“What is an acne remover?”

When starting a new acne treatment, many patients go through a period where their acne gets worse instead of better. This has come to be widely known as the “acne removal process”. Many people believe that “acne suction” is necessary to bring the acne deeper to the surface of the skin to eventually “eliminate” them out to get rid of the acne once and for all. They feel that this “removal” is actually a necessary part of the acne healing process.

Some patients are even encouraged when they experience an early period of worse after starting a new acne treatment because they feel that they are finally removing the underlying acne skin waiting for a chance to flare up. broadcast.

But what is really happen? Is it true that “bleaching” is a necessary part of an effective treatment or is this just a myth? Why do some people experience this initial breakout of acne when starting a new treatment?

Let’s start by taking a closer look at the widely held belief that pimples are hidden below the surface of the skin just waiting for an opportunity to rise to the surface where they will eventually emerge. This is the first misconception that needs to be debunked.

While it is true that acne formation can occur deep within the acne pore, there are many steps that cause or are ultimately the development of acne. Fully formed acne is Not lies below the surface of the skin waiting to break through in a “bleach”. The reality is that acne-prone pores can be very susceptible to certain acne treatments that can cause pores to become inflamed and trigger various steps that cause acne.

For example, some topical acne medications work deep inside the pore and change the way the pore works. Some can alter the growth of cells that line the inside of pores. Others can affect the growth of bacteria in the pores. These changes, along with other changes that acne medications can cause, have the potential to activate pores in a way that causes more acne to develop.

So, it is incorrect to believe that “exfoliation” is a necessary step in the acne treatment process to “bring acne, dirt, and debris to the surface of the skin” where they are ultimately eliminated. The truth is that we really don’t know the exact cause of so-called “acne”. It’s also important to understand that we don’t really know all of the ways that different acne medications work on acne-prone pores.

This makes it even more difficult to predict which treatments are more likely to trigger an initial purge. Furthermore, different patients may respond differently to each drug; some may “bleach” while others may not.

What acne treatments can cause acne to “recur?”

So what treatments can cause “acne?” As it turns out, a variety of acne treatments have been linked to early stages of increased acne breakouts. The culprits include both topical and oral medications. Some of the most popular include:







Isotretinoin (Accutane)

Birth control pills


Spironolactone is an oral tablet used by acne specialists to treat acne in women. It is especially helpful for women who experience “hormonal acne,” in which breakouts tend to appear along the face and jawline and tend to worsen with the menstrual cycle. .

Hormonal acne also tends to be resistant to many other acne treatments. Although it is uncommon for spironolactone to cause acne initially, we have seen it occur in a small number of female patients at the start of spironolactone treatment. In our experience, this “purification” period with spironolactone often does not improve with continued treatment, necessitating discontinuation of spironolactone and switching to an alternative treatment.


Isotretinoin, more widely known by the brand name Accutane, is known to cause worse acne in some patients, often shortly after starting treatment. It is estimated that 10% to 20% of patients will experience an increase in acne when starting Accutane.

Often referred to as “the Accutane purge”, the reality is that we really don’t know the real reason this happened. The presence of some markers such as prominent pores can sometimes be helpful in determining which patients may be at higher risk of being “purged”, but this is not well documented.

If not addressed immediately, the “Accutane removal” process can become very serious and can lead to very large cystic acne and scarring. Sometimes patients require treatment with an additional medication to end the inflammation if it becomes too severe. Close monitoring at the start of treatment with Accutane is important to be able to recognize early signs of deterioration for prompt intervention.

Oral contraceptives (Contraceptives):

Certain types of oral contraceptives (OCPs) can be very helpful in treating acne in women. Combination birth control pills are often the most acne-friendly option. The combination pills contain both the hormones estrogen (female) and progestin (male).

OCPs that contain only one progestin can make acne worse. Some types of progestin are worse than others for causing acne. Gynecologists will know which birth control pill is best for each patient, especially when used to treat acne. Some OCPs are even FDA-approved as acne treatments, such as Yaz, Ortho Tri-Cyclen, Estrostep Fe, and Beyaz. They can work to offset the unwanted effects of acne hormones and thus help improve acne.

Starting or stopping treatment with birth control pills can upset the hormone balance and lead to acne breakouts. It is not uncommon for a woman who has taken OCPs for many years to experience a flare-up of acne when OCP treatment is stopped. The same thing can happen for some women when starting a new OCP regimen. This type of flare can be difficult to control, often requiring more aggressive treatment.

