Acne By The Numbers
There are certain numbers that make a big difference in your acne treatment success. These numbers tell you how much of a product is enough and how much is too much, or how long you need to wait to see results, or what you can reasonably expect from an acne treatment.
The cold hard facts probably aren’t exactly what you see in acne product advertising. Here are some of the most important numbers about common acne treatments.
Accutane in pill form eliminates, on average, 32% of cystic acne lesions during the first 30 days of use.
Accutane in micronized (very small particle) form eliminates, on average, 87% of cystic acne lesions during the first 30 days of use.
Antibiotics never cure acne. They can only kill acne bacteria, and it’s actually the immune system that causes the redness, swelling, and inflammation of pimples as part of its efforts to kill the bacteria inside them. Even dead acne bacteria, it turns out, can trigger acne inflammation. And because of the phenomenon of antibiotic resistance2, antibiotics are a lot less successful at controlling bacteria than most people think.
- Rifampin fails to kill3 17% of acne bacteria.
- Tetracycline fails to kill 35% of acne bacteria.
- Amoxycillin fails to kill 40% of acne bacteria.
- Clindamycin fails to kill 50% of acne bacteria.
- Erythromycin fails to kill 52% of acne bacteria.
- Neomycin fails to kill 80% of acne bacteria.
- Cloxacillin fails to kill 100% of acne bacteria.
And even antibiotics that work reasonably well can cause some serious cosmetic side effects. One such side effect is a condition known as “blue smile.” It is not really all that common, probably affecting just 1 in 100 users of the acne antibiotics that can cause it. Certain antibiotics can stain dental enamel black or blue at different stages of tooth development.
- Clindamycin can cause staining of the teeth as late as age 8.
- Minocycline can cause staining of the teeth as late as age 15.
- Tetracycline can cause staining of the teeth as late as age 22.
Benzoyl peroxide, also known as BP, is the most commonly used over-the-counter product for acne. Choosing the right strength of benzoyl peroxide, however, makes a huge difference in how well it works.
2.5% benzoyl peroxide is usually safe for application4 over your entire face, although it may not be strong enough to kill all your acne bacteria. This is a good concentration for use with an antibiotic, however.
5.0% benzoyl peroxide kills acne bacteria but causes unacceptable side effects in most people who use it to treat their entire faces. About 80% of people who use 5% benzoyl peroxide will stop using it because of itching, burning, redness, or flaking of the skin.
10% benzoyl peroxide is just too strong to use all over your face. It’s OK for direct application to pimples, however.
Everybody knows that chocolate makes your skin break out, right? It turns out that it isn’t the fat in chocolate that is the problem. The fat in chocolate actually reduces inflammation in your skin.
The problem in chocolate for acne sufferers is the chemical theobromine. This is the substance that makes you feel good when you eat chocolate, and it can also “excite” your skin. The more chocolate you eat, the more your skin breaks out. How much more?
According to a study conducted at the University of Miami:
- Eating just one 2-oz (56 gram) dark chocolate bar per week may not cause any additional blemishes.
- Eating two 2-oz (56 gram) dark chocolate bars per week may cause an additional 8 to 10 blemishes.
- Eating three 2-oz (56 gram) dark chocolate bars per week may cause up to 85 additional blemishes.
Acne treatment can cost a few dollars a month or it can cost a few thousand dollars a month—and the most expensive treatments never come with a money-back guarantee. Even worse, the most expensive treatments, whether they are skin care products or medical procedures, usually have to be repeated.(It isn’t an accident that expensive products and expensive procedures require multiple applications.) Here are some representative costs of acne treatment at different budget levels.
- About $8 a week if you just upgrade from bar soap to Neutrogena and start using benzoyl peroxide on pimples.
- About $15 a week if you use a complete acne treatment system like Exposed Skin Care.
- About $50 a week if you buy most of your acne treatment products at a department store cosmetics counter.
- About $100 a week if you see a dermatologist once every three months and your insurance doesn’t cover the cost of visits.
- About $200 a week for a year if you spend an hour a week with your aesthetician working on small acne scars or post-acne spots on the skin.
Hydroquinone is the world’s most popular skin lightener. Most people can use hydroquinone to remove brown spots from the skin with minimal side effects6, although lightening of the skin where it is not intended is a common problem. A few people, however, need to involve hydroquinone altogether.
2% hydroquinone creams probably won’t cause any problems unless you happen to a hereditary condition known as ochronosis.
4% hydroquinone creams can cause problems on black skin.
Zinc is an important anti-inflammatory agent7. It actually works by decreasing the activity of the immune system, reducing the amount of inflammation it generates against acne bacteria. A combination of zinc and antibiotics, however, can bring surprising relief.
- 5% zinc in a zinc-only cream brings significant control over acne infections. Zinc ascorbate is the form of zinc that works best in acne skin creams.
- 0.06% zinc in combination with clindamycin, erythromycin, or chloramphenicol has the same effect.
- Layton A. The use of isotretinoin in acne. DermatoEndocrinology. 2009;1(3):162-9.
- Adawiyah J., Priya G., Roshidah B. Oral Antibiotics in Acne Vulgaris: Therapeutic Response Over 5 Years. Malaysian Family Physician. 2010;5(3):130-3.
- Hassanzadeh P., Bahmani M., Mehrabani D. Bacterial resistance to antibiotics in acne vulgaris: an in vitro study. Indian Journal of Dermatology. 2008;53(3):122-4.
- Mills O.H. Jr., Kligman A.M., Pochi P., Comite H. Comparing 2.5%, 5%, and 10% benzoyl peroxide on inflammatory acne vulgaris. International Journal of Dermatology. 1986;25(10):664-7.
- Vongraviopap S., Asawanonda P. Dark chocolate exacerbates acne. International Journal of Dermatology. 2016;55(5):587-91.
- Hydroquinone [CAS 123-31-9]: Supporting Information for Toxicological Evaluation by the National Toxicology Program. U.S. Food & Drug Administration – Department of Health and Human Services. 2009.
- Brandt S. The clinical effects of zinc as a topical or oral agent on the clinical response and pathophysiologic mechanisms of acne: a systematic review of the literature. Journal of Drugs in Dermatology. 2013;12(5):542-5.
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