What are common myths and treatment options for acne?

Common Acne Myths

Myth: Acne is Caused by Dirt and Poor Hygiene

The belief that dirt buildup and poor hygiene cause acne is false—acne results from androgen-induced sebum production, altered keratinization, bacterial colonization, and inflammation, not from surface dirt. 1, 2

• Approximately 59% of adolescents incorrectly believe dirt buildup causes acne, and 60% believe poor hygiene is pathogenic 1
• Excessive washing and harsh scrubbing can actually worsen acne by increasing irritation 3
• Washing 2-3 times daily with mild, non-medicated soap is sufficient—more frequent washing provides no additional benefit 3
• The pathogenesis involves four key factors: androgen-induced increased sebum production, altered keratinization of the pilosebaceous unit, bacterial colonization by Cutibacterium acnes, and inflammatory response 2

Myth: Acne Cannot Be Treated with Medications

Acne is highly treatable with medications—approximately 50% of adolescents incorrectly believe acne cannot be treated medically, despite robust evidence for multiple effective therapies. 1

• Topical retinoids (tretinoin, adapalene, tazarotene, trifarotene) combined with benzoyl peroxide are first-line treatments for all acne severities 4, 5
• Tretinoin 0.025% gel as monotherapy reduced acne lesion counts by 63% at 12 weeks in clinical trials 6
• Oral antibiotics (doxycycline, minocycline) combined with topical retinoids and benzoyl peroxide reduce inflammatory lesions by 58% at 6 months 6
• Combined oral contraceptives reduce inflammatory lesions by 62% at 6 months in females 6, 5
• Isotretinoin is the most effective treatment, targeting all four pathogenic factors of acne 5, 2

Myth: Acne Only Affects Physical Appearance

Acne significantly impacts mental health—only 34% of adolescents recognize that acne can affect mental health, yet it is associated with increased rates of anxiety, depression, and suicidal ideation. 1, 6

• Depression, social isolation, and suicidal ideation are frequent comorbidities in acne patients 2
• Acne can cause permanent physical scarring that persists a lifetime and has long-lasting psychosocial effects 2
• The American Academy of Dermatology recommends evaluating quality of life impact and presence of scarring, as these factors warrant more aggressive treatment regardless of lesion count 5
• Acne with significant psychosocial burden is an indication for isotretinoin therapy, even if severity is moderate 5

Myth: You Can "Wash Away" Acne

Acne cannot be eliminated by washing—the disease originates deep within pilosebaceous follicles, and excessive washing may worsen the condition through increased irritation. 3, 2

• Acne involves the pilosebaceous follicles and interrelated processes occurring beneath the skin surface 6
• Tretinoin works deep inside the skin, and this process takes time—applying more frequently than once daily does not accelerate results but may increase irritation 3
• Excessive irritation from rubbing, too much washing, or use of harsh products may worsen acne 3
• Patients should avoid frequent washings, harsh scrubbing, astringents, toiletries containing alcohol or spices, and certain medicated soaps 3

Myth: Topical Antibiotics Alone Are Effective Treatment

Topical antibiotics should never be used as monotherapy—resistance develops rapidly without concurrent benzoyl peroxide, making this a critical treatment error. 5, 7

• The American Academy of Dermatology strongly advises against using topical antibiotics as monotherapy due to rapid resistance development 5
• Topical antibiotics (clindamycin, erythromycin) must always be combined with benzoyl peroxide to prevent bacterial resistance 5, 8
• Fixed-dose combination products (clindamycin 1%/benzoyl peroxide 5%) provide superior efficacy compared to either agent alone 5
• Systemic antibiotics should be limited to 3-4 months maximum and always used with benzoyl peroxide 5, 8

Myth: All Acne Treatments Work the Same Way

Different acne medications target distinct pathogenic factors—understanding this allows for rational combination therapy based on acne severity and type. 4, 6

• Topical retinoids address altered keratinization and microcomedones through comedolytic and anti-inflammatory properties 5
• Benzoyl peroxide provides antimicrobial activity by releasing free oxygen radicals, with no bacterial resistance reported 5
• Oral antibiotics reduce C. acnes colonization and provide anti-inflammatory effects 4
• Hormonal therapies (combined oral contraceptives, spironolactone) reduce androgen-induced sebum production in females 4, 5
• Isotretinoin is unique in targeting all four pathogenic factors simultaneously 5, 2

Myth: Acne Only Affects Teenagers

Acne affects approximately 50% of individuals aged 20-29 years and an increasing number of adult females, making it far from exclusively an adolescent disease. 6, 9

• Approximately 85% of individuals aged 12-24 years and 50% of those aged 20-29 years are affected by acne 6
• Adult female acne may persist from adolescence or have first occurrence in adulthood, often requiring different treatment approaches 9
• Adult female acne is characterized by chronic evolution with frequent relapses requiring long-term maintenance therapy 9
• The disease has greater negative impact on quality of life in adult females than in younger patients 9