How to get rid of severe acne without skin dryness?

Hello,

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I understand acne is frustrating. You have grade-four acne, cystic lesion, and nodules. The most effective treatment for grade-four acne is Isotretinoin (Accutane). Isotretinoin is a vitamin A derivative and works great in acne. It acts by shrinking the oil-producing glands. Grade- 4 acne, if not treated in time, will leave scars on the face. All acne medications are drying because, in acne, the main goal is to control oil production that leads to acne. Please consult your dermatologist regarding Isotretinoin pills. It is a long-term treatment. Let me give you some information regarding acne.

1. Acne is a disorder of the pilosebaceous unit, pilo-hair, and sebaceous- oil-producing gland. These pilosebaceous glands are densely distributed over the face, neck, chest, back, shoulder, and arms. It also has a genetic component, meaning the appearance and severity of acne depend on the parent's genes.

2. The sebaceous gland produces oil expelled through the duct, opening on the skin surface.

3. Oil flows freely onto the skin as long as this duct is intact. If there is any blockage in the duct, the oil cannot come out, then it starts irritating the surrounding skin and causes comedones (black and white heads).

4. Our skin has a harmless commensal bacteria called Propionibacterium acne (P acne). This bacteria acts on the oil collected inside and causes inflammation leading to red bumps, pustules, cysts, and nodules as it progresses. If acne is not treated on time, it will leave scars.

5. Hormones strongly affect acne; increased androgen hormone can cause thickening of the wall of the duct, leading to its blockage and causing comedones (black and white heads). PCOD/PCOS - Polycystic ovarian disease or syndrome is the most frequent hormonal disease causing acne in teenagers and adult women.

6. Environmental and external emotional factors: Hot and humid climate, causing increased sweat, can clog the pores. Applying oil, oil-based cosmetics, and steroid cream are other causes of acne. In addition, psychological stress is one of the important factors in acne.

I would suggest a few general acne skin care tips:

1. Facewash, wash your face with mild cleansers like Cetaphil (water, cetyl alcohol, propylene glycol) cleanser if your face is dry, or use Benzoyl peroxide face wash if your face is oily. Wash your face thrice daily to remove excess oil and dust accumulating overtime on the face.

2. Sunscreen, use a good sunscreen with SPF (sun protection factor) 50, and apply it to the whole face 30min before you step out, irrespective of the presence of sunlight. UV (ultraviolet) rays will always be there during day hours (even if cloudy). So apply every four hours for maximum benefits. This is because sunscreen can protect your skin from UV rays for four hours. Hence you need to repeat it every four hours. Always use non-comedogenic sunscreen.

3. Do not prick or squeeze the acne. It will leave dark pigmentation and scars, which are even more difficult to treat.

4. Regular physical exercise much essential to keep hormones under check. Exercise for at least 40 minutes a day, six days a week

5. No oil massage, avoid oil massage to the scalp. It will aggravate dandruff. If there is oil flow on the facial skin, it can clog the pores leading to comedones.

6. Vitamin and water, eat vitamin A-rich fruits and vegetables like papaya, mango, musk melon, pumpkin, carrot, and beetroot, these have beta carotene in them, which is a good antioxidant that are very much helpful for healthy skin. Drink two to three liters of water daily to keep the skin hydrated.

7. Cosmetics, always use water-based cosmetics, which have the “non-comedogenic” label on them.

8. Stress management, stress (mental as well as physical) causes acne breakouts. Meditation is very helpful for controlling mental stress.

9. No facial hair waxing, waxing irritates hair follicles and can aggravate pimples. However, threading to remove unwanted hairs over the face is fine. Threading does not affect acne.

10. Never use a steroid cream, steroid causes very bad acne. It makes the skin very thin and sensitive. Avoid over-the-counter (OTC) steroid creams like Betnovate (Betamethasone valerate) and Panderm (Clobetesol, Ofloxacin, Ornidazole).

I hope I have cleared all your doubts.

Thank you.