Other medications can also cause “acne.”

Several other medications are known to cause acne in some patients. For example, lithium is an important drug used to treat bipolar disorder and can sometimes lead to acne. In addition, patients taking anticonvulsants such as barbiturates and anticonvulsants may develop acne as a side effect. While stopping these medications will help clear up acne, this is not an option because these medications are essential to controlling these conditions.

However, other cases of drug-induced acne are not associated with medically necessary medications. For example, bodybuilders taking androgenic steroids to build muscle can often experience significant breakouts, often associated with very large and cystic acne. Additionally, DHEA, a hormone sometimes used as an anti-aging treatment, can also lead to breakouts. Women undergoing hormone replacement therapy are also known to sometimes develop acne as a side effect of their hormone treatment.

In general, acne caused by medications or hormones can be very difficult to treat. Many patients depend on their medication to control their condition and cannot stop taking it. The appropriate treatment for these patients will depend on their individual circumstances.

Other causes of “acne”

While most people think of “acne” as something that is only caused by acne medications, there can be other causes of acne flare-ups. One of the most common reasons for acne to “break out” is due to emotional stress. For example, students who are under stress during an academic exam or who experience a stressful work environment or experience a stressful life event can often experience increased acne breakouts.

Another common scenario that can trigger a breakout is when someone moves to another city. The body is always on full alert to navigate in new environments, which can be a source of significant internal stress that may go unnoticed. At Advanced Acne Clinic, it’s not uncommon to see a patient with new breakouts after moving from another city.

How does stress cause acne to “break out?”

Emotional stress is often cited as a cause of increased acne. Anecdotally, it is not uncommon to see students in the middle of midterm or final exams experiencing both emotional stress and breakouts.

In addition, stressful life events or emotional circumstances may be associated with a higher tendency to acne. While there is some evidence to support a link between emotional stress and acne (1), we don’t have all the answers yet.

Some researchers believe that emotional stress can trigger the production of stress hormones in the body, which can, for example, cause an increase in testosterone, which may be an important cause of acne ( 2). Although the evidence is early, some have suggested that behavioral interventions such as biofeedback may help reduce stress and help calm acne.

How to reduce the risk of developing “acne”

Many patients prepare themselves for what they feel is the inevitable “bleaching process,” which seems to them a necessary and inevitable part of the acne healing process. Some patients are actually encouraged when their skin starts to break out more because they feel that this is a sign that their acne treatment is working by “pushing the acne deeper to the surface”. ” so that their skin is finally acne-free. This belief, however, needs some evaluation.

First of all, we already know that ‘cystic acne’ is not caused by ‘pushing fully formed acne up’ and that different medications and treatments have different effects on acne-prone pores. can lead to the early stages getting worse. We often don’t understand all the mechanisms that cause acne to get worse during treatment. However, there are ways to minimize the possibility of being “bleached”.

At the Advanced Acne Institute, when using a topical medication such as tretinoin or adapalene or another topical medication (particularly in the retinoid family), one way we try to minimize the possibility of “clearing” is Start treatment very slowly at first. For example, applying the medication every two or three days until the skin adapts to the slightly harsh effects of therapy can be helpful in preventing breakouts. It is only after the skin has acclimatized to the new therapy that the frequency of application is gradually increased as tolerated. Alternatively, starting with a low dose of the drug might be another helpful option we might recommend.

Another helpful tip we often recommend to our patients is to combine a harsh treatment with an effective moisturizer that can be applied prior to prescribing. This helps to soothe the skin and maintain optimal moisture levels which can help fight irritations that may develop. Staying hydrated is one of the key ways we strive to help reduce irritation and trigger breakouts.

The same considerations are important to minimize the likelihood of developing an acne flare-up when treating acne by mouth. For example, most dermatologists start using Accutane at a low dose at the start of treatment, in part to reduce the risk of flare-ups significantly. Careful follow-up by a dermatologist is also important to recognize the beginning of an “Accumane clearance” so that appropriate changes can be made such as reducing the dose or temporarily stopping treatment or even adding another medication if needed to help reverse the initial breakout.

Advanced Acne Treatment Institute is a unique dermatology facility located in Miami, Florida that specializes solely in the treatment of acne. We only focus on providing the most effective treatments to help our patients achieve clear, glowing skin. We are happy to share our insights and views on acne treatment as an educational service, however this information is provided for educational purposes only and should not be considered advice. medical care and is not a substitute for seeking advice and treatment by an appropriate medical professional.


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