Misperceptions about acne's causative and aggravating factors are common, and those affected by it are often blamed for their condition.[176] Such blame can worsen the affected person's sense of self-esteem.[176] Until the 20th century, even among dermatologists, the list of causes was believed to include excessive sexual thoughts and masturbation.[165] Dermatology's association with sexually transmitted infections, especially syphilis, contributed to the stigma.[165]

Cortisone is a quick fix for acne emergencies. We mean got a big board meeting tomorrow kind of quick. Go into the dermatologist’s office for a shot of this corticosteroid, and acne will disappear in 24 to 48 hours. The treatment works to curb inflammation, which makes it best for cystic breakouts and can be really good at combatting hormonal flare-ups. If done incorrectly, a cortisone shot can leave a small depression in the skin that lasts about eight weeks. “It’s a rare side effect that happens if dosage of cortisone is too high,” explains Linkner. “You want to go to someone who knows what they’re doing.”


C. acnes also provokes skin inflammation by altering the fatty composition of oily sebum.[45] Oxidation of the lipid squalene by C. acnes is of particular importance. Squalene oxidation activates NF-κB (a protein complex) and consequently increases IL-1α levels.[45] Additionally, squalene oxidation leads to increased activity of the 5-lipoxygenase enzyme responsible for conversion of arachidonic acid to leukotriene B4 (LTB4).[45] LTB4 promotes skin inflammation by acting on the peroxisome proliferator-activated receptor alpha (PPARα) protein.[45] PPARα increases activity of activator protein 1 (AP-1) and NF-κB, thereby leading to the recruitment of inflammatory T cells.[45] The inflammatory properties of C. acnes can be further explained by the bacterium's ability to convert sebum triglycerides to pro-inflammatory free fatty acids via secretion of the enzyme lipase.[45] These free fatty acids spur production of cathelicidin, HBD1, and HBD2, thus leading to further inflammation.[45]
Antibiotics. These work by killing excess skin bacteria and reducing redness. For the first few months of treatment, you may use both a retinoid and an antibiotic, with the antibiotic applied in the morning and the retinoid in the evening. The antibiotics are often combined with benzoyl peroxide to reduce the likelihood of developing antibiotic resistance. Examples include clindamycin with benzoyl peroxide (Benzaclin, Duac, Acanya) and erythromycin with benzoyl peroxide (Benzamycin). Topical antibiotics alone aren't recommended.
Pimples are raised red spots with a white center that develop when blocked hair follicles become inflamed or infected with bacteria. Blockages and inflammation that develop deep inside hair follicles produce cystlike lumps beneath the surface of your skin. Other pores in your skin, which are the openings of the sweat glands, aren't usually involved in acne.
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