Friday, January 28, 2022

Mild Acne: Symptoms, Causes, and Treatments

  • Mild symptoms are associated with both inflammatory and noninflammatory acne 
  • Acne develops when hair follicles become blocked with dead skin cells, oil and environmental debris 
  • Acne development is influenced by genetics, fluctuating hormones and lifestyle 
  • Mild acne typically responds well to over-the-counter treatments, prescription topical antibiotics and retinol

Mild acne is the most widespread skin disorder in the United States, affecting all ages and sexes. When excess sebum (oil), debris and dead skin cells accumulate within hair follicles,  noninflammatory acne develops. If left untreated, Cutibacterium acnes (formerly Propionibacterium acnes) bacteria can multiply rapidly and encourage inflammatory acne to form. 

Mild acne symptoms can develop in either type of acne; with rapid and targeted treatment, these symptoms can be resolved or greatly reduced. 

Mild Acne Symptoms

Mild acne is characterized by pores that are blocked with oil and debris called comedones. These are identified as either blackheads (open clogged pores) or whiteheads (closed clogged pores). 

With mild acne, comedones are low in number and breakouts are occasional. These lesions do not cause any swelling, redness, irritation or discomfort.

However, if not treated effectively, the oils can accumulate and increase the likelihood of bacteria multiplying. This leads to inflammation and the formation of raised, red bumps called papules. 

If the number of papules are few, this is still categorized as mild acne; however, if left unchecked these lesions will multiply in response to the bacteria, and skin will deteriorate to moderate or severe acne.  

Acne can develop almost anywhere on the body but is most strongly associated in those areas that have the highest concentration of oil-producing sebaceous glands. These areas include the forehead, nose, chin, shoulders and back.  

Mild acne vs. moderate acne

While mild acne can be recognized by the presence of comedones and several or no papules, moderate acne is associated with greater numbers of acne lesions, more inflammation and frequent breakouts over a widespread area.

Moderate acne manifests as papules, pustules, nodules. These are tender, pus-filled bumps that are accompanied by irritation, inflammation and redness. Moderate acne requires swift intervention to avoid or reduce the risk of developing severe acne and reducing the risk of scarring.

Causes of Mild Acne

Acne (no matter the severity) is instigated by the accumulation of sebum and dead skin cells within pores or skin follicles. This buildup can encourage acne-causing bacteria to proliferate and cause inflammation.

The scientific community has identified a number of causes that have been recognized as contributing to this buildup.

Comedogenic skin care products

Comedogenic substances are known to have an impact on acne development. These products have a tendency to block pores which can lead to breakouts.

In one small study examining the potential of cocoa butter to clog pores, researchers found a significantly larger number and greater size of microcomedones in participants who had applied the butter. 

Topping the list of substances to avoid are cocoa butter and beeswax, and oils such as coconut, avocado, almond and soybean.

Oily ingredients are not the only culprits when examining potential clog-inducing substances. Emulsifying agents found in cosmetics and facial washes are also responsible, and include hexadecyl, oleyl and isocetyl alcohol.

Diet

There are a plethora of studies that have examined the association between diet and acne. While studies can sometimes produce conflicting results, there is a general consensus that specific foods can bring on or aggravate existing acne. 

In one large study, results showed a strong correlation between whole milk, skim milk and acne development. Less so, but still relevant was cottage cheese and cream cheese. There is a general consensus that the hormones naturally present in milk trigger sebaceous gland activity.

Eating high glycemic foods can cause blood sugars to spike which releases a hormone called insulin. This hormone stimulates oil production and can increase the likelihood of acne breakouts. Another study examining patients with acne who followed a low glycemic diet had favorable results: decreased hormone levels and lesion counts. 

Foods considered high-glycemic include white bread, potatoes and white rice; breakfast cereals and bars; chips and pretzels; cakes and cookies.

Genetics

Many studies also support the theory that genetics play a role in acne development. In one large study of twins, 14% reported a history of acne; of these, researchers found 81% were due to genetic influences. Another study found that people who have acne after adolescence have a first-degree relative with the condition 50% of the time.

Looking at sebum production, a comparative study of identical and nonidentical twins found that identical twins had virtually the same sebum production; nonidentical twins had significantly  different rates.

