The Four Main Causes of Acne
For those who suffer from acne, the skin's natural rhythm of oil production and sloughing of dead skin cells is not in balance, as it is for those with healthy skin. Four principle factors have been identified:

1. Follicular keratinization – Acne sufferers tend to have abnormally "sticky" skin cells. Because of this, dead skin cells do not slough or shed as they should and instead plug the hair follicle. This leads to a build-up of oil.
2. Excess sebum production – Many acne sufferers have overactive sebaceous glands. This causes the production of greater quantities of sebum than is common.
3. Colonization of Propionibacterium acnes (P. acnes) – The skin environment of some individuals tends to be more hospitable to P. acnes, the bacteria that cause acne lesions.
4. Inflammation – Each of the three scenarios above may cause inflammation. When inflammation occurs, the acne condition worsens and may lead to scarring.

While these factors can individually contribute to the development of acne, most often they work together. The most common scenario is this: The overactive production of oil and presence of abnormally "sticky" cells cause the hair follicle to plug, thus promoting the growth of P. acnes. The obstructed follicle, engorged with sebum and dead skin cells, becomes visible at the surface of the skin in the form of a white papule (whitehead). If the follicle continues to dilate, the plug becomes further exposed and, due to the oxidation of its contents, the papule appears a dark color (blackhead). At this point, the follicle becomes the ideal environment for bacteria. As the bacteria release proteins (enzymes), inflammation occurs as characterized by a reddened appearance at the skin's surface. The sebum is then converted to free fatty acids that attract white blood cells to the area and further the inflammation. This is when pustules begin to form.

Effective Ingredients in Acne Treatment
What follows are some of the over-the-counter substances that are beneficial in the fight against acne. While none of them address all four causes of acne alone, ingredients such as these may be combined in a single formulation or within product families to offer a complete solution to control symptoms and help regulate the factors that cause the disease.

Ingredients To Address Follicular Keratinization

• Retinyl Propionate – Retinoids, a form of vitamin A, have long been used successfully in acne treatments. In fact, tretinoin, an acid form of vitamin A, is one of the most prescribed acne remedies today. In over-the-counter skin care products, retinol, the alcohol form of vitamin A, is often used.
• Glycolic Acid – Glycolic acid is the smallest, molecularly, of all the alpha hydroxy acids and can, therefore, penetrate between cells to loosen dead skin, remove build-up inside the hair follicle, and open clogged pores, comedones and other impactions in oily areas. Continued use helps keep dead skin cells from accumulating on the follicle wall, thus preventing inflammatory acne lesions.
• Salicylic Acid – Salicylic acid, a beta hydroxy acid, works as a keratolytic agent. By opening clogged pores, salicylic acid helps to reestablish the normal skin cell replacement cycle. It is further beneficial due to its antimicrobial and antiseptic properties.

Ingredients To Address Excess Sebum Production

• Zinc Pyrithione – An antibacterial and antifungal agent, zinc pyrithione works to stop the growth of certain bacterium on the skin, including P. acnes. It also helps to regulate sebum secretion.
• Sulfur – One of only a handful of over-the-counter acne treatments to secure FDA approval, sulfur is among the oldest medicines in use. In the treatment of acne, it reduces oil gland activity and dissolves the skin's surface layer of dry, dead cells. Additionally, it inhibits the growth of P. acnes.
• Niacinamide – Also known as vitamin B3, niacinamide decreases triglyceride production in the sebaceous glands. Studies have backed its ability to reduce sebum excretion rates and casual sebum levels.² Additionally, niacinamide is a potent anti-inflammatory.

Ingredients To Address Colonization Of P. Acnes

• Benzoyl Peroxide – A potent antiseptic and oxidating agent, benzoyl peroxide is one of the most commonly used ingredients in the treatment of acne. It is effective at eliminating P. acnes and reduces the quantity of comedones. Benzoyl peroxide does not promote antibacterial resistance, as can happen with the use of prescription antibiotics.
• Eucalyptus Oil – The most versatile essential oil in nature, eucalyptus oil has been used for sinus relief, sore throats, as a topical antiseptic for skin injuries and as an inhalant for asthma and other respiratory conditions. It is proven effective in the treatment of acne due to its antiseptic properties, which inhibit the growth of P. acnes.³
• Tea Tree Oil – Extracted from the leaves of the Australian Melaleuca Alternafolia tree, topical application of tea tree oil helps to reduce bacteria on the skin, lessens inflammation and generally improves the symptoms of acne. In a study comparing tea tree oil to the use of benzoyl peroxide, improvements were achieved among patients in both groups, while those using tea tree oil reported fewer side effects.⁴

Ingredients To Address Inflammation

• Aloe Vera – A plethora of research exists to demonstrate aloe vera's potent anti-inflammatory abilities. Of the more than 200 active components in aloe, it contains salicylic acid and sterols, both of which work to inhibit inflammation. Aloe also has antimicrobial properties that are beneficial in controlling P. acnes.
• Arnica – Commonly referred to as "Leopard's Bane," the arnica flower has been used in homeopathic medicine for hundreds of years. Arnica features anti-inflammatory and antibacterial properties, and aids in the healing of topical skin wounds.
• Bisabolol – An oil derived from chamomile, bisabolol has anti-inflammatory properties and is effective in reducing the potential for acne scarring.

