ACNE
Years ago, teenagers with acne were told to cut out the potato chips and given a tube of Clearasil. Today, we know far more about the reasons why some people develop acne and how it can most effectively be treated. All cases of acne are not created equal, and neither are all acne treatments. Although all acne has its roots in the same process — hormonal fluctuations that stimulate oil production — not all acne is equally severe and not all cases of acne will respond to the same types of treatments.
Most cases of acne fit within one of three main categories: Comedonal acne. This is the kind of mild acne that involves blackheads and whiteheads. It forms because a component of skin oil called sebum, along with old skin cells, block the pores of the skin. Comedonal acne appears most often on the forehead, nose, and chin. Inflammatory acne. This form of acne occurs when the area just under the “plug” (the blackhead or whitehead) becomes reddened and inflamed. Cystic acne. The most severe form of acne, cystic acne develops as the result of an actual infection in the area of the outbreak. Cystic acne often runs in families. It’s often very painful and can result in disfiguring, permanent scarring.
The type of treatment that works for you will depend both on the kind of acne you have, and the additional factors that seem to trigger acne outbreaks.
What is acne?
Common Acne (acne vulgaris) is a disease of the hair follicles of the face, chest, and back that affects almost all teenagers during puberty. It is not caused by bacteria, although bacteria play a role in its development. It is not unusual for some women to develop acne in their mid- to late-20s.
Acne appears on the skin as:
• occluded pores (“comedones”), also known as blackheads or whiteheads,
• tender red bumps also known aspimples or zits,
• pustules (bumps containing pus), and occasionally as
• cysts (deep pimples, boils).
One can do a lot to treat acne using products available at a drugstore or cosmetic counter that do not require a prescription. However, for tougher cases of acne, one should consult a physician for treatment options.
What causes acne?
No one factor causes acne. Acne occurs when sebaceous (oil) glands attached to the hair follicles are stimulated at the time of puberty or due to other hormonal changes. Sebum (oil) is a natural substance that lubricates and protects the skin. Associated with increased oil production is a change in the manner in which the skin cells mature, predisposing them to plug the follicular pore. The plug can appear as awhitehead if it is covered by a thin layer of skin, or if exposed to the air, the darker exposed portion of the plug is called a “blackhead.” The plugged hair follicle gradually enlarges, producing a bump. As the follicle enlarges, the wall may rupture, allowing irritating substances and normal skin bacteria access into the deeper layers of the skin, ultimately producing inflammation. Inflammation near the skin’s surface produces a pustule; deeper inflammation results in a papule (pimple); if the inflammation is deeper still, it forms a cyst.
How Doctors normally Treat Acne
Acne is a disorder of the skin caused by inflammation of the skin glands and hair follicles. Since it forms under the skin, washing away surface oils does not do much to prevent or cure it. Acne treatment falls into three categories:
• Cleansing & Exfoliating
• Keeping It Clear
• Medications
Cleansing & Exfoliating
It is a myth that people get acne because they don’t wash enough. Gentle washing is important, but too much washing can irritate the whiteheads and blackheads, causing them to be more infected and making more pimples. Use a mild cleanser such as Cetaphil, or an acne cleanser, or Benzoyl Peroxide 5 percent bar. Exfoliating, which removes the layer of dead skin cells, is also important for healthy skin. After washing your face with a mild cleanser, exfoliate with face facial scrub one to two times a week. This can help reduce dead skin cells and debris which can clog pores and cause more acne.
Keeping It Clear
To avoid further clogging of your pores, all cosmetics, lotions, and sunscreens should be oil-free! To avoid dry skin, use an oil-free lotion. And remember to beware of hair products and gels, as they tend to be very oily. Look for product labels that read “noncomedogenic”, meaning they won’t clog pores.
Medications
Benzoyl peroxide
Benzoyl peroxide can be found in many over the counter acne medications. It kills bacteria that worsen acne, unplugging oil ducts, and helping to heal acne pimples.
Retin-A
Retin-A is available with a doctor’s prescription, as well as in over-the-counter solutions at your local drug store.
Antibiotics
Antibiotics are available with a doctor’s prescription only. Antibiotics can be very helpful for acne that is swollen and red, or for acne that is not improving with other medications. The antibiotics kill the bacteria which contribute to whiteheads.
Accutane
Accutane is available with a doctor’s prescription only. Accutane is a very powerful pill – it is intended for people with severe scarring, or acne that cannot be controlled by other medications.
OUR ACNE TREATMENTS
Typical Acne treatments traditionally included two main categories, topical or systemic. Topical skin care treatments include , Thermage, Laser light, alpha hydroxy acids, Benzoyl Peroxide, topical antibiotics, retinoids, and other cleansers, soaps, or astringents.
A combination of treatments that target the four main factors that contribute to acne – Comedogenesis, Sebum production, P. acnes (the bacteria), and inflammation are usually the best treatment course.
