WHAT IS ACNE?
Acne vulgaris, which we commonly know as acne, affects virtually everyone at some point, and 40 to 50 million Americans suffer from this skin condition. It’s characterized by whiteheads, blackheads, small red pimples, and for some, large cystic and painful red bumps. It’s a nasty condition because for the most part it affects teenagers, who have the least tolerance for the psychological difficulties associated with it.
Severe cystic acne can lead to permanent damage, Adults are not immune to acne, and it tends to appear around the chin and jaw line. Some reports say that 80 percent of adult women report persistent acne, and 53 percent of women over the age of 33 have premenstrual acne flare-ups. Acne seems to be less common in men after the age of 25.
WHAT CAUSES ACNE?
Acne is common in teenagers because their puberty-dependent sex hormones are being released at high doses and the oil glands are particularly sensitive to these hormones. The fluctuations in hormone levels during both the menstrual cycle and menopause may also influence acne breakouts.
During these times, the oil glands are stimulated to produce more sebum (a waxy-like substance). In addition, in teenagers, skin cells reproduce rapidly. A hereditary component certainly exists, and some people have a predilection for excess buildup of skin cells and oil production.
Excess buildup of skin cells blocks a skin pore and forms a plug. If the plug is under the skin surface, it has a white color and we call it a whitehead. If the pore is open to the air, the plug turns black and is called a blackhead. The combination of the plug and excess sebum production results in a backup of oil, which is a breeding ground for propionic bacteria. When this bacteria flourishes it stimulates inflammatory signals that cause the red-hot, painful, and pus-filled pimples to form. In severe cases, large cysts form under the skin surface and these can lead to permanent “icepick” scarring.
TOPICAL AND/ OR ORAL TREATMENTS
Another key component in preventing and treating acne is to prevent pores from clogging or to unclog ones that are already blocked. I recommend using a water-soluble, easily rinsed, gentle skin cleanser and lukewarm water. Avoid bar soaps or cleansers with heavy alcohol or astringents because they can irritate the skin or aggravate existing breakouts.
I usually recommend a gentle cleanser made by Cataphyll, although many are available. Removing excess skin debris with a salicylic acid product can then follow cleansing. The Salicylic Acid breaks down and sloughs off the extra skin cells. Salicylic Acid is particularly good at penetrating oil glands and is much better than a glycolic acid. It also has anti-inflammatory characteristics that allow it to open up the pores and decrease the built-up inflammation. Salicylic Acid comes in many strengths and forms, including solutions, gels, lotions, and creams. Over-the-counter strengths range from 0.5 to 2 percent and it’s important to have a pH of 3 to 4. A pH above this may block effectiveness. Acid lotion base is probably best, as solutions or gels may dry and irritate the skin and cream bases may be too oily for acne-prone skin.
If Salicylic A doesn’t unplug the pores, then products derived from Vitamin an are available by prescription. These include Retin A, Renova, Differin, and Tazorac. All these products help to break down skin cells to treat clogged pores and prevent further clogging. These products have other benefits, too, in that there anti-inflammatory qualities help improve the appearance of aging skin. This is why they are great options for women in their forties who still have acne.
Some facts about these products:
- Retin A comes in multiple strengths, but the very concentrated versions can irritate the skin, so it may be beneficial to start with a milder version such as Renova.
- Differin is a bit less irritating and generally as effective as Renova, and also may be a good product to use when beginning treatment.
- Sunscreen use is essential as these products increase sun sensitivity.
- In addition, those who are pregnant, at risk of pregnancy, or planning a pregnancy should not use these products.
Treating the Bacteria
The goal is to disinfect the skin by removing or killing the bacteria responsible for causing acne. Benzoyl peroxide (BP) is a good product for treating acne caused by a type of bacteria known as propionic acnes.
This product comes in multiple strengths from 2.5 to 10 percent and in multiple forms such as soaps, washes, and cleansers. It’s good to use this product following an SA wash, which opens the skin pores and allows the BP to do its job more effectively.
Evidence exists that BP and a topical antibiotic, such as clindamycin (available by prescription) work together well. If BP alone isn’t working, the combination is a good option. If topical antibiotics are not effective enough, some people respond well to oral antibiotics. Of course, this generally shouldn’t be a first-line therapy because of the possible side effects of any antibiotic, including yeast infections, stomach upset, and increased sun sensitivity.
However, most people see acne clearing up quickly when they begin oral antibiotics. Today, the antibiotic minocycline seems to be the best option for acne. However, continued use causes the acne bacteria to develop resistance to the antibiotics, thereby making it ineffective. (This is what happened with erythromycin, an older antibiotic mostly out of circulation for this reason.)
PROCEDURES AND OTHER TREATMENTS
Those who don’t want to take a potentially dangerous oral medication may consider light-based laser treatments for improving acne. Lasers alone or lasers used in combination with a topically applied solution called photodynamic therapy have proven very successful. In fact, they may soon be the treatment of choice for moderate to severe acne control.
Steroid injections offer immediate-relief option for a bride on the day before her wedding. In such situations, the area is cleaned and a mild steroid is injected into the acne lesion. This causes mild discomfort, but most people don’t mind because they know that the lesion will be almost completely gone by the next morning.
When Acne Is Severe
Those with severe acne may be candidates for Accutane, a powerful drug taken orally that stop acne in its tracks. It’s only taken for a short period of time, but the results can last for months or years. The side effects and other facts important to note are:
The drug causes birth defects to a fetus if taken during pregnancy. This is such a big issue that a woman must have two negative pregnancy tests and agree to use effective contraception before she can get a prescription for the drug.
Some reports mention increased depression and suicide in people taking Accutane. I tend to find this data a bit suspect, but it is reported so I mention it.
Accutane significantly interferes with wound healing. Those who want a laser resurfacing treatment must wait about a year after finishing the Accutane treatment in order to undergo laser treatments.
There are a variety of approaches to help eliminate acne scars. Some techniques do not offer a permanent solution for acne scars.
Microdermabrasion is ideal for dark-skinned patients who have mild acne scarring because there is no risk of discoloration. It’ effects are similar to a chemical peel. Microdermabrasion requires no anesthesia and there is very little recovery time. This procedure minimizes the appearance of acne scars rather than providing a permanent solution
Chemical peels are for light scarring and minimize the appearance of acne scars rather than providing a permanent solution. The chemical solution is applied to the skin, the skin then blisters and peels, usually within 2-3 days. The peeling can continue for several days after. After the outer layer of skin has peeled the patient is left with smoother softer skin.
Fillers are injected under a depressed scar to elevate it to the level of the surrounding skin. This is a temporary solution that lasts from 6 months to one year.
Laser resurfacing is used for shallow scars. The laser removes skin so that a new layer can grow in its place. The procedure takes only a few minutes for small areas up to an hour for larger areas. Laser skin resurfacing is most successful for patients with lighter skin. Recovery takes several days and there may be some redness for several weeks and the skin may have a pinkish tone for several months after the surgery.
For information on how to treat acne scarring contact Riverwalk Medical and Wellness.