Even though acne and dandruff are different skin diseases, they have quite a lot in common. They are both triggered by an excess oil production by the sebaceous or oil-producing glands on our skin, which are present in maximum numbers on our face and scalp (Puberty is a time when these problems can aggravate simultaneously due to hormonal changes). Both dandruff and acne also display an excessive shedding of dead skin cells which can mix with the excess oils and clog the hair follicles and gland openings (called pores). Clogging leads to excess proliferation of Malassezia furfur, an yeast- leading to scaling and flaking in dandruff and growth of a bacteria Cutibacterium acnes which can produce the inflammatory lesions associated with acne. A severe variant of dandruff called seborrheic dermatitis can also present on face with swollen and red papules like acne.

If you have noticed acne with dandruff, you should visit a qualified dermatologist for exact diagnosis of seborrheic dermatitis and/or acne. Seborrheic dermatitis and dandruff need antifungal shampoo and topicals like ketoconazole for treatment, while acne is best treated by antibiotics and retinoids as per its severity. However, you can take certain general measures before the doctor visit to help reduce the problem:

·        Avoid using oils and heavy creams on face and scalp.

·        Avoid touching scalp and face repeatedly and comb your hair back from the face.

·        Use mild non comedogenic skin products for daily skin care.

Acne is a skin disease with multiple causes. The major factor is excessive oil production by glands on the skin (especially face), along with clogging of pores, proliferation of bacteria C. acnes and hormonal factors also contributing to the development of inflammatory acne lesions. Hence acne treatment needs multiple strategies as well which can target the various factors increasing your acne. Facewash is a key component of daily skin care regimen and you should look at the following things for choosing a facewash in acne-prone skin:

·        Facewash should be mild; do not use soap on the skin which is harsh and can cause excessive dryness. Gentle foaming face wash can help skin without drying it out.

·        Choose a product labelled non comedogenic as such products do not clog your pores (which can aggravate acne).

·        Facewashes with salicylic acid, benzoyl peroxide, glycolic acid are marketed for their anti-acne action. However, consult your dermatologist before using any active product as they can cause irritation, dryness and even aggravation of acne if not used correctly.

·        Use your facewash twice daily and pat your face dry after washing (do not rub).

·        Sunscreen and moisturiser are essential components of your skincare regimen. Choose products that complement your facewash to avoid further damage to your skin.

·        Visit a dermatologist before deciding on products if you have active acne. Remember, only facewash cannot treat acne alone; hence combining it with other medicines and cosmeceuticals is necessary. Often, procedures like chemical peels can help expedite results of treatment.

Retinol is a Vitamin A derivative widely used for different skin issues like acne, acne marks, fine wrinkles and antiaging. It acts by increasing cell turnover (pushing new cells from the bottom layer of skin to the top), reducing oil production and improving collagen support to skin to make it firmer. Prolonged use can make the skin look brighter, younger, firmer and remove spots as well.

However, using retinol has a number of disadvantages:

·        Starting retinol on active acne can cause Purging. This is a severe acne breakout that lasts for one to two months and may cause marks or scars. Continued use settles the purging after two months.

·        Severe pus filled and nodular acne may not respond to retinol which is weaker than other topical retinoid products.

·        Retinol often causes dryness and irritation and hence it is advised to start with a low dose and intermittent short-time application.

·        Retinol makes the skin thinner and more sensitive to sun damage. Hence it is to be used at night along with appropriate daytime sun protection.

·        Retinol should not be used in pregnancy as it can harm the baby.

Due to these side effects and potential problems, you should consult a dermatologist before using retinol for your acne. A good skin care regimen with mild facewash, appropriate sunscreen and moisturiser is essential before starting retinol, especially if your skin barrier is damaged. Doctors may also recommend starting alternate day application with short contact time for your skin to become used to retinol.

