Dealing with Persistent Acne: When to See a Dermatologist?

Acne issues

Hello, doctor.
My skin is generally neutral; it tends to be slightly dry in winter and slightly oily in summer, and it is somewhat sensitive.
For many years, I have had a small number of persistent acne lesions (fewer than ten), which have also left some post-inflammatory hyperpigmentation.
Given this situation, do I need to see a dermatologist, or can I use over-the-counter acne creams on my own? Could you recommend which ingredients are suitable for self-care? Additionally, some skincare products are labeled as non-comedogenic.
Could you please explain this term? Thank you!

Xin Xin, 30~39 year old female. Ask Date: 2000/11/17

Dr. Zheng Lizhen reply Dermatology

If the number of acne lesions is not significant and the inflammation is mild, it may be sufficient to use topical medications.
However, this does not mean that seeing a dermatologist is unnecessary! The physician can adjust the treatment based on the current condition and provide consultations.
Additionally, medications may be covered by health insurance, making it more cost-effective than DIY treatments.
At home, you can use products containing alpha hydroxy acids (AHAs), retinoids (such as tretinoin, retinol, or retinaldehyde), or salicylic acid to reduce the formation of acne and comedones.
Products labeled as "non-comedogenic" indicate that they will not cause open or closed comedones, but "comedogenicity" is a complex result and not solely dependent on individual ingredients.
A product that does not contain the listed "comedogenic" ingredients does not guarantee that it won't cause acne, and conversely, products containing comedogenic ingredients may not necessarily lead to breakouts.
Therefore, whether a product will cause comedones can only be assessed based on the individual's propensity to form comedones and the concentration of "comedogenic" agents in the product.
Additionally, not having comedones does not mean one will not develop acne! "Acnegenicity" is a separate consideration! (Note: Substances that may cause comedones include: Butyl Stearate, Cocoa Butter, Corn Oil, D&C Red Dyes, Decyl Oleate, Isopropyl Palmitate, Isocetyl Stearate, Lanolin, Linseed Oil, Mineral Oil, Olive Oil, Oleic Acid, Peanut Oil, Petrolatum, Sesame Oil, Stearic Acid, etc.)

Reply Date: 2000/11/17

More Info

Dealing with persistent acne can be frustrating, especially when it affects your self-esteem and overall skin health. Based on your description, it seems that you have a mild but persistent case of acne, which has left some post-inflammatory hyperpigmentation (dark spots) on your skin. Given that your skin is sensitive and you experience variations in oiliness depending on the season, it is advisable to consider a few factors before deciding whether to see a dermatologist or to manage the condition on your own.

When to See a Dermatologist
1. Severity and Persistence: If your acne has been persistent for several years and is not responding to over-the-counter treatments, it may be time to consult a dermatologist. They can provide a more tailored treatment plan that may include prescription medications, topical treatments, or even procedures like chemical peels or laser therapy.

2. Skin Sensitivity: Since you mentioned that your skin is sensitive, a dermatologist can help identify any underlying issues that may be exacerbating your acne. They can also recommend products that are less likely to irritate your skin.

3. Post-Inflammatory Hyperpigmentation: If the dark spots left by your acne are bothersome, a dermatologist can suggest treatments to help fade these spots, such as topical retinoids, hydroquinone, or laser treatments.

4. Self-Care Limitations: If you find that over-the-counter products are not effective or if you are unsure about which products to use, a dermatologist can guide you in selecting the right skincare regimen.

Over-the-Counter Treatments
If you decide to manage your acne on your own initially, there are several active ingredients commonly found in over-the-counter acne treatments that you might consider:
1. Benzoyl Peroxide: This ingredient helps to kill acne-causing bacteria and can reduce inflammation. It is effective for mild to moderate acne.

2. Salicylic Acid: This beta hydroxy acid helps to exfoliate the skin and unclog pores. It is particularly beneficial for oily skin types.

3. Retinoids: Over-the-counter retinoids like adapalene can help promote cell turnover and prevent clogged pores. They are effective for both acne treatment and reducing hyperpigmentation.

4. Niacinamide: This ingredient is known for its anti-inflammatory properties and can help reduce redness and irritation associated with acne.

Non-Comedogenic Products
You mentioned products labeled as "non-comedogenic." This term indicates that the product is formulated to not clog pores, which is crucial for acne-prone skin. When choosing skincare products, look for those that are oil-free and specifically labeled as non-comedogenic. Ingredients like glycerin and hyaluronic acid are often safe for acne-prone skin as they provide hydration without clogging pores.

Conclusion
In summary, while you may start with over-the-counter treatments, it is essential to monitor your skin's response. If you notice that your acne persists or worsens, or if you have concerns about your skin's sensitivity or the appearance of dark spots, seeking a dermatologist's advice would be beneficial. They can provide a comprehensive evaluation and a personalized treatment plan that addresses both your acne and any associated skin concerns. Remember, managing acne is often a process that requires patience and the right approach tailored to your skin type and condition.

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