We offer an alternative to traditional acne treatments when those therapies have failed. We can provide you with the most advanced technologies available today to treat your skin.
Thermage
The FDA approved Thermage procedure heats the water in overactive sebaceous glands causing a mild thermal injury that changes the activity and function of the glands. Thermage penetrates deep into you skin to target the deep sebaceous glands that can cause cystic acne. Shortly after the first treatment, you will start to see a reduction in acne lesions. This treatment also improves the appearance of atrophic scars.
Treatment sessions take about 30-60 minutes
1-3 treatments recommended at 6-12 week intervals
Slight erythema and swelling may occur and usually resolves in 2-12 hours
Photodynamic Therapy (PDT)
Levulan PDT can improve mild to moderate acne. Levulan inactivates the bacteria that trigger acne, exfoliates the skin to unclog pores, and decreases the activity of overactive sebaceous glands in the skin. This is exciting because sebaceous glands are the root cause in the formation of acne so it has a long lasting effect even on the most severe cases.
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COMMON QUESTIONS ABOUT ACNE TREATMENTS
Here are the most common questions we receive about acne treatments.
Why does acne appear most often in teenagers ?
The primary trigger for acne is fluctuating hormones — specifically, the male hormone testosterone. (Women do have some levels of testosterone.) When teenagers hit puberty, their hormones start surging — and often, so does acne.
Can what I eat cause acne breakouts ?
No The primary trigger of most cases of acne is the fluctuation of hormones. Hormones stimulate the oil glands to produce more sebum, which can block pores. Bacteria can then grow within the pores, causing them to become inflamed and break out. That happens at times of major hormonal change, such as during the menstrual cycle, and during the teen years, no matter what you eat. So despite what your grandmother told you, eating too many potato chips won’t make you break out in pimples. But there some evidence that certain diets may have an effect on acne, Studies, such as one published in the Journal of the American Academy of Dermatology, have suggested that high consumption of dairy products raises the risk of getting acne because of the hormones in milk, cheese, and yogurt. However, subsequent studies have not supported the theory. Still other studies of acne’s relationship to nutrition have shown that a diet with a high glycemic index, such as white breads, waffles, and other carbs, worsens acne.
Why do some adults have acne ?
Although the hormonal fluctuations that cause acne are most common during the teen years, they can also affect adults. Women may experience hormonal swings during their menstrual cycle, pregnancy, and menopause that result in acne breakouts. Acne can also be a side effect of certain medications, such as anticonvulsants and steroid drugs. Some people may also have a genetic predisposition to acne. One study found that 50% of adults with acne had a parent, sibling, or child with acne.
Should I stop wearing makeup if I have acne ?
You don’t have to stop wearing makeup altogether, but you might try switching brands or going with a different type. If you’re noticing breakouts along the sides of your temples, hair creams or gels might be exacerbating your acne. Look for cosmetics and toiletries with the label “noncomedogenic,” meaning that they don’t clog pores.
Does acne mean I’m not keeping my face clean enough ?
Not necessarily In fact, scrubbing too hard at your face can aggravate your acne, and using alcohol-based astringents can dry out the skin. Acne is triggered by hormones, and while gentle, regular cleansing with soap and warm water can sometimes help with mild breakouts, more significant acne requires more than just good hygiene.
What acne treatments are best for me ?
That depends on many factors: your age, whether you’re male or female, how severe your acne is, and how long you’ve had it, among others. There are several options available. For mild to moderate acne, many dermatologists will start with a combination of a topical cream or gel containing either a retinoid or benzoyl peroxide along with a topical antibiotic. For more inflammatory acne, an oral antibiotic may be added. For more significant cases of acne, women may be placed on birth control pills or on the drug spironolactone, a water pill which also blocks male hormones. Severe cases of acne may be treated with the drug isotretinoin, which is very effective. However, side effects and blood abnormalities must be monitored monthly and requires registration with the FDA to obtain a prescription. There are also various types of light or photodynamic therapies available.
When should I see a dermatologist for acne treatment ?
If over -the-counter treatments, like products containing benzoyl peroxide or salicylic acid, along with gentle cleansing, don’t work for you (give them a chance — it can take 4-12 weeks to clear up acne), a dermatologist may be able to help. Severe acne requires aggressive treatment to prevent scarring.
Will my acne ever go away ?
Most often, acne will go away on its own at the end of puberty, but some people still struggle with acne in adulthood. Almost all acne can be successfully treated, however. It’s a matter of finding the right treatment for you.
What causes acne ?
