Acne

Image by Megan Bagshaw

What is it?

  • A common skin disease caused by several factors:  Genetics, bacteria, excess oil production, hormone levels, and hair follicles clogged by oil and dead skin cells.

  • It can come in different forms from “whiteheads” (closed comedones) and “blackheads” (open comedones) to cysts.  They usually appear on the face, chest, upper back and shoulders as these areas have the most oil glands.  

 

What makes acne worse?

  • Hormone changes around puberty and in perimenopausal women are often the most common worsening factor.   Hormones directly cause an increase in oil production from our oil glands which cause skin cells to become more “sticky” around the hair follicle openings which block pores and cause the whiteheads and blackheads.  Bacteria grow in the hair follicle and get inflamed and eventually cause the follicle to rupture open causing more inflammation, scarring and pain. 

  • Stress makes many skin conditions worse including acne and reacting to stress by picking and squeezing pimples can actually cause more damage to the skin.

  • Medications – such as testosterone, lithium, many birth control pills, seizure and mood drugs, prednisone and many others can make acne much worse. 

  • Diet – there is a weak association between dairy products including skim milk and a high glycemic index diet (carbohydrate rich diets such as bread, rice, potatoes, pasta, candy, chocolate, sweets etc).   If you suspect diet to be playing a role, simply avoid those foods. 

 

Do I need to do any tests as part of the diagnosis?

  • In most cases the answer is NO as this tends to be a clinical diagnosis

  • Hormone levels are typically normal

  • It is rare to have to do a skin biopsy for diagnosing this condition

 

What are the treatment options available?

  • Results from any treatment typically takes 4-8 weeks to see optimal results so don’t give up! Doctors can prescribe topical creams and gels that are either antibacterial or comedolytic (ability to unclog pores) if acne is mild.   If acne is more severe, treatments like oral antibiotics, hormone modulators, or Accutane may be prescribed.  Below is a summary of options available for acne.

 

  1. Lifestyle modifications

  • It is recommended that people with acne wash their face 2x per day with lukewarm water and a gentle non-abrasive cleanser.  Do not scrub too hard as this can aggravate your skin even more. Also avoid using skin care or makeup with irritating ingredients like oils, botanicals, and perfume.   Choose moisturizers and sunscreens that are “non-comedogenic” or “fragrance-free”.  This means that the product does not have any ingredients that can potentially clog or irritate your skin.  Avoid picking and squeezing pimples!

 

  2. Topical Medications

  • Topical medications are lotions, gels and creams that you apply on your skin.  Most are applied once daily just before bed with a good moisturizer.  Some are available OTC (over the counter) and some by prescription.  OTC acne products usually contain salicyclic acid or benzoyl peroxide.   These active ingredients reduce the amount of oil that your body produces and also fights inflammation.  They typically should be used to prevent new pimples from forming as field therapy and not “spot treatment”.  If you have mild acne, OTC products may be enough to reduce your pimples.  Prescription products are for those who do not respond to OTC treatments.  They usually contain a retinoid like tretinoin, tazarotene, adapalene or trifarotene or a stronger concentration of benzoyl peroxide or a topical antibiotic like clindamycin or erythromycin. 

  3. Oral Medications

  • When OTC or prescription topicals are just not strong enough, oral medications or systemic treatments may be recommended.  These are usually for treating moderate to severe acne. 

  • These include:

    • oral antibiotics 

    • oral birth control tablets

    • other hormone modifying medications like spironolactone

    • accutane 

4.  Other therapies

  • Blue and red light therapy, photodynamic therapy, microdermabrasion, intense pulsed light, chemical peels, microneedling, and laser scar resurfacing are other non medication forms of therapy for treating acne and acne scarring.   Many of these techniques use light energy to kill bacteria or physical means to remove blocked pores or improve consistency of the skin or from scarring resulting from acne.  However, these are typically not insured services, and need to be repeated several times for optimal results.   If you are interested in pursuing any of these other therapies please discuss this with our Cosmetic Director and she will be happy to meet with you and review your options.