Resources:
1 American Academy of Dermatology. Acne. http://www.aad.org/public/publications/pamphlets/common_acne.html; Updated November, 2009.
2 Draelos Z, Matsubara A, Smiles K. The effect of 2% niacinamide on facial sebum production. Jour Cos Laser Ther. 2006; 8(2):96-101.
3 Takahasi T, Kokubo R, Sakaino M. Antimicrobial activities of eucalyptus leaf extracts and flavonoids from Eucalyptus maculata. Lett App Microbio. 2004; 39(1):60-64.
4 Bassett IB, Pannowitz DL, Barnetson RS. A comparative study of tea-tree oil versus benzoyl peroxide in the treatment of acne. Med J Aust. 1990; 153(8):455-8.

Dr. Ahmed Abdullah is CEO and founder of Lexli International, Inc. and formulator of the company's Lexli® line of professional aloe-based skincare products. A board-certified plastic/reconstructive surgeon and a leading aloe researcher, Abdullah is a recognized expert on the restorative and medicinal effects of aloe vera. In fact, he is a pioneer in the use of pharmaceutical-grade aloe in surgical applications, a practice that is growing in popularity.

ATZEN, Inc.
The ATZEN, Inc. line, PURIFY™, features the acne fighting Clear Serum - Calm and Clear™. The concentrated serum addresses the damage acne causes to dermis and epidermis: scars, redness, enlarged pores, breakouts, and premature aging. The serum also helps prevent scars and discoloration. 800-830-1491 or www.atzen.com

BiON
BiON's Acne Control Kit follows a three step system to kill the bacteria, reduce sebum production and reduce inflammation. The Acne Control Kit for Oily, Combination or Normal skin types includes: Antibacterial Cleanser, Salicylic Glycolic Gel, Green Tea/Clay Poultice and Moisture Complex. 877-715-2466 or www.bionresearch.com.

Circadia by Dr. Pugliese
A Cleansing Gel with Salicyclic Acid is a clear foaming cleanser that is gentle enough to be used in a daily routine. The fast-acting formulation provides exfoliation and deep pore cleansing without disturbing the skin's protective barrier. This product is ideal for teens and adults struggling with oily/acne prone skin. 800-640-4710, www.circadia.com or CRR# 140

Edimi Skin & Body Care™
The pores of the skin have several functions, including breathing, detoxing and penetration. None of these duties will perform efficiently and effectively unless the pores are 'reamed out' as far into the deepest layers as possible. Deep Pore Cleanser by Edimi Skin & Body Care™ will bust through and dissolve blockages, leaving the pores clean. 888-362-8425 or www.edimi.com

Éminence Organic Skin Care
The Éminence Garlic and Tomato Masque is specially formulated to treat acne at the source and to balance oil production. The antibacterial power of odorless garlic purifies the skin. Blemishes and acne are healed quickly while antioxidant-rich tomatoes combat free radicals and promote healing. 888-747-6342, www.eminenceorganics.com or CRR# 165

GlyMed Plus®
The Sulfur Masque Acne Medication acts as both a skin clarifier by absorbing excessive sebum, the factor responsible for attracting bacteria, and a soothing post-extraction mask to quickly calm extraction induced irritation and inflammation. The inclusion of grapefruit peel oil not only stimulates micro-circulation for enhanced healing but also adds a fresh, citrus scent. 800-676-9667, www.glymedplus.com or CRR# 174

glō•therapeutics
Clear Anti-Blemish Treatment by glō•therapeutics, helps to battle breakouts at the root thus eliminating current blemishes and preventing future flare-ups. Benzoyl peroxide, one of the key ingredients, begins working immediately for quick results in blemish emergencies. Meanwhile, aloe vera barbadensis, another key ingredient, improves skin hydration, offers anti-inflammatory benefits and aids in healing and repairing epidermal cells. 800-232-0398 or www.gloprofessional.com

HydroPeptide®
Used weekly, HydroPeptide®'s Instant Peptide Miracle Mask helps to clear the complexion and fight signs of age. Oil-controlling kaolin and bentonite clays extract impurities without drying skin. Enzymes increase cell turnover by 25 percent to prevent future breakouts and bearberry contributes to an even skin tone. For the finishing touch, four high-performance peptides plump skin to visibly reduce the appearance of fine lines.
800-932-9873, www.hydropeptide.com or CRR# 280

Lexli® Pure Aloe Simple Truth™
Lexli®'s Aloe-based Acne Treatment Kit, a new approach to acne treatment, is composed of a package of four products – cleanser, exfoliant, clarifier and moisturizer – that work together to address each of the main causes of acne. Using clinically proven ingredients of the highest quality, the products, used as directed, control symptoms and help eliminate the condition. 877-893-3417 or www.lexli.com

