What is acne (acne vulgaris)?
Acne (acne vulgaris) is a chronic skin disease caused by clogged pores, proliferation of acne bacteria, and inflammation. It is not just a problem for adolescents; it is a very common condition, with over half of women experiencing "adult acne" after their 20s.
If left untreated, believing it "will heal eventually," acne scars (scarring, hyperpigmentation) can remain, and treating them is more difficult than treating the acne itself, making early intervention crucial. Modern acne treatments have greatly advanced, and many people can regain clear skin with appropriate topical and oral medications.
Self-care and over-the-counter medications have limitations.
Many cases worsen due to excessive washing, insufficient moisturizing, or ineffective over-the-counter medications. Prescription medications (adapalene, benzoyl peroxide, etc.) from medical institutions are far more effective than over-the-counter drugs and are covered by insurance.
Mechanism of Acne Formation
Acne occurs when the following four factors overlap:
- Excessive sebum secretion (hormones, stress, genetics)
- Clogged pores (keratinization abnormality blocking pores)
- Proliferation of acne bacteria (multiplying in an anaerobic environment using sebum as nutrients)
- Inflammation (immune response to acne bacteria)
Types and Stages of Acne
| Stage | Name | Appearance | Inflammation |
|---|---|---|---|
| 1 | Microcomedone | Invisible early stage | None |
| 2 | Whitehead (closed comedone) | Small, white to skin-colored bumps | None |
| 3 | Blackhead (open comedone) | Dark center with open pore | None |
| 4 | Red pimple (papule) | Red, raised, painful | Present |
| 5 | Pustule | Yellowish-white pus at the tip | Present (strong) |
| 6 | Cyst/Nodule | Large, deep red swelling, high risk of scarring | Present (deep) |
Treat acne at the whitehead/blackhead stage.
The best time for treatment is at the comedone (white or blackhead) stage, before inflammation occurs. If it progresses to red pimples, the risk of scarring increases. We recommend seeking medical attention as soon as you notice small bumps.
Acne Severity Classification
| Severity | Criteria | Primary Treatment |
|---|---|---|
| Mild | 5 or fewer inflammatory lesions on one side of the face | Mainly topical medication |
| Moderate | 6-20 inflammatory lesions on one side | Topical + oral antibiotics |
| Severe | 21-50 inflammatory lesions on one side | Topical + oral + isotretinoin consideration |
| Very Severe | Accompanied by cysts/nodules, scarring in progress | Referral to a specialist institution + isotretinoin |
Characteristics and Causes of Adult Acne
Adult acne, which occurs after the age of 20, has different characteristics than adolescent acne.
- Often on the chin, around the mouth, and along the jawline (U-zone)
- Difficult to cure and prone to recurrence
- Often worsens before menstruation
- Worsened by stress, lack of sleep, and irregular eating habits
- Hormonal imbalance involved (PCOS, stress-related)
Aggravating Factors for Adult Acne
- Hormonal imbalance (menstruation, pregnancy, birth control changes, etc.)
- Stress and lack of sleep
- Excessive intake of high-GI foods and dairy products
- Irritation from cosmetics and skincare products
- Skin dryness (excessive washing, insufficient moisturizing)
- Humidity and friction from masks (maskne)
- Drug-induced (e.g., steroids, lithium)
Treatment Options
Topical Medications (Daily Basic Treatment)
| Drug | Characteristics/Action |
|---|---|
| Adapalene (Differin) | Retinoid that unclogs pores, effective from the comedone stage |
| Benzoyl Peroxide (BPO) | Antiseptic and角質剥離 (exfoliating) action, effective for inflammatory acne, no resistance |
| Adapalene + Benzoyl Peroxide (Epiduo) | Combined drug, provides both effects in one product |
| Benzoyl Peroxide + Clindamycin (Duac) | Anti-inflammatory + antiseptic + antibiotic |
| Clindamycin (Dalacin T Gel) | Topical antibiotic, for inflammatory acne |
| Nadifloxacin (Acnuam) | Topical antibiotic |
| Sulfur/Salicylic Acid based | For mild cases/as an adjunct |
Adapalene and benzoyl peroxide may cause irritation initially.
During the first 1-2 weeks, redness, peeling, and dryness may occur. This is often a sign that the medication is working, and most people get used to it and improve within about 2 weeks. The trick is to start with a small amount once a night, while moisturizing sufficiently.
Oral Medications
| Drug | Usage Scenario |
|---|---|
| Vibramycin (Doxycycline) | Moderate inflammatory acne, 2-3 months |
| Minomycin (Minocycline) | Alternative, be careful of hyperpigmentation as a side effect |
| Roxithromycin | Macrolide, when tetracyclines are contraindicated |
| Tranexamic Acid | Prevention of post-inflammatory hyperpigmentation |
| Herbal Medicine (Jumi Haidoku-to, Seijo Boko-to, Keishi Bukuryo-gan) | Constitutional improvement, adjunctive |
| Low-dose birth control pills (LEP/OC) | Effective for menstrual-related adult acne |
| Isotretinoin (self-pay) | For severe/refractory cases, referral to a specialist institution |
Oral antibiotics are generally used for about 3 months.
