Common reasons why your acne treatment might not be working; new ideas to treat your acne from a Der

Cynthia Bailey, MD|February 21, 2010
BeatingHeadAgainstWallAre youfrustrated with your acne? Do you feel like your ‘beating your head against the wall’ with your current acne treatment? There are different reasons why people get pimples. It may be that you have one of the less common reasons for pimples.  Getting the right diagnosis and adding a specialized treatment medicine may finally clear up your acne. In my practice, patients with pimples usually have one of the following problems:
  1. Acne Vulgaris, the most common form of acne
  2. Pityrosporum Folliculitis, which is also really common
  3. Staph. Folliculitis, which is really an infection
  4. Gram Negative Folliculitis, which happens because of acne treatment medicines
This sounds really complicated, but it’s actually not. The important point is that if you have one of the ‘folliculitis’ acne conditions, you need different treatment to clear up your pimples. If you think you have one of these forms of acne, talk with your doctor about getting the right treatment.  What you need to know: Acne Vulgaris This is the most common reason for pimples and it's what we all think of as acne.  People with acne vulgaris have both blackheads and pimples, usually around the nose, cheeks and chin as well as the forehead.  The pimples may gradually spread to the neck and back.  As this form of acne worsens, the pimples and blackheads get bigger and more numerous.  In this type of acne the skin is usually really oily. Acne vulgaris responds to the standard acne treatments.  Topical acne treatment products aim to unclog the blackheads in the pores and kill the acne causing germ p. acnes. If over the counter products don’t work, doctors add stronger prescription products and oral  antibiotics that basically do the same thing.  Really bad cases of acne vulgaris may be treated with the powerful drug Accutane. Pityrosporum Folliculitis Pimples and clogged pores happen with this form of acne too, but they are in different areas of your skin and they look different than in acne vulgaris. The pimples and clogged pores usually start on the forehead, the nose and along the jaw line.  There are often little pimples on the neck at the hairline and in the little indentation below the ear.  They also happen on the chest and back. The key points are that there are often millions of little pimples and clogged pores on the forehead and many of the clogged pores are covered over by skin instead of open like blackheadsThe pimples on the chest and back are really bright red almost like a bug bite and they either itch or are really tender.  There may even be pimples or dandruff on the scalp. You’re more prone to this type of acne if you or your family members have a history of allergies or asthma.  You’re also more likely to get pityrosporum folliculitis if you’re often really sweaty, like if you're an athlete or you live in a hot climate.  That’s because this type of acne is due to an overgrowth of normal skin yeast germ called pityrosporum and the germ grows really well on sweaty, oily skin in predisposed people. We all have this yeast germ in the pores on our face and upper body.  Sweating and having a genetic predisposition (people with allergies and asthma) promotes the growth of the yeast, which then causes the pimples and clogged pores. Obviously, treatment needs to kill the yeast and regular acne medicines don’t.  My favorite treatment for pityrosporum folliculitis is pyrithione zinc in the form of soaps and cleansers. I like the Calming Zinc Bar Soap for the face and the Foaming Zinc Cleanser for the back, neck, chest and scalp.  It’s also important to use medicines that unclog the pores such as benzoyl peroxide, glycolic acid or salicylic acid.  My Acne Skin Care Kits for the face and the back include these ingredients. Staph Folliculitis and Gram-negative Folliculitis These are skin infections and require prescription oral antibiotics that specifically kill these types of germs. Staph. folliculitis is caused by the staphylococcus bacteria that causes impetigo.  25% of everyone you know carries this germ on their body.  Most of the time it doesn’t cause any problems, but it can.  One of the skin problems looks like acne with pimples and white heads.  This can occur anywhere on the body, including the usual acne vulgaris places on the face and back.  Any break in the skin including injuries, or your acne lesions, can become infected with staph.  When pimples become infected with staph. they get really big and are much more sever than normal. Regular acne treatments don’t work against staph.  Your doctor needs to do a culture of your pimples (a test for the bacteria) to tell if you have a staph. infection and then prescribe the correct antibiotic.  Ask them to do this if you’re not getting better on your acne treatment. Gram negative folliculitis is the strangest of all these conditions.  It happens when doctors do such a good job of killing the p. acnes bacteria with topical or oral antibiotics that this germ moves into the pores and starts causing pimples.  What I see in patients with this problem is that their pimples (not their blackheads) all of a sudden get really bad in spite of being on antibiotics. The gram negative germ is not killed with the acne antibiotics and needs to be treated by different types of antibiotics that we don’t usually use to treat acne.  This is one of the most common reasons that acne patients come to see me after being treated by another doctor.  It’s easy to fix if you know to look for it.  It’s one of the reasons I try to get my acne patients off both oral and topical antibiotics as soon as possible. Remember, this information is intended to be educational, giving you a better understanding of the range of acne problems that affect the skin so that you can have a valuable discussion with your doctor of skin care professional.  It isn’t intended to give a specific diagnosis or treatment for your skin problem. If you found this post helpful, you may also like to read: Dermatologist's Tips for Dry Flaky Skin on Your Face and Scalp Photo attribution: Elaine with Gray Cats / CC BY-SA 2.0

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