Acne: Causes, Treatments, and Effective Management Strategies - Dermatology

Acne issues!

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Hello: I started developing acne in the sixth grade, and I am still experiencing it now.
I think genetic factors might be the main reason because my mother also had a face full of acne when she was young, and I probably inherited her "excellent" genes, resulting in my own face blooming with acne.
However, it wasn't until early this year that I began to seriously address this issue, so I started gathering relevant medical information online and browsing related books in bookstores.
I realized that my previous methods for fighting acne were incorrect.
From what I understand, to treat acne, it is essential to find a trustworthy dermatologist and undergo a patient treatment plan for at least six months to see results.
The formation of acne can be attributed to three main causes: (1) abnormal keratinization of the skin follicles leading to clogged pores, preventing sebum from being expelled and causing comedones; (2) abnormal secretion of excess sebum by the sebaceous glands; (3) weakened skin antibacterial capacity, allowing acne bacteria to invade the follicles as soon as comedones form.
But why does healthy skin suddenly exhibit these three symptoms? From what I know, there are many reasons, including individual constitution, diet, lifestyle habits, and environmental factors.
The process of acne formation, based on the information I've seen, begins with the skin entering a phase of excessive sebum production.
If the follicular sebaceous duct undergoes excessive keratinization, it can lead to a mixture of sebum and shed epithelial cells accumulating at the follicular opening, forming comedones.
Subsequently, comedones act like ticking time bombs; although they may not be visible to the naked eye, any bacterial invasion can cause immediate inflammation in the affected follicles, as comedones provide a breeding ground for acne bacteria.
Therefore, "reducing" comedones seems to be the urgent priority in treating acne.
My current goal is to address this issue from four main aspects: (1) preventing excessive keratinization of the skin to ensure that the follicles are not blocked by too much dead skin; (2) preventing the sebaceous glands from secreting excessive amounts of sebum (though I am not confident in this area); (3) maintaining skin cleanliness to avoid the accumulation of excess sebum and dirt on the face; (4) enhancing the skin's antibacterial capacity to prevent existing comedones from easily becoming inflamed.
Thus, I underwent a three-phase acne treatment at a hospital in Hsinchu: Phase One: primarily oral medications such as antibiotics to control sebum secretion, along with topical clindamycin (Clindagel) to enhance the skin's antibacterial capacity.
Phase Two: continuing with oral antibiotics and using topical tretinoin (third-generation retinoid) to thoroughly improve follicular conditions and normalize metabolism while also helping to expel existing comedones.
Phase Three: proper sun protection and using whitening agents for the treatment of post-acne pigmentation to remove acne scars.
I am currently in Phase Two and feel that the results are quite good.
However, every time I ask my doctor questions during my visits, she seems to respond hurriedly, making me feel like she is impatient (perhaps her practice is too busy), which has made me hesitant to ask her further questions, so I have come to you for help! These questions will assist me in my future acne-fighting techniques!
Questions:
(1) The doctor told me that once I complete all three phases of treatment, if I want to maintain the results, I should regularly use tretinoin or products with a concentration of 15% or higher of alpha hydroxy acids.
What are your thoughts on this?
(2) I read that due to the maturation of the sexual glands during puberty, stimulated by androgens, the secretion of sebum increases and can sometimes be as thick as "cream." Is this true?
(3) If my follicular keratin metabolism is normal, does that mean that even if there is excessive sebum secretion, as long as I maintain good cleanliness, the follicles will not become clogged and form comedones?
(4) Besides improving the differentiation of epithelial cells on the skin follicles to reduce comedones, does tretinoin also have a controlling effect on the sebaceous glands to prevent excessive sebum secretion?
(5) Is inflammation of the follicles always associated with the presence of comedones? If the follicles are metabolically normal and there are no comedones, can they still become inflamed due to poor antibacterial capacity if bacteria invade?
(6) This question follows up on the previous one.
I often wonder about my brother's face.
He is naturally beautiful and almost never has acne, but because of this, he is more relaxed with his diet and does not clean his skin as thoroughly as I do, resulting in many small comedones on his face.
However, although his face is full of comedones, very few of them develop into folliculitis, while I have significantly fewer comedones but they easily progress to folliculitis, leaving behind many acne scars.
If comedones are the primary cause of follicular inflammation, why do my brother and I have such different situations? Is it a matter of metabolic capacity or the "antibacterial capacity" I keep mentioning?

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Zheng, 20~29 year old female. Ask Date: 2002/06/26