All these studies confirm that genetics strongly influences acne. 

Hormones

Hormonal acne occurs when fluctuations in hormone levels spur acne flare-ups during puberty, pregnancy and menopause. Higher androgen levels (male sex hormones present in both men and women) can trigger excess sebum production, change skin cell activity and increase the presence of bacteria. 

Changes in hormones will therefore prompt intermittent acne flare-ups as levels fluctuate and then return to a balanced state. 

Stress 

It’s a well-known fact that stress can have a detrimental effect on the mind and body, and cause life-threatening damage or even death.  

When looking at the relationship between stress and acne, few studies have been performed, and for many, researchers do find a link but aren’t clear on its exact role. What has been established is that states of depression, anxiety and stress do not cause but instead worsen existing acne. 

One study examined psychological stress, sebum production and acne in adolescents. Researchers found a positive correlation between stress level and severity of acne but determined that sebum levels were not a factor. They concluded that other factors were at play but did not speculate as to which ones.

Another theory is that emotional stress impacts the gut-brain-skin axis which contributes to skin inflammation. Fluctuations in emotions cause a disturbance in the gut which promotes local and systemic inflammation.   

Can You Get Rid of Mild Acne?

Yes, you can get rid of mild acne. As every person responds differently, it may take some trial and error to find the treatment that works best for you. It is also important to use your treatment consistently and as directed to achieve optimal results. 

Over-the-Counter Treatments for Mild Acne

There is a wide range of over-the-counter (OTC) medicated skin care treatments for mild acne including face and body washes, creams, foams and gels. Choose a product that includes active ingredients to not only treat acne but to suit your skin type. 

Azelaic acid

Azelaic acid is a gentle yet powerful skin care ingredient that is an established acne treatment.  As an antibacterial agent, it can effectively kill acne-causing bacteria; through its keratolytic activity, it promotes skin cell turnover to maintain clear pores and prevent comedones from forming. 

For symptoms of mild inflammatory acne, azelaic acid’s anti-inflammatory properties can reduce the swelling, pain and redness that is often present.     

In contrast to many acne-fighting medications that can be harsh and overdrying, azelaic acid is gentle on skin and is typically well tolerated.

Benzoyl peroxide    

Benzoyl peroxide is the cornerstone of acne treatment as it has been proven very effective against acne. As an antibacterial, it can effectively kill P. acnes bacteria on the skin and within follicles; as a keratolytic, it can gently slough off dead skin cells, and break up and clear pores of comedones. Benzoyl peroxide is also effective in reducing excess oil production.

While beneficial for noninflammatory acne, benzoyl peroxide works particularly well for inflammatory acne: it targets the source of inflammation; reduces swelling, redness and irritation; and helps heal lesions.   

Benzoyl peroxide can be found in facial cleansers and foams; gels, creams and lotions. When choosing a product, opt for a low-strength concentration of 2.5% to determine how your skin reacts and to minimize the effects of dryness or irritation.  

Salicylic acid

Salicylic acid is a beta hydroxy acid and a natural compound that can effectively treat both inflammatory and noninflammatory mild acne. It is both an anti-inflammatory and antibacterial agent to target bacteria and the accompanying discomfort; it also exfoliates skin and maintains clear pores. 

In one study comparing benzoyl peroxide, retinoic acid and salicylic acid, researchers found that  salicylic acid demonstrated superiority as a keratolytic agent to address comedonal acne. 

Prescribed Treatments     

If OTC treatments are not effective against mild acne, there are several stronger prescription medications available that are known to be effective.

Mild inflammatory acne will respond well to topical antibiotics as they are formulated to kill the C. acnes bacteria responsible for inflammation. Retinol can also provide an anti-inflammatory effect as well as effectively clear blocked follicles of blackheads and whiteheads.

Lastly, professional treatments can work in tandem with medications to bring about greater results. These include LED light treatments and mild chemical peels.   

Antibiotics

Topical antibiotics are usually chosen for mild acne, as this route is typically adequate without having to resort to stronger systemic therapies that have greater side effects.

Two of the most widely prescribed antibiotics are erythromycin and clindamycin. Importantly, antibiotics are not customarily prescribed as monotherapy due to the development of bacterial resistance. As such, benzoyl peroxide or another agent would be included as a means of dual therapy.

