P. acnes also provokes skin inflammation by altering the fatty composition of oily sebum.[44] Oxidation of the lipid squalene by P. acnes is of particular importance. Squalene oxidation activates NF-κB (a protein complex) and consequently increases IL-1α levels.[44] Additionally, squalene oxidation leads to increased activity of the 5-lipoxygenase enzyme responsible for conversion of arachidonic acid to leukotriene B4 (LTB4).[44] LTB4 promotes skin inflammation by acting on the peroxisome proliferator-activated receptor alpha (PPARα) protein.[44] PPARα increases activity of activator protein 1 (AP-1) and NF-κB, thereby leading to the recruitment of inflammatory T cells.[44] The inflammatory properties of P. acnes can be further explained by the bacterium's ability to convert sebum triglycerides to pro-inflammatory free fatty acids via secretion of the enzyme lipase.[44] These free fatty acids spur production of cathelicidin, HBD1, and HBD2, thus leading to further inflammation.[44]
Considerations: Side effects are generally mild and short lived. Most common, in 1-5% of people are itching, burning, stinging, and tingling. Other side effects were reported in less than 1% of people. There have been a few reports from darker skinned people of lightening of the skin. Azelaic acid has not been well studied in people with dark complexions.1
If even a trace of sodium lauryl sulfate is left on the skin for more than an hour, however, the upper layer of living skin cells is irritated and dies. Tiny flakes of skin make the texture of the skin look uneven, and they can clog pores. The scent of sodium lauryl sulfate also causes your nose and tongue to be less sensitive to sweet tastes and their associated odors, so you will crave sugar.
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Diet. Studies indicate that certain dietary factors, including skim milk and carbohydrate-rich foods — such as bread, bagels and chips — may worsen acne. Chocolate has long been suspected of making acne worse. A small study of 14 men with acne showed that eating chocolate was related to a worsening of symptoms. Further study is needed to examine why this happens and whether people with acne would benefit from following specific dietary restrictions.
This inflammatory cascade typically leads to the formation of inflammatory acne lesions, including papules, infected pustules, or nodules.[1] If the inflammatory reaction is severe, the follicle can break into the deeper layers of the dermis and subcutaneous tissue and cause the formation of deep nodules.[1][66][67] Involvement of AP-1 in the aforementioned inflammatory cascade leads to activation of matrix metalloproteinases, which contribute to local tissue destruction and scar formation.[44]

Unfortunately, the vast majority of acne products are formulated incorrectly and/or made with cheap ingredients. Even dermatologists get it wrong and you shouldn’t assume that a treatment system is good for you just because dermatologists or celebrities say so online. They are most likely paid for their testimonial. Instead, make an effort to find out what the actual users of the products are saying. Amazon is a great place to start.

According to Dr. Bailey, it’s not enough to have a facial cleanser designed for acne-prone skin. Half the battle is properly washing your face. Here’s what she recommends: “First, wet your face with warm water, then lather your cleanser over all of your facial skin. Depending on your skin type, you can use your fingers, an exfoliating cloth or a sonic skin-cleansing brush system. Rinse well with warm water to remove the lather entirely. Some of the important acne cleanser ingredients will stay behind, but the cleanser’s foaming agents, as well as built-up oil, dead cells, products and bacteria, will be rinsed off of your skin.”


Postinflammatory hyperpigmentation (PIH) is usually the result of nodular acne lesions. These lesions often leave behind an inflamed darkened mark after the original acne lesion has resolved. This inflammation stimulates specialized pigment-producing skin cells (known as melanocytes) to produce more melanin pigment which leads to the skin's darkened appearance.[34] People with darker skin color are more frequently affected by this condition.[35] Pigmented scar is a common term used for PIH, but is misleading as it suggests the color change is permanent. Often, PIH can be prevented by avoiding any aggravation of the nodule, and can fade with time. However, untreated PIH can last for months, years, or even be permanent if deeper layers of skin are affected.[36] Even minimal skin exposure to the sun's ultraviolet rays can sustain hyperpigmentation.[34] Daily use of SPF 15 or higher sunscreen can minimize such a risk.[36]


There are two big guns used to take down acne, and they're both great at doing entirely different things. Salicylic acid is a beta hydroxy acid that comes from willow bark and works primarily as an exfoliator, breaking down fatty acids like sebum so your pores don’t clog. (Glycolic acid works similarly but is less effective.) These acids do their thing on comedones — whiteheads, blackheads, and other non-red bumps.

Before you can find the best acne treatment for you, you have to know what type of skin you have. It’s also good to understand how your skin reacts to different weather conditions and foods that you may eat. Most people don’t realize that the skin is your body’s largest organ. It’s complex and is designed to encase and protect your body and all of your vital organs.
Scars (permanent): People who get acne cysts and nodules often see scars when the acne clears. You can prevent these scars. Be sure to see a dermatologist for treatment if you get acne early — between 8 and 12 years old. If someone in your family had acne cysts and nodules, you also should see a dermatologist if you get acne. Treating acne before cysts and nodules appear can prevent scars.
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