PCOS or polycystic ovarian syndrome is an endocrine problem affecting many women of child bearing age in today’s world, ranging from teenage to pre menopausal women. The common problems seen are – irregular periods, acne, unwanted facial and body hair, dark skin patches and weight gain.

Acne is seen in 10-34% of the affected women, mainly due to increased production of male hormones like testosterone in the body from the polycystic ovaries. This is known as hyperandrogenism. These acne typically occur in jawline, lower face, neck and chest; they are resistant to common acne medicines.

PCOS related hormonal acne requires hormonal medicines along with acne treatment. Oral contraceptive pills with oestrogen and progesterone are prescribed often; accompanied by anti-androgen drugs like spironolactone if needed. Along with this a good skincare regimen and topical antibiotics and retinoids need to be prescribed. Often procedures like chemical peels and laser toning are recommended along with medicines for faster and better results.

If you have PCOS related acne, visit a dermatologist for guidance. A course of medicines and procedures for at least 6 months is often required for clearance. Doctors will also recommend necessary lifestyle modifications like avoiding high carb food and sweets, physical exercise and weight loss.

Acne and makeup have a complicated relationship. Often in today’s world you need to apply makeup for professional reasons. However, if you have an acne prone skin, choosing appropriate makeup requires some research. Apart from aggravating existing acne, cosmetics can cause clogging of pores and irritation, which causes people who haven’t had acne before to develop “acne cosmetica” that appears as tiny bumps and whiteheads over forehead, chin and cheeks.

Whether you have pre-existing acne or acne cosmetica, you should remember the following tips when choosing and doing your makeup:

·        Choose water-based light cosmetics instead of oil based, heavy and greasy products. Products labelled “oil-free”, “non comedogenic” or “does not clog pores” is most preferable. Daily skincare products should also be light and non-comedogenic.

·        Don’t apply too many layers of makeup. Apply products lightly and clean your makeup sponges and brushes regularly.

·        Wash your face twice daily with a mild cleanser.

·        Always remove makeup, even eye and lip makeup, by double cleansing (makeup remover and cleanser) at the end of the day, followed by moisturiser application before bedtime. Skipping moisturiser due to fear of acne can increase dryness and irritation thus aggravating existing acne.

·        A layer of sunscreen and moisturiser should be applied before applying makeup in the daytime.

Since acne can leave long lasting cosmetic concerns like marks and scars, if you notice acne after applying makeup you should consult a dermatologist for proper diagnosis and treatment. Your doctor can also help you choose the right skincare regimen and cosmetic products.

A lot of people would swear their acne was caused only by coffee! However, there is no evidence that drinking coffee can cause acne in someone who has never had acne before. But drinking too much coffee, especially with milk and sugar can worsen existing acne. Here's why:

● Caffeine, one of the main ingredients of coffee, is a stimulant and elevates stress hormone levels like cortisol in the body. Too much caffeine can cause high cortisol levels which often worsen acne.
● Drinking too much coffee and caffeine in the evening times can lessen your sleep. Lack of sleep has a deteriorating effect in skin quality.
● Many people take milk in their coffee- milk is known to have a direct effect on increasing acne. Milk increases insulin levels in the body which can cause or worsen hormonal acne e.g. in women with PCOS.
● Sugar is another culprit which can also increase insulin and insulin-like growth factor I to worsen acne similar to milk.
Try to avoid cow milk in your coffee (plant-based milk is safe) and use low calorie sweeteners instead of sugar. Decaffeinated coffee is another option to cut down on caffeine. If you can follow this, your daily coffee will not have too much effect on your acne.

However, please consult a dermatologist for proper diagnosis and treatment of acne.

Masturbation and acne have no proven link. The myth that masturbation can cause acne has possibly resulted from the fact that both appear around puberty and are related to levels of testosterone.

As a male enters into his teens, puberty starts and levels of male hormones including testosterone rises in the body. This leads to over-activity of oil glands in the skin producing more oil/sebum, which can clog the pores, incite inflammation and cause acne, especially when bacteria like C. acnes is present. This teenage acne is a very common phenomenon, such that many people do not think of it as a medical problem.

