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Acne

 

Acne is the most common skin disease in the United States, affecting 40 to 50 million Americans. Acne generally occurs in teenagers (85% develop acne each year) and young adults, though it can affect anyone and is common into our 40s and sometimes beyond.  Acne is characterized by plugged pores, inflamed pimples and deeper, tender lumps (cysts). It usually occurs in the areas of increased oil (sebaceous) glands – face, chest and back.  Many adult women, even those who never experienced teenage acne, develop hormonal acne during their 20’s or 30’s.

Causes:

Acne is generally thought to be due to genetics, puberty, hormones and occlusion (e.g. sports helmets that trap oils, certain make-ups). Research has shown that four key elements contribute to acne. They are: excess oil, clogged pores, bacteria, and inflammation. During adolescence or with natural hormonal fluctuations, the body begins to develop more sebum oil, which is produced to ensure our skin does not dry out. When sebum cannot flow freely to the skin, clogged pores result. Bacteria already found on the skin’s surface, flourishes in the excess oil, and causes inflammation. 

In the acne seen in adult women, the hormonal fluctuations of the menstrual cycle, pregnancy, menopause or birth control pills have a major effect on acne severity. This type of acne is often cyclical and occurs around the mouth and chin.

Treatment:

We don't have a way to "cure" acne, but we have many great treatment options to manage it. Because every case is different, one treatment may not be as effective for one person as the next. Sometimes we have to try more than one treatment until we find the right combination for you. Fortunately, when acne is properly treated, it can restore the confidence and positive self-image that often wane in people afflicted by acne. Some common options include:

  • Cleansers:

    Cleansers containing glycolic acid, salicylic acid, or benzyl peroxide reduce acne and decrease redness. These agents dry out the skin, remove debris, and unclog clogged pores. Some cleansers containing benzyl peroxide will dry the skin, causing it to peel, and thereby helping prevent the growth of bacteria.

  • Topical Retinoids:

    Topical retinoids (vitamin A) work by loosening the plugs in clogged pores, decreasing oil production and are helpful in removing superficially clogged pores that cause blackheads and whiteheads. They are also great for lightening dark spots that can be left behind when acne is healing.

  • Topical Antibiotics:

    Topical antibiotics are used to remove the skin bacteria that leads to papules and pustules. They may be used in combination with other agents.

  • Oral Antibiotics:

    Oral antibiotics may be prescribed for more severe acne lesions, and are mot effective in treating papules, pustules, and cysts. They work to decrease inflammation and bacteria around the acne lesion.

  • Isoretinoin (Accutane):

    Isoretinoin is an oral medication that is only used for more severe or persistent acne. Isoretinoin, which is high-dose vitamin A, reduces the size of the skin’s oil glands and the amount of oil the skin produces. The reduction in oil also leads to the reduction of bacteria living in the skin. Isoretinoin also slows down how fast the skin produces skin cells inside the pore, which helps pores from becoming clogged. There are many severe side effects of Isoretinoin, which need to be understood before undertaking this medication as a course of treatment. 

  • Birth Control Pills:

    Birth control pills may help reduce acne in female patients by decreasing the effect of male hormones that increase or trigger acne development. Birth control pills can have serious potential side effects that must be considered when determining your acne treatment plan.

  • Aldactone:

    This is an oral medication that can help with female hormonal acne. There are potential side-effects with this medication that must  be considered when determining your acne treatment plan.

  • Procedures:

    Several procedures can be used on their own or ideally as a part of a treatment plan.  These include: Blue light treatment, during which we expose the affected skin to the blue wavelength of the visual light spectrum; this procedure helps reduce the natural bacteria in the skin and is anti-inflammatory. Chemical peels can help decrease inflammatory lesions and promote exfolliation. They also lighten dark spots.  Microdermabrasion and extractions are ways to remove blackheads and whiteheads.

If scarring from acne occurs, some options such as chemical peels, dermabrasion, or laser therapy may help reduce the appearance of scars. Talk to Dr. Ahmed if you are interested in this type of treatment.

Prevention:

Research has proven that heredity, hormones, menstruation and emotional stress can trigger acne, or make it worse. Although many of these factors cannot be avoided, it is recommended that patients not wash or scrub the skin excessively, which can irritate the skin and make acne worse. Diet does not generally contribute to acne, except in the case of allergy or sensitivities, which generally increase inflammation.