Chemical peels

Chemical peels are usually included alongside other mild acne treatments for better outcomes and commonly use either alpha- or beta-hydroxy acids such as glycolic or salicylic acid. 

Both of these acids have antibacterial properties to effectively treat acne lesions. Both work to loosen the bonds of skin cells to effectively exfoliate, clear pores and prevent breakouts. 

In one small study, researchers found that both acids were equally effective, with salicylic acid having longer-lasting effects and fewer side effects.

Retinol

While retinoids are a mainstay of acne treatment due to their powerful exfoliating properties, they may be too potent for mild acne and cause dryness and irritation.

Retinol is a milder and more gentle form of retinol and is therefore more appropriate for mild acne symptoms. It also provides anti-inflammatory benefits. 

Unlike other exfoliants, retinol deeply penetrates the top layers of skin to stimulate collagen and elastin production. This not only unclog blocked pores, but helps smooth and strengthen skin. 

LED treatments

LED ( light-emitting diode) treatments can be used alongside OTC products or prescribed medications to achieve greater results. 

When looking at the various forms of light therapy, the strongest evidence supports the efficacy of blue light and combination blue-red light as having the greatest effect on mild acne lesions.

The longer wavelength or the red light can penetrate deeper into the skin to target sebaceous glands, and kill P. acnes bacteria; the blue light also provides the same anti-inflammatory effects but on the top layers of skin.

In one study of blue and red LED therapy for both noninflammatory and inflammatory acne,  researchers found improvements of 34% and 78%, respectively. They concluded that this therapy is safe, effective and non-painful. 

Natural Treatments for Mild Acne

Natural treatments can be used solely to treat mild acne or used in tandem with an OTC or prescribed medication. They can provide soothing relief to irritated, inflamed skin. And they also help restore lost moisture – which is often an unwanted side effect of acne treatments. 

At-home face masks

Face masks for mild acne work to draw oil and impurities from the skin’s surface, clear pores, reduce inflammation and gently exfoliate. DIY at-home face masks can not only treat existing acne but prevent future breakouts as well.

Cucumber mask

Both cucumber and aloe vera calm and soothe acne. Aloe vera is a rich moisturizer and a known acne-fighter due to its anti-inflammatory properties; mildly astringent cucumber can help clear skin or excess oils and tighten pores.  

Ingredients:

  • 2 tbsp aloe vera gel
  • 1/2 cucumber

Instructions:

  1. Puree cucumber in a blender
  2. Combine aloe vera gel and cucumber in a bowl
  3. Apply mixture  to your face, avoiding the eye area
  4. Allow to rest for about 30 minutes
  5. Gently wash off with lukewarm water

Other effective natural acne-fighting ingredients that can be used in a DIY face mask recipe: 

  • Tea tree oil has disinfectant and antibacterial properties to dry up and heal comedones 
  • Witch hazel unclogs pores, hydrates and balances pH 
  • Zinc can treat inflammatory acne by killing P. acnes bacteria

Lifestyle Changes

Making some lifestyle changes can go a long way in supporting your chosen method of acne treatment.

Diet has been linked to acne breakouts – notably sugary and high carbohydrate foods and dairy products. Eating these foods can cause a spike in blood sugar which causes an increase in insulin and triggers oil production.

Following a Mediterranean diet that focuses on whole foods, whole grains, fresh fruits and vegetables will help maintain healthy skin.

Adhering to a skin care regimen will also help keep mild acne at bay. Your skin will look its best when you choose skin care products that are designed for your skin type and condition. 

Lastly, it is important to stay consistent with your acne treatments and to allow time for them to show their effects.

Takeaway

Mild acne is characterized by minor, infrequent breakouts of comedones over a small area of skin. However, if left untreated, inflammatory papules could form when oils accumulate and bacteria multiply. 

Mild acne typically responds well to OTC products as well as natural at-home treatments. There are a wide range of products to choose from, and there are formulations for each skin type.  Lifestyle modifications such as changes to diet and a comprehensive skin care routine can help you achieve a clear complexion and healthier skin. 

For mild acne that fails to respond to OTC treatments, consult your doctor or dermatologist for treatment options tailored to your specific needs.

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