Long-term use of antibiotics carries a risk of antibiotic resistance, so use is generally recommended for within 3 months. Combining them with topical medications (especially benzoyl peroxide) can help prevent resistance.
Other Treatments
- Comedone extraction (not covered by insurance): Removal of contents from large whiteheads/blackheads
- Chemical peeling (self-pay): Glycolic acid, etc.
- Sulfur camphor lotion
- Dermaroller/Fractional laser (scar treatment, specialist institution)
Dealing with Acne Scars
Acne scars are largely divided into three types, each with a different treatment approach.
| Type | Appearance | Primary Treatment |
|---|---|---|
| Post-inflammatory hyperpigmentation (PIH) | Brown marks, improve over time | Oral tranexamic acid, topical hydroquinone, sunscreen, natural resolution in several months to 1 year |
| Post-inflammatory erythema | Red marks | Natural resolution in several months, sunscreen, vascular laser (specialist institution) |
| Scars (craters) | Uneven texture, deep marks | Fractional laser/dermaroller (specialist institution, self-pay) |
Preventing scarring is the best prevention.
Once crater-like scars form, treatment is difficult, so early treatment of the acne itself to prevent scarring is the best prevention. Start treatment at the red pimple stage.
Basics of Proper Skincare
Cleansing
- Twice a day (morning and night), lather generously with a foaming net and wash gently.
- Rinse thoroughly with lukewarm water.
- Do not scrub or wash too frequently (this can lead to excessive sebum secretion).
- After washing, gently pat dry with a towel.
Moisturizing
- Even with acne-prone skin, moisturizing is essential (dryness can actually increase sebum secretion).
- Use non-comedogenic products with low oil and high water content.
- Lotions and emulsions containing ceramides and hyaluronic acid.
- Avoid oil-based products as they can clog pores.
Sunscreen
- Especially during acne treatment, UV light can worsen hyperpigmentation, so it's essential.
- Choose non-comedogenic, low-oil formulas.
- SPF 30 or higher, PA++ or higher daily.
Makeup
- If possible, use mineral foundation and non-comedogenic products.
- Cleanse early after returning home.
- Keep makeup tools (brushes, sponges) clean.
Acne Countermeasures in Lifestyle Habits
Diet
- Limit high-GI foods (white rice, bread, sugar).
- Avoid excessive intake of dairy products (especially skim milk).
- Eat a balanced diet of vegetables, fish, soy, and fermented foods.
- Be mindful of vitamin B group, zinc, and dietary fiber.
- Drink more than 1.5L of water per day.
"Chocolate = acne" is a misconception.
There is no established evidence that chocolate or fried foods directly cause acne. High-GI foods (foods that rapidly raise blood sugar) are considered to have a stronger correlation. Extreme dietary restrictions are unnecessary, but limit refined sugars and sweet beverages.
Lifestyle Habits
- Sleep 7 hours or more, go to bed by 11 PM.
- Promote metabolism with moderate exercise.
- Manage stress (yoga, deep breathing, hobbies).
- Wash pillowcases and towels frequently.
- Keep hair off the face.
Actions to Avoid That Worsen Acne
What not to do
Many cases worsen due to self-treatment. Please avoid the following:
- Popping pimples (spreads inflammation, causes scarring)
- Touching or picking with fingernails
- Washing face multiple times a day
- Using alcohol sanitizer on the face
- Daily use of strong scrubs/peels
- Neglecting moisturizing
- Trying multiple over-the-counter medications/supplements
- Applying topical steroids to acne (worsens it)
Characteristics of Our Clinic's Acne Treatment
- Treatment for mild to moderate cases centered around topical medications (adapalene, benzoyl peroxide).
- For moderate or severe cases, rapid improvement with a combination of oral antibiotics + topical treatments.
- Low-dose birth control pills can also be prescribed for menstrual-related adult acne.
- Concomitant use of herbal medicines (Jumi Haidoku-to, Keishi Bukuryo-gan, etc.) depending on constitution.
- Guidance on tranexamic acid and sunscreen for hyperpigmentation.
- For severe cases and cases with scarring, referral to a specialist dermatology institution (isotretinoin, laser treatment).
- Thorough guidance on skincare and lifestyle habits.
- No appointment needed, same-day visits OK / Open daily 9 AM - 9 PM / 1 minute walk from Jujo Station.
Acne can always be improved with treatment.
Acne is a medical skin condition that requires treatment. Don't suffer alone; please consult us before scars remain. Early treatment can significantly reduce future skin problems.
