The Journey to Clear Skin: Sarah’s Acne Story

Part 1: The Skincare Basics of Acne Treatment

LInda_Cropped_HeadShot_2017We are introducing an exciting blog series called “The Journey to Clear Skin: Sarah’s Acne Story,” where one of my wonderful staff Sarah Chehab will be my guest blogger once a month. Here, Sarah will be sharing her acne journey with you, along with lots of skincare pearls along the way.

As everyone knows, acne is probably the most common skin condition I treat as a dermatologist. Not an hour goes by during my work week without my having to help a patient with acne. And unbeknownst to the lovely insurance companies who are reluctant to adequately cover the acne medicines, treatments, or office visits for a patient, acne can plague every age, ethnicity, and skin type, female or male. It is not at all simply a teenage annoyance. And not everyone “grows out of it” either. I am a prime example of middle-age cystic acne. If I didn’t use my prescription acne medications daily and consistently, my acne would be persistent and the scarring may be permanent. Plus the kicker is that I never, ever had any problems with acne until my forties. Yay for middle age! Unfortunately, my acne story is not an uncommon one. Let’s learn about acne, shall we?


Introducing Sarah and her blog series “The Journey to Clear Skin: Sarah’s Acne Story.”


Sarah_HeadShot_2017_edited-2Dr. Honet sees patients regularly for acne, and believe it or not, these individuals are not always your typical teenagers experiencing a physical and hormonal milestone. Dermatologists are now seeing a growing number of acne in middle-aged adults, especially in women. It is truly remarkable to witness the level of confidence one may gain when their acne has improved.

I had struggled with nodulocystic acne for much of my adolescence, that eventually continued to early adulthood and to now. It’s frustrating, I know. So, I decided to make a change. Not only did I want to clear up my acne, I sought to improve the overall appearance, texture, and health of my skin and eventually reverse and prevent any scarring and damage I had acquired.

Like many individuals, I’ve had my fair share in the sun, and of course I did so without any sunscreen. I would somehow tell myself that my red, inflamed, aching skin was actually going to be a healthy road to a beautiful tan. Times have definitely changed since I started working at HDC, because let’s face it, I got sucked into the wonderful world of skincare and healthier skin. I believe achieving healthier skin comes down to three things—commitment, compliance, and most importantly, patience. With that being said, I now find myself completing an 8-month long cycle of isotretinoin, or more commonly and commercially known as Accutane.

Acne is an interesting disease of the skin because often the general public views acne as a rite of passage. Dr. Honet sees acne patients every day, and a week doesn’t go by without her seeing a young kid whose acne has already caused irreparable damage to the skin. If only that kid’s parents had brought him in sooner. Not that it is hopeless, because more damage can be prevented once the acne is adequately controlled. But once the damage is done, scarring can be a challenge to reverse, and the treatment for the scarring that has already happened, which now is a cosmetic concern, can get very expensive.

Yes, most teenagers will get a pimple or two, but when the acne causes permanent damage like pitted scarring and uneven pigmentation, it can be emotionally and psychologically damaging, so much so that self-esteem and social confidence can be irreparably compromised. When acne is causing permanent scarring, is unremitting, and affects the psyche, it is no longer a rite of passage. Often, these young people will resort to buying every over-the-counter acne medication in hopes of “curing” their acne, when they should be actually seeking professional help from a dermatologist early on in the game. In fact, a 2011 statistic showed that Americans spent nearly $400 million on OTC acne medication. Wow! I can’t even imagine how much money is spent today in 2017.

Believe it or not, acne is a skin condition in which many factors can interplay and affect acne and its severity. There are five main factors that affect acne. They are genetics, hormones, oil-gland activity, inflammation, and bacteria. Since naturally, the genetics component cannot be altered, the treatment approach for acne deals with the four others. From antibiotics to retinoids, the key is to find the ideal treatment regimen for a particular patient, but remember, most of the best acne treatments are only available by prescription. That’s where a visit to your friendly board-certified dermatologist like Dr. Honet may mean the world of difference and the fastest path to clearer and unblemished skin.

Over the last few years, I have tried a combination of topical and oral medications to help manage the severity and frequency of my breakouts before committing to isotretinoin. And over the next few months, I will discuss the various treatment options available for acne. But today, let’s talk about the basics of skincare and acne treatment.

