This allows for the overgrowth of bacteria found normally on skin -- Propionibacterium acnes (P. acnes) -- producing irritating chemical substances, which further fuel the inflammation. The end result is acne.
"It can be characterized by anything from whiteheads and blackheads, to tiny hard pimples you barely see, to pus-filled nodules, even fluid-filled cysts with roots deep in the skin," says Sumayah Jamal, MD, PhD, an assistant professor of dermatology and microbiology at the NYU Medical Center in New York City.
'Gold Standard' vs. New Treatments
For decades, doctors have said the "gold standard" for treating mild to moderate acne has been a combination of a deep pore cleanser like benzoyl peroxide (it attacks excess oil) and a topical antibiotic or sulphur drug to combat the bacteria. For some patients, treatment also included the topical prescription medication Retin A to help speed clearing. And it's a combination that is still in use today.
"If a patient has mild to moderate acne, this is still frequently my first recommended treatment. It's the easiest and the most economical, and it works very well for many people," says Jamal.
But while it works well, it can dry and irritate skin. And it was this very complaint that became the impetus for developing one of the first "boutique" acne treatments -- an over-the-counter product known as ProActiv Solution.
Blanketing the nation with celebrity-packed infomercials, product inserts, and direct mail ads, it fast became one of the most popular private-label acne treatments around. But what's in it -- and does it really work?
"It contains a much lower percentage of benzoyl peroxide, in a vehicle that isn't as drying as most prescription medications. And that frequently makes compliance better; so in that respect, yes, it can work better for some people," says Jamal.