Written by: Dennis A Porto MD (@daporteaux)
1. People with acne have poor hygiene
Acne is not related to hygiene. Acne is a disorder in the keratinization of the skin. Keratinization is the process by which skin cells mature as they move from deep within the skin to the skin’s surface. People with acne have abnormal keratinization that leads to the presence of comedones (also known as black heads and white heads).
It is true that some of these comedones may become infected by bacteria, forming pustules. Antibiotics and antibacterial soaps are used to treat this, but realize that if there weren’t comedones to infect in the first place than you wouldn’t be getting pustules at all, regardless of hygiene. This is why retinoids like Accutane and Retin-A work: they aren’t antibiotics but instead prevent comedone formation by normalizing keratinization.
2. Squeezing my acne helps lesions disappear faster
It seems simple: you squeeze all the gross pus out of a pimple it will heal quicker, right? Unfortunately, you are only seeing what is happening on the skin’s surface. Underneath the top layer of the skin, you are squeezing pus deeper into the skin causing more redness, inflammation, and possibly spreading an infection that could take weeks to resolve. In addition, by manipulating acne, you risk creating scars and the dreaded light and dark spots left behind even after the acne disappears. I frequently see patients who complain about their “acne” although the only things I can identify are excoriations from manipulation of acne that has long since resolved. Resist the temptation to manipulate your acne.
3. Acne is just a cosmetic problem and I’ll grow out of it
This is a common misconception among young men. They view acne as purely cosmetic and feel that treating their acne isn’t masculine. The truth is, however, that by not treating acne you risk permanent scarring even if you eventually do “grow out of it.” Acne is a real medical problem with both medical and psychological impacts on quality of life. Treating it aggressively and early is your best bet to both healthy and cosmetically pleasing skin.
4. Medical treatment of acne is unnatural. I prefer instead to use natural cactus apricot scrubs, tea tree oil, and drink free range kale kombucha
There are many patients who are suspicious of medical treatment as “unnatural” and look to alternative medicine remedies instead. First off, the term “natural” is meaningless. Arsenic and lead are natural, for example, but you would never treat your acne with these. Second, there is no such thing as “alternative medicine.” There is only medicine that has evidence to support its use and medicine that does not yet have evidence to support its use. Physicians happily integrate “natural” remedies into their practices when they are backed by evidence. A good example is the adoption of fish oil to treat high cholesterol: there is good evidence that this works and so doctors are eager to accept it. However, in the context of acne, the best treatments are those that have been around for years: retinoids, antibiotics, and benzoyl peroxide.
5. My acne is better so I can quit my medication
Actually, your acne is better because you are on medication. However, it is true that when dermatologists prescribe things like oral antibiotics, they typically aren’t used long term. Even when these oral medicines are discontinued, however, it is important to be diligent about washing with your benzoyl peroxide and applying your topical retinoid. This prevents acne from forming in the first place and thereby prevents you from having to restart oral medication.