The Basic Acne Skincare Regimen

No matter what medications are prescribed for you, a basic and consistent skincare regimen is absolutely essential. I know that everyone feels like there are days when you’re just too tired or too busy and end up skipping steps. But this is a big, big mistake. Believe me, I know. I get it. But the basics are the fundamental building blocks to maintaining healthier skin. I use over-the-counter products, specifically Cetaphil cleansers and CeraVe moisturizers or any of a number of cosmeceutical skincare products we sell in the office. Whatever you use, just remember that consistency and compliance are key. So here’s the basic skincare regimen for everyone, no matter whether you have acne or not, but especially important for those of you who do struggle with acne:

  • Cleanse with a gentle cleanser twice a day, every day. Yes, twice a day! Whether your cleanser is a medicated one prescribed and recommended by your dermatologist, or one you found yourself and love, the twice-a-day cleansing is so very important.
  • Moisturize twice a day. I know it sounds counterintuitive, especially for us oilier-skinned girls and guys, but when you moisturize, you normalize your skin hydration so that your skin doesn’t have to work so hard at the process of acne healing. Believe it or not, if you strip your skin too much of its natural oils, no matter how oily it is, it will overcompensate by making more oil. This is not a good situation when you’re actually trying to get rid of your acne and suppress the activity of your oil glands. There are so many oil-free, specially-formulated moisturizers for oily skin. Also, here at HDC, we have several we can recommend to you.
  • Never, ever skip your acne medications, especially if your skin is doing great. We often see this happen, where a patient is doing so great that she or he stops the medications, topical or oral or both. This is a huge mistake. Remember, your skin is clear and healthy because you’re using your “stuff.” If you stop, the acne is going to start creeping back and showing up on your skin again. Dr. Honet is always talking about how some patients with hypertension think that because their blood pressure has become normal, that they either don’t have hypertension anymore or they stop their medication. And then surprise—their blood pressure is high again! So much for not having hypertension anymore.
  • Over-the-counter treatments can help, but often they aren’t the complete answer. Over-the-counter (OTC) treatments are numerous and often the sheer numbers can be overwhelming and confusing, but many of them can be helpful. Active ingredients like benzoyl peroxide, salicylic acid, and glycol acid are somewhat effective in suppressing bacteria and oil production. Such acne treatments from companies like Neutrogena®, Clean & Clear®, and Proactiv® can be great at improving mild, non-scarring acne.The key word here is mild. The problem is that often people will wait too long to seek professional care when the acne is moderate to severe and is scarring. Attempting a short trial of OTC treatment is okay as long as it is short and the acne is not scarring or worsening despite OTC treatments. Remember acne is a dynamic, fluctuating skin disease, responding and reacting to a multitude of factors, like environment, hormones, medications, makeup, and even diet. Also, sometimes what once worked well for you won’t necessarily stay effective anymore. Seeing a dermatologist on the earlier side not only means intervening before the damage to your skin sets in, but also can prevent the condition from worsening.
  • Be patient with the treatment course. I know how frustrating acne can be and how depressing it can be to see another zit pop out on your skin, but any treatment regimen will take time and effort on your part. There really isn’t a magic potion or pill that will work overnight. Just as your acne took a long while to appear and get worse, it will take a good amount of time to clear your skin, too. Plus, some patients require more time and may need regimen tweaking to get the perfect balance for their skin.

According to the American Academy of Dermatology, anyone’s acne can be treated, no matter how severe. The standard acne regimens are usually extremely effective in many of the patients we see. And like I mentioned before, some of the most important keys to success is having and maintaining commitment, compliance, and most importantly, patience during the course of treatment. Plus, you have to really, really want clearer skin, because the work to get there can be hard and challenging. And finally, when the standard treatments fail to clear the skin, some patients, including myself, need extra help and will need treatment with isotretinoin. In the coming months, I will continue “Sarah’s Acne Story,” where Dr. Honet and I will discuss about the standard prescription medications and other various treatment options available for improving skin health and clearing acne.

Happy, Healthy Skin!

–Sarah and Dr. H

The Journey to Clear Skin: Sarah’s Acne Story