evidence continues to mount that adequate levels of zinc help reduce acne symptoms, on average by approximately 40%. While zinc will likely not completely clear anyone’s skin, this is still significant and is more than placebo.

It turns out that oysters contain far more zinc than any other food. In fact, 3 ounces of oysters (about 6 cooked or raw oysters) contain about 74mg of zinc, almost 500% of the daily value for zinc. However, because high levels of zinc can be toxic, be sure to keep your total zinc intake below 100mg per day.

If you are not fond of oysters, supplementing with a 30mg zinc gluconate pill per day should be plenty to get the benefits.

While there is still not enough compelling evidence to conclude that diet and acne are in fact related, in this one instance, perhaps indulging in a few oysters could be a fun way to provide some extra insurance against breakouts.

responsive-2We’ve been working on a new acne.org design for a few months now. It uses what they call Bootstrap 3, which basically means it should work pretty flawlessly on all devices, desktop, tablet, and mobile.

It’s also super clean looking and should appear more crisp on retina screens like the iPhone, iPad, or MacBook.

A big thanks to Paul for being in charge of the design and taking acne.org solidly into 2014 and beyond.

If you guys find any bugs or even just things you think could be done better, please comment here and let me know.

cr_logo_homeConsumer reports recently tested some popular acne treatments. They pitted Proactiv against AcneFree and found no difference in efficacy. “After eight weeks, acne was never wiped out completely, but in half to two thirds of volunteers, the number of blemishes was reduced by an average of about 40 percent.”

My 2 cents: 40% efficacy is nowhere near good enough. Over the many years that I have been researching both over-the-counter and prescription treatments, this 40% mark is often where treatments land. Keep in mind that when you give people a placebo, their acne clears up on average about 30%. I think any acne treatment should aim to completely clear acne. Having 40% less acne still means you are broken out, and who wants that? People who closely follow The Regimen almost always get completely clear. I would like to see these large brands give people much larger sizes of 2.5% benzoyl peroxide and instruct their users exactly how to gently cleanse and apply the benzoyl peroxide in order to get completely clear.



Consumer reports also tested zappers which use heat to supposedly shrink acne lesions. They tested Zeno as well as No! No! Skin. The authors of the test concluded, “Both devices shrank most acne lesions but eliminated only about 13 percent of them.”

My 2 cents: I am surprised at Consumer Reports conclusion on heat devices. Our team here at acne.org did our own test on Zeno and ThermaClear heat therapy devices on volunteers in our office. In our small, anecdotal study, neither device visibly shrunk or eliminated any lesions. More on heat devices here.

References:

  • “Acne treatments come out a wash.” Consumer Reports. 2012; 77(1): 9.