Nature Pure Labs
Medicated with five percent benzyl peroxide, the Nature Pure Labs Acne Treatment Gel is most effective for treating and controlling mild to moderate acne. It clears up acne blemishes and helps prevent the appearance of new blemishes. The formula contains allantoin, which for decades dermatologists have utilized to maintain skin's well-being and it also contains chamomile which soothes and calms the skin. 866-640-7546 or www.naturepure.com

OBAGI®
CLENZIderm M.D. ™ is a three-step acne system that uses a liquid form of benzoyl peroxide, clinically proven to clear acne fast. Most benzoyl peroxide formulas remain on the surface of the skin. However, acne starts below, deep within the hair follicles or pores. As a result, this RX treatment instantly penetrates the pores and reduces acne from the start. 800-636-7546 or www.obagi.com

Osmosis Pür Medical Skincare
The Osmosis Clarify Serum clears acne, normalizes oil production, shrinks pores and calms inflammation while restoring the epidermal barrier and dermal thickness. The Osmosis Acne Blend increases scar tissue remodeling, helps clear stubborn bacteria and improves wound healing. 877-777-2305 or www.osmosisskincare.com

pevonia® BOTANICA
Part of Ligne Clarifyl – the Acne/Problematic Skin line, the Spot Treatment incorporates natural enzyme and oat to provide a deep exfoliation that prevents infection, unclogs pores and impedes bacterial growth. Its antiseptic formula expedites healing and calms acne sensitivity. Encouraging rapid healing, it keeps skin follicles clean, clear and bacteria-free. 800-PEVONIA, www.pevonia.com or CRR# 278

Phytomer
Acne concerns can be addressed with this Anti-Blemish Target Gel, a spot treatment that acts with precision on pimples and blemishes, quickly improving the skin's appearance while preventing the appearance of new breakouts. Red seaweed extracts work to naturally purify the skin while salicylic acid exfoliates and provides an antiseptic action. Dermatologically tested, this non-comedogenic gel can be used throughout the day, even over makeup. 800-227-8051, www.phytomerusa.com or CRR# 122

Phytoceane
Oily, problematic skin is regulated with Hydra-Balancing Cream Zero Blemish. Made to purify, matify and regulate the production of sebum and provide antiseptic and anti-bacterial action, this cream provides immediate comfort. Sea-buckthorn oil, cinnamon and hazelnut oil combine in a paraben-free formula to tighten pores and help prevent the appearance of blemishes. Jania rubens, a marine coral, adds intense hydration to restore proper skin balance. 877-623-2620, www.phytoceaneusa.com or CRR# 122

Repêchage®
Repêchage Hydra Medic® Beta Hydroxy Serum penetrates pores to help control acne blemishes and help stop breakouts before they start. Its skin exfoliating formula, with salicylic acid (beta hydroxy acid) works overnight to help keep the skin clear of future breakouts. Synergistic tea blend and herbal infusion helps to calm and soothe the skin. Lavender oil is used for its aromatherapy, calming and anti-inflammatory properties. 
800-248-7546 or www.repechage.com

Rhonda Allison® Cosmeceuticals
The Rhonda Allison Beta Green Tea Cleanser and Blemish Serum provides antibacterial support, minimizes surface bacteria, deeply cleanses the pores, enhances skin purity and provides potent healing elements. The cleanser works gently and therapeutically to reduce surface oils and deliver a deep-pore cleanse while the Blemish Serum provides antiseptic, antibacterial, antioxidant and healing support. 866-313-7546, www.rhondaallison.com or CRR# 222

SAIAN®
SAIAN® Acne Spot Treatment treats break-outs overnight. It kills germs and bacteria, disinfects and dries blemishes to treat even the most severe and cystic acne without leaving red spots and discoloration. No added color, fragrance, glycerin, parabens, chemicals, fillers or preservatives – all natural and 100 percent pure. 800-291-1130, www.saian.net or CRR# 250

Sanítas Skincare
The Sanítas Skincare Tea Tree Mask calms and heals skin with therapeutic clay mask formulated to absorb sebum, eliminate blemishes, brighten skin and tighten pores. Made with tea tree oil, green tea, rosemary and salicylic acid, this mask is ideal for spot treatments or as a weekly treatment to absorb excess oils and sebum. 888-855-8425, www.sanitas-skincare.com or CRR# 153

SESHA Skin Therapy
Sesha's Acne Spot Gel is a treatment that fights comedones by regulating the production of DHT, a hormone that induces the over-activity of the sebaceous glands, and thereby controlling excess oil flow and also preventing the spread of bacterial. 888-977-3742, www.seshaskin.com or CRR# 239

SONYA DAKAR The Problem Skin Specialist®
Rescue acne-prone skin from clogged pores and build-up with Sonya Dakar's Triple Action Organic Scrub. Linipack seeds penetrate skin to perform three actions: deep-pore cleansing, polishing and smoothing skin texture. Lavender, tea tree and green tea extracts infuse acne-healing nutrients to fight bacteria and leave skin feeling smooth and clean. 818-898-9293 or www.sonyadakar.com