When the testosterone levels rise, the body also starts showing secondary sexual characteristics like development of beard and pubic hair, and gives rise to urge for masturbation, which is also a normal occurrence. Tests have shown that testosterone levels rise mildly during the act of masturbation, but go back to normal afterwards with no long lasting effect. This mild and temporary rise of testosterone levels don't have any effect on sebum production or acne.

If you are suffering from teenage acne, please visit a dermatologist and get a correct diagnosis and treatment plan, as this acne can be long lasting and leave cosmetic problems like marks and scars.

Pregnancy can have different effects on acne; some women report no change or even decrease in acne during pregnancy. However, women who suffered from acne in teenage and have a history of previous hormonal acne often complain of aggravation of acne in pregnancy.

This aggravation usually starts in first trimester, probably due to rise of androgens in the body. Hormones like progesterone which remains high throughout pregnancy can worsen acne. This acne gets better only after delivery as the hormone levels normalise.

Treatment of acne during pregnancy is tricky as quite a few acne treatments can cause possible harm to the baby and are best avoided at this time. General measures like mild and safe products for skincare regimen, avoiding heavy makeup, taking enough water should be followed to maintain skin quality.

Please visit a dermatologist for a detailed treatment plan. Procedures like chemical peel and laser toning done for quicker resolution of acne and marks are best avoided till after delivery.

Acne irritates a lot of women in pregnancy, especially if you have previous history of teenage acne or hormonal issues. Most acne increase in late first trimester and into the zecond trimester, then persists through the rest of pregnancy.

As you already know, you have to avoid using most medicines in pregnancy, so options of treating acne in pregnancy are few. The following general measures can help you to prevent new acne and avoid exacerbation of existing acne:

● Wash your face twice daily with mild cleanser and remove makeup daily if you are using any. Maintain daily skincare regimen with non comedogenic sunscreens and moisturisers.
● Avoid touching or picking at existing acne lesions as it can increase the acne or cause marks and scars.
● Wash your scalp regularly and avoid touching of your hair to your face repeatedly.
● Maintain a healthy diet and drink plenty of water to keep your skin fresh and healthy.
● Avoid pollution and skin irritants.

Consult your dermatologist for recommendations on what medicine you can use safely. As a rule, oral medicines will be avoided; topical antibiotics like clindamycin are preferred for treating pregnancy acne. Spot treatments with benzoyl peroxide may also be tried. Procedures like chemical peels and lasers are best avoided though chances of harm to baby is minimal.

Acne can sour the experience of pregnancy in many women, especially those with previous hormonal problems like PCOS. But unfortunately, treatment options for acne in pregnancy are limited. General measures like cleaning face regularly, avoid popping or scratching existing acne and maintaining a healthy diet are the first steps to be taken.

Topical treatment is preferred over oral medicines in pregnancy. For mild cases, you can use topical antibiotics like clindamycin local application. Spot treatment by benzoyl peroxide is also an option. Azelaic acid, which acts in mild acne and acne related redness and spots, is also safe to use.

If acne is severe, oral antibiotics like azithromycin may be prescribed by your dermatologist for short periods.

Retinoids, which are a mainstay of acne treatment, have to be avoided as they affect the baby in pregnant women. This includes oral isotretinoin as well as topical application of adapalene, tretinoin etc.

Hormonal medicines like contraceptives and spironolactone, which give excellent results in hormonal acne, are also strictly prohibited in pregnancy.

Please consult a doctor before using any medicine for your acne in pregnancy. If mild, waiting for delivery might be the most prudent thing to do. Chemical peels with salicylic and other acids and lasers which treat acne and acne marks quickly are also best avoided in pregnancy. However, salicylic acid in very low concentrations like in cleansers may sometimes be prescribed.