No one factor causes acne. Acne occurs when sebaceous (oil) glands attached to the hair follicles are stimulated at the time of puberty or due to other hormonal changes. Sebum (oil) is a natural substance that lubricates and protects the skin. Associated with increased oil production is a change in the manner in which the skin cells mature, predisposing them to plug the follicular pore. The plug can appear as a whitehead if it is covered by a thin layer of skin, or if exposed to the air, the darker exposed portion of the plug is called a “blackhead.” The plugged hair follicle gradually enlarges, producing a bump. As the follicle enlarges, the wall may rupture, allowing irritating substances and normal skin bacteria access into the deeper layers of the skin, ultimately producing inflammation. Inflammation near the skin’s surface produces a pustule; deeper inflammation results in a papule (pimple); if the inflammation is deeper still, it forms a cyst.
What other skin conditions can mimic acne ?
There a few other conditions that mimic acne:
• Rosacea: This condition is characterized by pimples but not comedones and occurs in the middle third of the face, along with redness, flushing, and superficial blood vessels. It generally affects people in their 30s and 40s and older.
• Pseudofolliculitis: This is sometimes called “razor bumps” or “razor rash.” When cut too close to the skin, growing hairs twist into the skin and produce tender bumps. This is a mechanical problem, and treatment involves shaving less (growing a beard, laserhair removal). Pseudofolliculitis can, of course, occur in patients who have acne, too.
• Folliculitis: Pimples can occur on other parts of the body, such as the abdomen, buttocks, or legs. These represent not acne but inflamed follicles. If these don’t go away on their own, doctors can prescribe oral or external antibiotics, generally not the same ones used for acne.
• Gram-negative folliculitis: Some patients who have been treated with oral antibiotics for long periods of time develop pustules filled with bacteria that are resistant to the antibiotics that were previously used. Bacterial culture tests can identify these germs, leading the doctor to prescribe different antibiotics or other forms of treatment.
When should someone start acne treatment ?
Since everyone gets acne at some time, the right time to treat it is when it becomes bothersome or when the potential for scarring develops. This can be when severe acne flares suddenly, for mild acne that just won’t go away, or even when a single pimple decides to show up the week before one’s prom or wedding.
What can people do to get rid of their acne ?
Lifestyle – Moderation and regularity are good things, but not everyone can sleep eight hours, eat three good meals, and drink plenty of water a day. One can, however, still control acne despite one’s frantic and unpredictable routine. Probably the most useful lifestyle changes one can make is to never to pick or squeeze pimples. Playing with or popping pimples, no matter how careful and clean one is, nearly always makes bumps stay redder and bumpier longer. People often refer to redness as “scarring,” but fortunately, it usually isn’t permanent. It’s just a mark that takes months to fade if left entirely alone. Open the pores – Occasional visits to an aesthetician who is an expert at safely removing blackheads during a facial can be beneficial. Cleansing and skin care – Despite what one might read in popular style and fashion magazines, there is no magic product or regimen that is right for every person and situation.
What is a good basic skin regimen ?
These are all good basic skin regimens that may help with the acne battle:
• Cleanse gently twice daily.
• Apply a gel or cream containing 5% benzoyl peroxide; an alternative is sulfur or resorcinol. Use a pad containing 2% salicylic acid to help exfoliation each morning.
• At night, apply a spot cream containing sulfur to the affected areas.
• Use a light skin moisturizer and water-based makeup.
Are there any effective natural acne treatment options ?
Some natural treatments may be helpful in reducing acne inflammation and breakouts:
Tea tree oil. Gels containing 5 percent tea tree oil may be as effective as are lotions containing 5 percent benzoyl peroxide, although tea tree oil might work more slowly. Possible side effects include contact dermatitis and, if you have rosacea, a worsening of those symptoms. One study reported that a young boy experienced breast development after using a combination lavender and tea tree oil hair product. Tea tree oil should be used only topically.
Alpha hydroxy acid. This natural acid is found in citrus fruit and other foods. When applied to your skin, alpha hydroxy acid helps remove dead skin cells and unclog pores. It may also improve the appearance of acne scars. Side effects include increased sensitivity to the sun, redness, mild stinging and skin irritation.
Azelaic acid. This naturally occurring acid is found in whole-grain cereals and animal products. It has antibacterial properties. A 20 percent azelaic acid cream seems to be as effective as many other conventional acne treatments when used twice a day for at least four weeks. It’s even more effective when used in combination with erythromycin. Prescription azelaic acid (Azelex, Finacea) is an option during pregnancy and while breast-feeding.
Bovine cartilage. Creams containing 5 percent bovine cartilage, applied to the affected skin twice a day, may be effective in reducing acne.
Zinc. Zinc in lotions and creams may reduce acne breakouts.
Green tea extract. A lotion of 2 percent green tea extract helped reduce acne in two studies of adolescents and young adults with mild to moderate acne.
Aloe vera. A 50 percent aloe vera gel was combined with a conventional acne drug (tretinoin) and tested for eight weeks on 60 people with moderate acne. The combination approach was significantly more effective than tretinoin alone.
Brewer’s yeast. A specific strain of brewer’s yeast, called CBS 5926, seems to help decrease acne. Brewer’s yeast is the only item in this list that’s taken orally. It may cause flatulence.
