My acne journey and the mistakes I made.

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Hey guys,
How are you all doing?

Today I wanted to talk about my Acne journey, all the mistakes I made and what I could have done differently. Hope it enlightens and helps you guys :)
Also I want to mention that I am in no way saying that anyone struggling with acne is not beautiful or attractive. Any hardship that comes your way be it big or small only makes you stronger as a person. Love to all the people with acne <3

So, I started having acne when I was in 6th grade and I didn't get the occassional pimple here and there, I had full blown acne with pustules and scars and all. I went to the dermatologist and he prescribed me medicine, I took it and it didn't get better immediately so I stopped and started trying different totkas (home remedies) and face washes and other commercial acne products, basically whatever other poeple said worked for them, i tried it. It still didn't get better, so I went to a different doctor, he gave me a different, stronger medicine and i took it, but the acne got worse so i stopped taking the medicine, then another went to another doctor and the acne got better so I stopped the medication and it started all over again. This went on throughout my highschool, college and into my Med school life. By this time I was really psychologically disturbed, I remember crying in my prayers for the acne to stop.
Finally, my prayers were answered about a decade later when I came to my 3rd year in med school and had to take dermatology as a subject.  Thats when i learned what acne is, what happens to your skin and body under the surface and how I should have handled my treatement.

So,

WHAT IS ACNE?

80% of people living in developed countries suffer from acne at some stage in their lives and still most of us don't know what it really is.

"Acne lesions develop from the sebaceous glands associated with hair follicles: face, back, chest and anogenital area" (Reference: Rachael Morris-Jones, FRCP, PhD, PCME (ed.) ABC of dermatology sixth edition by John Wiley & Sons, Ltd;2014)

Now, sebaceous glands are in simple words, oil producing glands and they are present in many parts of the body but acne only develops in the oil glands that have hair follicles in them.

A quick anatomy of sebaceous gland:
Taken from: https://www.bioalternatives.com/en/acne-vulgaris-symptoms-treatments/

I added two more labels to the above picture

So basically,
"The main changes in acne include 
• thickening of the keratin lining and subsequent obstruction of the sebaceous duct resulting in closed comedones (‘whiteheads’) or open comedones (‘blackheads’ whose colour is due to melanin, not dirt)"
 (Reference: Rachael Morris-Jones, FRCP, PhD, PCME (ed.) ABC of dermatology sixth edition by John Wiley & Sons, Ltd;2014)

WHITE HEADS/CLOSED COMEDONES

Keratin is, simply put, the outer most layer of the skin which in a healthy skin does not cover the skin pores. In acne, due to various reasons (which I'm not discussing in this article) the keratin cells start multiplying and cover the pore, now the oil/ sebum which is still being produced by the sebaceous glands inside the skin pore starts collecting inside, this is when a white head/closed comedone forms.
(Reference: Rachael Morris-Jones, FRCP, PhD, PCME (ed.) ABC of dermatology sixth edition by John Wiley & Sons, Ltd;2014)

BLACK HEADS/OPEN COMEDONES

Black heads form when there is excess production of oil/sebum by the sebaceous gland but there's no keratin layer covering the pore hence it is called an open comedone.
These are commonly called black heads due to their black appearance which is because of melanin (pigment in the skin) and not dirt.



Now white heads and black heads are not inflammatory because there's no infection in them.
When a bacteria called Propionibacterium acnes is present in the white or black heads, the body attacks the bacteria and an inflammatory reaction happens which casuses redness, swelling pain and pus thus forming, what we call in common language, a pimple.

so remember the first step in the formation of acne is comedones/black or white heads and we need to put a stop right here.

Now finally,

HOW TO TREAT ACNE?

excuse my handwriting please :)

Now to ideally you would want to stop this process at the comdeones stage.
For that doctors normally prescribe the following:

1. Topical retinoids

"Topical retinoids are vitamin A derivatives that are anti-inflammatory and comedolytic."
 (Reference: Rachael Morris-Jones, FRCP, PhD, PCME (ed.) ABC of dermatology sixth edition by John Wiley & Sons, Ltd;2014)
Meaning of Comedolytic : Drugs that break up comedones and open clogged pores. 
(reference: https://medical-dictionary.thefreedictionary.com/comedolytic)

2. Topical acids 

Like azaelic acid and salicylic acids these are also comedolytic. 

3. Benzoyl peroxide

"Benzoyl peroxide has been available for the treatment of acne for many years; it has bacteriostatic effects against P. acnes and is mildly comedolytic. It is available with or without prescription at concentrations ranging from 1% to 10% in numerous formulations including lotions, creams, gels and washes."
 (Reference: Rachael Morris-Jones, FRCP, PhD, PCME (ed.) ABC of dermatology sixth edition by John Wiley & Sons, Ltd;2014)


I do want to mention that if you have very mild acne you may not need medication at all and a good cleanser will work for you.

Now coming to the mistakes I made,

FIRST MISTAKE 

When you start taking these medications initially you break out because the pores open up and all the collected sebum opens up to the bacteria present in the environment. This is a major cause of withrdrawal from treatment. Hence you should couple these medicines with a topical antibiotic and patience ;) (i know that a pimple brings so much anxiety along side it but you have to wait, because it WILL get better). Let the medicine do it's work. It will take some time depending on your skin type and the extent of the disease for the medicines to work.

SECOND MISTAKE

As soon as I saw a little difference I stopped the medication. DO NOT do that untill your doctor advises you. These medicines take time because you need to let your skin adjust to this new routine of not producing too much keratin. 
Also, if the causative factors are still present, you willllll break out again and you need to discuss the underlying cause of your acne with your doctor.

THIRD MISTAKE

These medicines will dry out your skin and cause flakiness. therefore add a water based moisturizer to your routine. Oily skin DOES NOT mean you don't need moisture. 

FOURTH MISTAKE 

Use of the wrong cosmetic products. 
If you have dry/sensitive skin, use creams or if you can tolerate oil based products. If you have oily skin, use gels or water based products.
Do not overload your skin with products. Keep it simple, use a good cleanser, stick to your drug regimen and finally moisturize your skin.

FIFTH MISTAKE 

Not everyone needs oral retinoids(accutane) or oral antibiotics. You have to give topical medications a full chance. If they fail even after you have stuck to the regimen and your doctor decides to start you on oral medication, only then you should do it. You have to keep in mind that There is an over prescription of Retinoids (esp. in Pakistan). I have a 16 year old cousin who has very mild acne and was started on oral retinoids by her doctor at her first visit.

SIXTH MISTAKE 

Changing doctors because the drugs don't work immediately or cause you breakouts initially. 

FINAL WORD

Although I am a doctor, i am not a specialist, these are just some of the things that helped me through my journey. Therefore, please DO CONSULT A DERMATOLOGIST before using any product on your skin since every skin type is different. Secondly, I have not talked about oral medication prescribed for acne because for the most part the mistakes are the same.
I have also not talked about my journey of taking oral retinoids(accutane), yes I did take them because i was non compliant and did not give my topical medication a full chance and got to the extent where my acne left permanent scars on the skin.

I hope this helped you. 
If you want me to talk about my retinoid journey or anything else in detail, you are most welcome to comment or DM me on my instagram page. I'd be more than happy to help. 

Live life, have Fun and give love to everyone and anyone. <3

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