What is Acne?
Acne is a skin condition 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. Typical teenage acne develops between ages 12 to 18, but may occur as early as age 8.
Many adult women, even those who never experienced teenage acne, develop hormonal acne during their 20’s or 30’s, and most find this very frustrating.
What are the causes of Acne?
Acne is generally thought to be due to genetics, puberty, hormones and occasionally oil–based cosmetics.
Diet and dirt are not causes of acne. The dark pigmentation in blackheads is pigment from the hair follicle. Excessive washing and scrubbing can actually make acne worse.
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.
Why is Acne treatment necessary?
While it is true that teenage acne often resolves on it’s own by age 18-20, it can cause significant scarring if left untreated. Emotional scars can often spoil the teen years, and acne can be equally distressing for adult women who often lament that they are starting to get wrinkles and still have acne.
How is Acne treated?
All dermatologists use combination therapy to treat acne. What combination is used will depend upon whether the acne is primarily plugged pores (blackheads and whiteheads) or inflammatory lesions (cysts and papules).
For comedones (plugged pores) topical medications with vitamin A acid-like compounds and benzoyl peroxide are usually used first. Treatment is an ongoing process and improvement may take up to 6 weeks to start.
For more severe acne, oral antibiotics such as tetracycline, minocycline, doxycycline or sulfamethoxazole and often added to the topical gels/creams. These antibiotics help to reduce inflammation even though acne is not caused by an infection. Tender. swollen acne cysts can be treated with cortisone injections if they are caught early on.
Acne related to hormonal fluctuations is usually treated with birth control pills often in combination with spironolactone (which helps to block the effect of hormones on oil glands) or oral antibiotics. Contrary to old case reports, detailed studies have shown that antibiotics of the kind used to treat acne do not reduce the effectiveness of contraceptive pills.
When is Accutane used?
Accutane is a unique, very effective acne medication which has been available for nearly 30 years. It works by temporarily shrinking the oil (sebaceous) glands, thus “starving” the acne. Because it causes birth defects if female patients become pregnant while taking this drug, it’s use is limited to those patients who have failed other treatments or who have more severe acne. A course of treatment with Accutane (isotretinoin) is usually 4-8 months depending on dosing, response to treatment, weight of the patient and tolerance of side effects. Because Accutane shrinks the oil glands of the skin, dry lips/nose/eyes can be a problem. These common side effects are usually easy to control.
How can patients assure the best result from treatment?
Treating acne is a team project, and following through with the recommended treatment is the most important part of this teamwork. The most common cause of treatment failure is failure to use the proscribed medication. Treatment is usually very successful and can make the patient look and feel better as well as preventing scars.