Acne is a skin condition which has plugged pores (blackheads and whiteheads), inflamed pimples (pustules), and deeper lumps (nodules). Acne occurs on the face, as well as the neck, chest, back, shoulders, and upper arms. Although most teenagers get some form of acne, adults in their 20’s, 30’s, 40’s, or even older, can develop acne. Often, acne clears up after several years, even without treatment. Acne can be disfiguring and upsetting to the patient. Untreated acne can leave permanent scars; these may be treated in the future. To avoid acne scarring, treating acne is important.
Types of Acne and How Acne Forms
Acne is not caused by dirt. Testosterone, a hormone which is present in both males and females, increases during adolescence (puberty). It stimulates the sebaceous glands of the skin to enlarge, produce oil, and plug the pores. Whiteheads (closed comedones), blackheads (open comedones), and pimples (pustules) are present in teenage acne.
Early acne occurs before the first period and is called prepubertal acne. When acne is severe and forms deep “pus-filled” lumps, it is called cystic acne. This may be more common in males. Adult acne develops later in life and may be related to hormones, childbirth, menopause, or stopping the pill. Adult women may be treated at the period and at ovulation when acne is especially severe, or throughout the entire cycle. Adult acne is not rosacea, a disease in which blackheads and whiteheads do not occur.
Cleansing
It is best to wash your face with a mild cleanser and warm water daily. Washing too often or too vigorously may actually make acne worse.
Diet
Acne is not caused by foods. However, if certain foods seem to make acne worse, try to avoid them.
Cosmetics
Oil-free, water-based moisturizers and make-up should be used. Choose products that are “non-comedogenic” (should not cause whiteheads or blackheads) or “non-acnegenic” (should not cause acne). Remove cosmetics every night with mild soap or gentle cleanser and water.
Treatment
Control of acne is an ongoing process. All acne treatments work by preventing new acne breakouts. Existing blemishes must heal on their own, and therefore, improvement takes time. If acne has not improved within two to three months, treatments may need to be changed. The treatment will vary according to the type of acne. Occasionally, an acne-like rash can be due to another cause such as make-up or lotions, or from oral medication. It is important to help your physician by providing an updated history of what you are using on your skin or taking internally. any non-prescription acne lotions and creams help mild cases of acne. However, many will also make your skin dry. Follow instructions carefully.
Topicals
· The physician may prescribe topical creams, gels, or lotions with vitamin A acid-like drugs, benzoyl peroxide, or antibiotics to help unblock the pores and reduce bacteria. These products may cause some drying and peeling. The physician will advise you about correct usage and how to handle side effects.
· Before starting any medications, even topical medications, inform your physician if you are pregnant or nursing, or if you are trying to get pregnant.
· Acne surgery may be used by to remove blackheads and whiteheads. Do not pick, scratch, pop, or squeeze pimples. When the pimples are squeezed, more redness, swelling, inflammation, and scarring may result.
· Microdermabrasion may be used to remove the upper layers of the skin improving irregularities in the surface, contour, and generating new skin.
· Light chemical peels with salicylic acid or glycolic acid help to unblock the pores, open the blackheads and whiteheads, and stimulate new skin growth.
· Injections or corticosteroids may be used for treating large red bumps (nodules). This may help them go away quickly.
Oral
Antibiotics taken by mouth such as tetracycline, doxycycline, minocycline, or erythromycin are often prescribed. Spironolactone, a long-standing high blood pressure medication, has also been shown to decrease oil production and provide control in some patients of acne outbreaks.
Birth Control Pills
Birth control pills may significantly improve acne, and may be used specifically for the treatment of acne. It is also important to know that oral antibiotics may decrease the effectiveness of birth control pills. This is uncommon, but possible, especially if you notice break-through bleeding. As a precautionary measure use a second form of birth control.
Other Treatments
· In cases of unresponsive or severe acne, isotretinoin (Accutane) may be used. Patients using isotretinoin must understand the side effects of this drug. Monitoring with frequent follow-up visits is necessary. Pregnancy must be prevented while taking the medication, since the drug causes birth defects.
· Women may also use female hormones or medications that decrease the effects of male hormones to help their acne.
· Photodynamic therapy using the blue wavelength of light, in conjunction with topical Levulan, can be helpful in severe refractory cases of cystic acne.
For those patient with problematic acne, I would encourage you to come in and consult with our experienced medical aestheticians to get the right treatment plan for your type of acne. There are lots of options available but figuring which is best for you can be understandably difficult.
Dr. Barry Eppley
Indianapolis, Indiana