ACNE is a common disorder. Approximately 30-85% of teenagers are estimated to have acne at some point in their lives. Acne affects males and females, generally occurs earlier in females and is usually more severe in males. Teens with acne are very vulnerable to negative thoughts that impact self-esteem and identity. These feelings contribute to general insecurity and feelings of inferiority. Studies have found that “adequate therapy for acne improves quality of life for patients as their acne improves.”
Patient compliance is a significant problem with treating acne. Patients often have too high of expectations for therapy and expect their acne to resolve instantly. There are multiple treatment options available. Your healthcare provider will choose the best combination of treatments to clear your acne and provide a maintenance plan to help keep it under control.
Some common MYTHS linked to acne are described below:
a. Dirt or poor hygiene – Dirt does not cause acne. Many believe plain soap & water will cure acne because it is caused by being dirty. Contrarily, excessive washing of the skin can lead to dryness, irritation and rebound oiliness.
b. Sun exposure and tanning – Certain wavelengths of light may improve acne short-term; but will not improve the overall outcome. Excessive exposure to sunlight causes premature aging due to collagen destruction and leads to skin cancers. If sunlight improves your complexion, get moderate amounts of it. Don’t sunburn or “bake” for hours. Don’t bother with sun lamps, since they can’t duplicate natural sunlight.
c. Makeup – Most cosmetics are water-based and noncomedogenic. We recommend foundation with silicone derivative to smooth any dry scale. Green tint undercover primers will offset red color of acne and superficial scarring.
d. Chocolate, candy, ice cream, greasy or fatty foods, and caffeine – Studies do not support this theory. It takes 3 weeks for a blemish to form!
As you begin treatment, keep in mind acne improvement takes 2-3 months!! BE PATIENT AND CONSISTENT. Stick with your treatment plan provided by your healthcare provider and you will see results.
WHAT CAUSES ACNE?
Acne is caused by the oil glands of the skin becoming plugged and breaking open. At puberty, the oil glands in the skin start producing an oily material called sebum. Sebum is discharged onto the skin’s surface. Sometimes the wall of the oil gland breaks and spills the sebum within the skin. The sebum irritates the skin tissues and causes redness, swelling, and pus—in other words, a pimple. Plugged oil glands may form blackheads and whiteheads. Blackheads are not caused by dirt. In mild acne, only a few oil glands break open; in severe acne, many do. How easily oil glands do this seems to be “built into” you. Acne runs in families. It is impossible to prevent acne, since there is no way of changing your oil glands.
AGE AND ACNE
Acne usually begins in the teens, gradually worsens, and then after a time improves. How long
you will have acne is impossible to predict. Acne gets worse and improves by itself. There is
usually no explanation for these ups and downs. Don’t assume that because your acne gets worse you’ve done something wrong. And, if your acne gets better briefly, it may not have happened because of treatment. In women, acne frequently worsens about the time of the menstrual period.
Dirt does not cause acne, despite what you may have been told. The oil on the skin’s surface does no harm. Special soaps, astringents, abradants, and acne cleansers are a waste of money. Wash your face with ordinary soap and water only as much as you need to keep it clean. Too much washing and scrubbing can cause skin irritation. Cleanliness may be next to godliness, but it doesn’t help acne. Do not pick, squeeze, or otherwise manipulate your pimples; it can leave scars.
DIET AND ACNE
Foods do not cause acne. Many persons try all sorts of diets and are frustrated because they don’t help. For some people, certain foods make acne worse. Chocolate, nuts, cola drinks, and root beer are the most common offenders. A few people who drink large quantities of milk—more than a quart a day—find that this worsens their acne. Aggravation of acne by food varies from person to person. Many acne patients can eat chocolate without trouble; others find that even a few pieces of chocolate cause new pimples. Find out for yourself if the foods just mentioned aggravate your acne. Eliminate one for a month and then test its effect by eating a large amount of the suspected food. If your skin improves when you stop eating a food and gets worse when you eat it, repeat the test. Acne has ups and downs of its own; make sure that the worsening isn’t just a coincidence. If certain foods make your acne worse, avoid them.
NERVES AND ACNE
Acne is not caused by nerves and worry but may become worse under stress such as examinations or pressure at work. These are usually mild, temporary flare-ups. Some persons react to stress by picking, squeezing, or rubbing their pimples, and this can make their acne worse.
Acne can usually be controlled with treatment until you outgrow it. Outgrowing acne often takes years, and treatment may be required for many months or years. Treatment depends on the severity of the acne. Mild acne can usually be controlled with medicines applied to the skin (topical treatment). Moderate acne usually requires antibiotics taken by mouth (systemic treatment), in addition to topical therapy. For persons with severe scarring acne, isotretinoin (Accutane) is the preferred treatment.
TREATMENT OF MILD ACNE
Antimicrobials applied to the skin are the standard treatment for mild acne. Antibiotics are available in liquid, cream, and gel forms and all should be applied thinly to the entire face. They dry to leave an invisible antibiotic film on the skin. It’s important to leave this antibiotic film on for some hours; apply your medicine in the morning after washing or shaving, and at bedtime. If you use makeup, apply the antibiotic first, then put the makeup over it. The antibiotic should be applied to the entire skin area involved with acne—don’t just put it on a few pimples.
Benzoyl peroxide is an antimicrobial often helpful in the treatment of acne. It is available by
prescription and over-the-counter. Benzoyl peroxide tends to dry out the skin and cause scaliness.
Some persons are not able to tolerate benzoyl peroxide. It is best to apply benzoyl peroxide
medicine only once a day. Start with a concentration of 5% or less.
In addition to antimicrobials, we often prescribe medicines to “unplug” the oil glands. These
“unplugging” medicines remove blackheads and help prevent pimples. Tretinoin (Retin-A and
other brands) and adapalene (Differin) are medicines that help remove blackheads. They also
improve acne. Sometimes they dry out and irritate the skin.
TREATMENT OF MODERATE ACNE
For moderate acne, we use antibiotics taken by mouth in addition to medicines applied to the
skin. Tetracycline, erythromycin, and minocycline are among the internal antibiotics used in
treating acne. Sometimes it is necessary to try several different antibiotics, or a combination,
before acne is controlled.
TREATMENT OF SEVERE AND/OR SCARRING ACNE
Severe acne is best treated with Accutane (generic name is isotretinoin), since it is by far the most effective medicine for treating acne. Deep acne lesions causing scars are an indication for Accutane treatment. Accutane controls acne by reducing the activity of the oil glands of the skin. It is taken by mouth every day for about 5 months. After that, over 95% of persons will be rid of their acne. One year after stopping Accutane, between 80% and 90% of persons will still be free of their acne. Three years after stopping Accutane, a little more than half of the persons will still be acne free. Accutane has many minor side effects such as dry lips, nose bleeds, and dry skin. These are only nuisances. Accutane’s main drawback is its high cost. It’s a remarkably safe medicine, except that women must not get pregnant when taking Accutane. If a woman gets pregnant while taking Accutane, serious birth defects are likely. This effect only lasts while the woman is taking Accutane; 1 month after stopping Accutane, it is safe to get pregnant.
A water-based makeup or foundation lotion, or a flesh-tinted acne lotion, can be safely used to
hide blackheads and other blemishes.
Customized treatments are available to help patients overcome stubborn acne outbreaks as well as a host of other unique skin care conditions.