Acne
Acne is the most prevalent chronic inflammatory skin disease in the United States. It affects almost 50 million people every year. The majority of cases occur in adolescents and young adults. However, older adults of both sexes and all races and ethnicities also suffer with acne. The psychological and physical consequences of acne are well known including embarrassment, low self-esteem, lack of confidence, scarring, and hyperpigmentation.
Acne is an inflammatory disease that can develop anywhere on the body but usually appears on the face, chest, neck, back and buttocks. The key to acne management is early treatment to control the factors that cause acne and scarring.
What causes acne?
Acne begins in the hair follicles. Your pores are the openings of the hair follicles. In adolescence, hormones are raging, and these hormones stimulate the sebaceous glands within the hair follicles to produce excess sebum (skin oils). Dead skin cells accumulate in the sebum and clog the pores, creating the perfect environment for skin bacteria to colonize resulting in inflammation and a bacterial infection (P. Acnes) in the pores.
In addition to hormone changes in puberty, the following can increase the risk of developing acne:
- Heredity and genetics
- Occlusive or “comedogenic” cosmetics that clog pores
- Certain medications (e.g. Lithium)
- Stress
- Pregnancy
- Polycystic Ovarian Syndrome (PCOS)
- Metabolic Syndrome
- Hot and humid climates
- Cosmetics and moisturizers with coconut oils or cocoa butter
The types of acne lesions
The mildest forms of acne are blackheads and white heads. Blackheads are open pores filled with debris which oxidizes and turns dark. Whiteheads are closed pores clogged with dead skin cells, sebum and bacteria. Inflammatory lesions include papules (raised, red bumps), pustules (pus – filled pimples), nodules (solid lumps beneath the skin) and pus-filled cysts. Many people have all the types of acne at the same time.
How is acne diagnosed?
Dr. Higgins will review your medical and family history, discuss your symptoms and evaluate your condition. She will perform an examination of your skin with a dermatoscope, a special microscopic tool that allows her to examine each skin lesion.
What are the treatment options for acne?
Treatment is focused on controlling the various factors that cause acne, including:
- Reducing the production of sebum
- Reducing bacterial growth
- Unclogging the pores by promoting cell turnover
- Breaking down blackheads and whiteheads
- Reducing inflammation which helps to prevent scarring
- Preventing the buildup of dead skin cells.
Multiple approaches are needed to address each of these factors which means a combination of topical products and sometimes oral prescription medications. The first step is to develop a new skincare routine that includes washing your face twice a day with a mild cleanser. Use skin care products that don’t clog pores, stop scrubbing and picking at your acne.
We can discuss with you the benefits of laser and light-based therapies (blue and red-light treatments) that can help kill bacteria and shrink oil glands to reduce oil production. Chemical peels facilitate skin cell turnover, and open pores. Steroid injections are used to shrink nodular and cystic acne lesions.
Low-dose oral antibiotics are sometimes used to reduce skin bacteria, which decreases inflammation and prevents scarring. Topical retinoids like Retin-A, and Differin® are prescribed to unclog pores and keep them open. Topical salicylic acid, benzoyl peroxide and azelaic acid are anti-bacterial. Anti-inflammatory topical medications include Aczone® (Dapsone).
For adult women with acne, there are oral contraceptives that are approved to treat acne and regulate hormones. A medication called Aldactone® (spironolactone) works by blocking the effects of hormones on the sebaceous glands.
For the most severe cases, when other treatments fail, Isotretinoin is very effective. Isotretinoin actually shrinks the oil glands and dramatically improves acne, but it requires monthly appointments to monitor your progress and check for any potential side effects.
Importantly, while effective treatments are available, most require a month or two before they begin to work; and some can make acne worse before it improves. In addition, not every treatment works for every patient.
