New Ideas to Treat your Acne from a Dermatologist
Are you frustrated with your acne?
Do you feel like your current acne treatment has stopped working — or never worked well enough in the first place?
There are different reasons why people get pimples. Maybe your acne isn’t “just” acne. You may actually 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 dermatology practice, patients with pimples usually have one of the following problems:
- Acne Vulgaris, the most common form of acne.
- Pityrosporum Folliculitis, which is also really common.
- Staphylococcal Folliculitis, which is really an infection.
- Gram Negative Folliculitis, which is an infection that happens because of acne-treatment medicines.
Telling which of these you might have 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. Here’s what you need to know:
How to tell if you have 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 like my Ultimate Acne Solutions Kit.
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.
How to tell if you have 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 blackheads. The pimples on the chest and back are really bright red, almost like a bug bite, and they either itch or both itch and hurt. 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, such as if you are an athlete or you are in a hot climate. That’s because this type of acne is due to an overgrowth of a normal skin yeast germ called Pityrosporum (also called Malassezia), 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.
Being on acne-treating medicines for a long time can predispose you to this type of acne, too.
You can have both acne vulgaris and Pityrosporum folliculitis together. That means you will have classic blackheads and pimples along with the bright red, itchy pimples and millions of the little flesh colored bumps that are closed and plugged pores. Yes, the body is amazing!
Obviously, treatment of “PF” needs something that will reduce the growth of the Pityrosporum yeast, and regular acne medicines don’t.
My favorite treatment for Pityrosporum folliculitis is pyrithione zinc in the form of soaps and cleansers.
Pityrosporum yeast love to flourish in clogged pores and to coexist with acne vulgaris. That means that it’s also important to use medicines that unclog the pores and treat acne.
Options include benzoyl peroxide, glycolic acid or salicylic acid. The products in my Ultimate Acne Solutions Kit plus the Calming Zinc and the Foaming Zinc cover all the bases for the face, back and chest, to treat Pityrosporum folliculitis.
How to tell if your pimples are due to Staphylococcal folliculitis or gram-negative folliculitis
These are skin infections and require prescription oral antibiotics that specifically kill these types of germs. You need to go to your doctor, ideally, someone specialized in treating skin problems such as a dermatologist.
Staph. folliculitis is caused by the staphylococcus bacteria that causes impetigo.
Over 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 such skin problem 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 a good job with antibiotics of killing the acne causing bacteria called P. acnes. When P. acnes is gone, the gram negative bacteria move into the pores and starts causing pimples.
I suspect this when a patient’s 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. And it’s one of the important 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.