What is acne?
Acne consists of blocked pores (blackheads and whiteheads), pimples and deeper bumps that occur in areas with higher concentrations of oil glands. These areas include the face, neck, chest, back and shoulders. Acne is the most common during the teenage years, but can occur in adults as well. Some people experience their first acne breakouts in their 20's or 30's.
How does acne form?
Acne usually begins during puberty when hormone levels rise. The hormones stimulate the oil glands to make sebum. This sebum is excreted through a hair follicle and out a pore onto the skin. Oil and shedding skin cells stick together to plug the pore and form a comedo. Bacteria grows in the oil and dead skin cells and make chemicals that cause inflammation. The comedo can rupture under the skin and cause redness, swelling and pus. Sometimes the blocked pores will be white and sometimes they will be black. The black discoloration is oil that has oxidized when air touches it. It is not dirt.
When should you treat acne?
Acne can be very devastating psychologically for both teenagers and adults. People with severe acne may become depressed and may avoid social situations. Severe acne can form permanent scars on the face which remain even after the acne has cleared. Even people with mild acne can be traumatized by their condition. Some people aren't bothered by their acne at all. You should seek treatment for your acne when it becomes bothersome to you.
How is acne treated?
Most people with acne are treated with varying combinations of the following products. Acne treatments work by preventing new acne and take time to work. If acne hasn't improved in about 6 weeks, changes to your treatment may be needed.
Cleansing with a mild cleanser and warm water twice a day is recommended for most people. Sometimes a cleanser with either salicylic acid or glycolic acid is recommended. Washing too often or using a harsh scrub may make acne worse. Hair should also be washed regularly.
This comes in wash, lotion, gel or cream form and can help unblock your pores and reduce bacteria. It can also help prevent bacterial resistance when used with antibiotics. It can cause some dryness and peeling and can bleach fabrics so careful use is recommended. Some newer prescription forms have added ingredients that are gentler on the skin.
Retinoids (Retin A, Differin, Avita, Tazorac):
These topical creams, gels or solutions are especially helpful in unblocking the pores and are an important part of acne treatment. They can also cause dryness and peeling. Some newer forms are gentler on the skin.
Topical antibiotics and antibacterials:
These are applied directly to the skin to help control bacteria and include erythromycin, clindamycin, sulfacetamide and azelaic acid.
Oral antibiotics are prescribed for more moderate-severe acne and work by both controlling bacteria and helping to reduce inflammation. The most commonly used antibiotics are the tetracycline, doxycycline and minocycline. Erythromycin is also used though the acne bacteria has developed more resistance to it. Sulfa antibiotics can also work well, but are not prescribed as often because of the risk of severe allergic reaction. Oral antibiotics can have side effects ranging from sun sensitivity and nausea to vaginal yeast infections and skin discoloration.
Some female patients may get some improvement of their acne with birth control pills. Others may not notice any change or may get worse. Typically oral contraceptives would not be a stand-alone treatment for acne, though two pills including Ortho Tri-Cyclen have been FDA approved for the treatment of acne.
This oral medication, which is also used as a blood pressure medication, may be helpful in women who break out on the lower face and who notice a direct correlation between their menstrual cycle and their breakouts.
Accutane is a wonderful option for people with severe, resistant, scarring acne. Used properly, it is a safe and effective treatment and can clear acne long-term. The most important issue with isotretinoin is that it can cause birth defects so female patients must be abstinent or use 2 forms of birth control during the 5-6 month treatment and for one month before and one month after treatment. The federal government has begun a new program called iPledge to try to reduce the number of pregnancies on this medication. This involves registering medical providers, pharmacists and patients. Female patients who have the potential to get pregnant have a mandatory 30 day waiting period after registering before they can start the medication. All patients have blood work drawn before starting isotretinoin and monthly during the treatment.
One can often achieve short-term improvement of acne with sunlight, although,studies have shown that in the long term, sunlight can worsen acne. This is presumably due to UV damage, but has not been confirmed yet. (the exact mechanism appears to be related to free radicals generated by light). You should also know that there are light treatments (Blue Light / Clear Light) that -while they dont work for everyone - may improve acne for long periods of time.
Large painful pimples and cysts can be injected with a small amount of a low-strength cortisone solution and can flatten out overnight. This treatment works the best for new cysts. This treatment can usually be done the day the patient calls the clinic and only takes a minute.
Acne can sometime be improved by peels that unblock pores. Both glycolic acid or salicylic acid peels, as well as regular facials, applied by a qualified esthetician have been shown to be effective. The NWFace Spa at the Woodmark has several wonderful estheticians.
Does diet make a difference?
Diet probably does not make a significant difference in acne. A recent study suggests that milk intake might have a very low positive correlation with acne, but the study was based on women recalling the amount of milk they drank years before. If you find that a particular food seems to make you break out more, then you might want to limit that food, but there is no proof that chocolate or greasy food makes acne worse.
Are cosmetics OK?
Wearing make-up is fine as long as you choose a foundation or cover-up that is oil-free and non-comedogenic. Make sure that you wash your face every night.
What about moisturizer?
Some people with acne have very oily skin and may not require any moisturizer. Others may be very dry and will need one daily. Acne medications can make your skin drier, so even people with oily skin may benefit from a moisturizer. Choose one that is oil-free and non-comedogenic. There are many facial moisturizers available. Neutrogena, Cetaphil, Aveeno and Olay are among other brands that have a wide selection. For morning use, choose a moisturizer with an added sunscreen and an SPF of at least 15.
What can be done for acne scarring?
What people think of as scars can range from true scars which are indentations or dents in the skin to flat red or dark spots on the skin. Flat red spots are typically lingering inflammation and will gradually fade with time. Dark spots are areas of increased pigment caused by inflammation. This pigment is called post-inflammatory hyperpigmentation. Some acne products such as the retinoids or azeleic acid may help fade these spots with time. Prescription bleaching products and chemical peels can also help significantly. True scars can be treated with a variety of methods including laser resurfacing, deep chemical peeling, microexcision and punch grafting, and fillers such as Restylane.