Conditions

Acne | The Biggest Variable in Dermatitis Treatment

Table of Contents

When acne accompanies chronic dermatitis, it is a variable that significantly influences the treatment strategy.

We will guide you on why acne occurs, why it is particularly important in the context of dermatitis treatment, and how to manage it.

1. Causes of Acne

In normal skin, sebum is naturally discharged outward through the pores.

Cross-sectional illustration of a healthy skin pore showing sebum being normally secreted from the sebaceous gland and discharged through the pore, using a faucet analogy.

However, when dead skin cells begin to block the pore entrance, sebum cannot escape and begins to accumulate. This stage is known as a comedo (whitehead).

Cross-sectional illustration of a pore where acne begins to form, showing dead skin cells blocking the pore and sebum being over-secreted and accumulating, using a faucet analogy.

If the pore becomes completely blocked, acne bacteria proliferate, leading to inflammation. This can result in red papules, pustules, and in severe cases, nodules or cysts.

Cross-sectional illustration of a completely blocked pore showing dead skin cells blocking the pore, acne bacteria proliferating, and inflammation beginning, using a faucet analogy.

2. Why It Is a Variable in Dermatitis Treatment

The core issue of atopic dermatitis, rosacea, and seborrheic dermatitis is skin barrier damage. Since a weak barrier is vulnerable to external irritation, protecting the skin with a thick cream is the foundation of treatment.

However, thick moisturizers can clog pores. While a typical acne patient could use light formulations like lotions or gels, light formulations often contain many preservatives and can be irritating. Furthermore, light formulations have a weak protective barrier role.

Detailed information about moisturizers can be found on the MD Cream page.

The choice of anti-inflammatory ointment also changes. For dermatitis, Protopic is usually considered first, but when acne is present, Elidel is used. This is because Protopic can clog pores and worsen acne. While Elidel has slightly lower anti-inflammatory effects than Protopic and carries a somewhat higher risk of contact dermatitis based on experience, it is a more suitable choice when acne is present.

3. Deciding Whether to Treat Acne | Wood’s Lamp Examination

It is impossible to accurately determine with the naked eye whether or to what extent pores are clogged.

A Wood’s lamp examination reveals accumulated sebum and bacterial byproducts inside the pores as fluorescence, allowing for an objective confirmation of whether acne treatment is necessary.

Detailed information can be found on the Wood’s Lamp Examination page.

Clinical photograph showing sebum fluorescence as pink dots around the cheeks and nose during a Wood's lamp examination — used to evaluate the degree of pore clogging for acne treatment.

4. Deciding When to Treat Acne | TEWL Test

The skin barrier may temporarily weaken during acne treatment.

Therefore, we check the state of the skin barrier with a TEWL test and only begin acne treatment once the barrier condition falls within the normal range (approximately 0 – 8 g/m²/h).

Detailed information can be found on the TEWL Test page.

Diagnostic scene where skin barrier function is objectively measured by placing Transepidermal Water Loss (TEWL) measurement equipment on the back of a patient's hand.

5. Acne Treatment

The core of treatment is retinoids (Vitamin A derivatives). For dermatitis patients, retinoids perform two functions:

  1. Inhibiting pore clogging — They prevent pores from clogging by inhibiting excessive dead skin cell and sebum production. Thus, they not only treat acne but also enable the use of thick moisturizers.
  2. Strengthening the skin barrier — Long-term use makes the skin barrier stronger.1

However, retinoids can temporarily weaken the skin barrier by thinning the stratum corneum during the initial stage of use.2 In dermatitis patients whose barriers are already damaged, it is crucial to minimize this initial irritation, and the timing and method of introduction are adjusted according to the state of the barrier.

Retinoids are available as oral medications and topical creams. While the mechanism is the same, the delivery route differs, so the order is determined based on the condition of the pores.

  • Isotinon (Oral Retinoid) — Acts from inside the pore through the bloodstream. It can reach the necessary areas even if the pores are clogged, so it is used when pores are significantly blocked.3
  • Aklief (Topical Retinoid) — Must enter the pore from the skin surface. Since it can only reach the necessary areas if the pores are open, it is used after emptying the pores with Isotinon if they are heavily clogged.

In cases where pores are not significantly clogged, treatment may start with Aklief from the beginning. The starting point is decided based on the Wood’s lamp examination results.

6. Conclusion

For dermatitis patients, thick moisturizers are essential for barrier protection, but they can cause acne by clogging pores. Retinoids provide a solution to this dilemma by inhibiting pore closure and strengthening the barrier in the long term.

The condition of the pores is confirmed via Wood’s lamp examination, and treatment involves an appropriate combination of Isotinon and Aklief based on the results.

The presence of acne affects the choice of not only moisturizers but also anti-inflammatory ointments. Protopic is selected if there is no acne, while Elidel, which clogs pores less, is chosen when acne is present.

References

  1. Aubert J, Piwnica D, Bertino B, et al. Nonclinical and human pharmacology of the potent and selective topical retinoic acid receptor-γ agonist trifarotene. Br J Dermatol. 2018;179(2):442-456.
  2. Yoon J, Bhatt LR, Yoo HJ, et al. Retinoid Induces the Degradation of Corneodesmosomes and Downregulation of Corneodesmosomal Cadherins: Implications on the Mechanism of Retinoid-induced Desquamation. Korean J Invest Dermatol. 2011;18(3):112-118.
  3. Layton AM. The use of isotretinoin in acne. Dermatoendocrinol. 2009;1(3):162-169.

Frequently Asked Questions

Can’t I just use a light moisturizer?

Light formulations like lotions or gels are less effective as a protective barrier and can be more irritating than creams because their high water content requires more preservatives. It is ideal for dermatitis patients to use thick creams with high occlusive power and manage pore-clogging issues with retinoids.

Do retinoids irritate the skin?

Retinoids can temporarily weaken the skin barrier as the stratum corneum thins during the initial period of use. Therefore, we first check the barrier condition and adjust the timing of introduction and dosage. In the long term, they actually contribute to strengthening the barrier.

Are Isotinon and Aklief ever used simultaneously?

Generally, they are not used at the same time. We take a sequential approach, emptying the pores with Isotinon and then switching to Aklief once the barrier has recovered.

Is a Wood’s lamp examination absolutely necessary?

The Wood’s lamp examination is performed free of charge. Since it is difficult to accurately evaluate the degree of pore clogging with the naked eye, this test is used to objectively check the pore condition and establish a treatment plan.