Acne is one of the most common skin diseases; it affects both adolescents and adults. This skin disease ranges from mild to severe and can lead to scarring if left untreated. Patients often worry about the appearance of acne and the social embarrassment it may cause. There are many effective treatments available depending on the patient and the severity of the disease.
Acne often initially occurs during adolescence. A combination of hormones, genetics, environmental factors, and bacteria are major contributors to this condition. Blackheads, whiteheads, and cysts, which may become swollen and painful, appear on the face, chest, back and shoulders.
Therapies range from the use of topical creams and gels, washes, oral antibiotics or even the use of isotretinoin in more severe cases. There are also lasers and non-laser treatments including Blu-light, IPL, microdermabrasion and specifically designed chemical peels and acne facials to reduce the appearance of acne.
During your acne appointment, our dermatologist, Dr. Eric Tabor, and one of his certified Nurse Practitioners, Physician Assistants or Aestheticians will help create an acne treatment plan individualized to meet your specific needs.
Acne vulgaris (the medical term for acne) affects approximately 45 million people in the United States and is the most common reason patients will visit the dermatology office.
Acne vulgaris is generally thought to be caused by four main factors:
- abnormalities of the pilosebaceous (hair follicle plus oil gland) unit such as increased sebum (oil) production due to an increase of hormones circulating in the blood
- bacterial overgrowth of a normal skin bacteria called Propionibacterium acnes (more commonly called P. acnes)
- hyperkeratinization or thickening of the skin cells that line the hair follicle/oil gland apparatus
Many people still believe that acne is caused by dirty skin. While washing the skin can help remove excess surface oils and dead skin cells, washing alone usually isn’t enough to overcome the biological factors causing acne lesions to arise. Washing the skin twice a day gently with water and a mild soap is usually all that is recommended. When that isn’t enough, acne medications may be recommended to help curb outbreaks.
Stress is commonly blamed for the development of acne. Stress can have many physiologic effects on the body, including changes in hormones that may theoretically lead to acne. In some cases, the stress may be caused by the acne lesions, not the other way around. Stress is commonly blamed for the development of acne.
Typically, acne is thought to begin at puberty and be resolved by the early 20’s. This is not always the case. In some cases, acne may persist into adulthood. Such types of acne include severe forms that affect the body called truncal acne as well as the face which is more common in men and acne associated with the menstrual cycle in women. In other cases, acne may not present itself until adulthood. Such acne is more likely to affect females than males. Hormonal changes due to pregnancy, ovarian pathology, and oral contraceptive pill changes are just a few examples of hormonal changes that can lead to acne.
Contrary to popular belief, acne is not caused by food. Following a strict diet will not clear your skin. While some people feel that their acne is aggravated by certain foods, particularly chocolate, colas, peanuts, shellfish and some fatty foods, there is no scientific evidence that suggests food causes or influences acne. Avoid any foods which seem to worsen your acne and, for your overall health, eat a balanced diet–but diet shouldn’t matter if the acne is being appropriately treated.
Everyone’s acne must be treated individually. If you have not gotten good results from the acne products you have tried, consider seeing a dermatology provider. Your provider will decide which treatments are best for you. Look for “noncomedogenic” cosmetics and toiletries. These products have been designed to be non-pore clogging and will not cause comedones (whiteheads and blackheads) or in other words be noncomedogenic. Some acne medications cause irritation or pronounced dryness particularly during the early weeks of therapy, and some cosmetics and cleansers can worsen this effect. Please consult your dermatology provider should you have any questions about the products you are using.
Yes. In general, acne lesions should not be picked or squeezed by the patient. In particular, inflammatory acne lesions should never be squeezed. Squeezing forces infected material deeper into the skin, causing additional inflammation and possible scarring.
Scarring is best prevented by getting rid of the acne. Dermatologists can use various methods such as topical medication, lasers, or dermabrasion to improve the scarring caused by acne. The treatment must always be individualized for the specific patient. It is important that the acne is well controlled before any procedure is used to alleviate scarring.
The time for improvement depends upon the product being used, but in almost all cases it is more a matter of weeks or months instead of days. For a typical acne visit, I begin a regimen at the initial visit and then request a follow-up visit 6 weeks later. At this point, 50% improvement would medically be a great achievement. In everyday life, however, this means hypothetically if you had 10 lesions for the first visit, you would still have 5 lesions remaining in a 50% improvement scenario. It is very important for patients to be aware of this time frame so they do not become discouraged and discontinue their medications. Conversely, if you see no change whatsoever at the 12-week point, you might want to check with your dermatology provider regarding the need to change treatments.
No–always use your medication exactly as your dermatology provider has instructed. Using topical medications more often than prescribed may induce more irritation of the skin, redness and follicular plugging, which can delay clearing time, and will not improve the outcome of your treatment. If oral medications are taken more frequently than prescribed, they won’t work any better, but there is a greater chance of side effects.
Topical acne medications are made to be used on all acne-prone areas, not just individual lesions. In other words, we recommend that a patient with acne treats the whole face, chest, back, or whatever body part you are trying treat. It should not be used for spot treatment unless otherwise indicated by your dermatology provider. Part of the goal is to treat the skin before lesions can form and to prevent formation, not just to treat existing lesions.
Topical acne medications are made to be used on all acne-prone areas, not just individual lesions. In other words, we recommend that a patient with acne treats the whole face, chest, back, or whatever body part you are trying treat. It should not be used for spot treatment unless otherwise indicated by your dermatology provider. Part of the goal is to treat the skin before lesions can form and to prevent the formation, not just to treat existing lesions.
This is a common problem. Many patients try to associate taking their medication with a routine daily event such as brushing teeth or applying makeup. It also helps to keep the medication close to the area where the reminder activity is carried out. My recommendation is to keep a sticky note on the mirror, that way when a patient is getting ready for work or school, they will be reminded to take/apply their medicines.
If you forget a dose of the oral medication, it is not a good idea to double up on the medication at this can increase side effects. You should just continue the regimen as prescribed. The same goes for the topical treatments as it was discussed before: just because you use the medicines more doesn’t mean that you will get better results.