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If you have acne, formally known as Acne vulgaris, you are not alone. It is the most common skin condition in the United States with approximately 1 out of every 5 Americans being impacted annually. That said, the two demographics most susceptible to experiencing acne are teens and young adults. However, acne does not discriminate — it can occur at any age.
Acne doesn’t discriminate by age.
Newborns get acne. Children get acne. Middle-aged adults get acne. Menopausal women get acne. Anyone can get acne but thankfully there is a silver lining. With the right personalized treatment approach acne can be highly manageable. In recent years, many medical advances have been made; the incorporation of new, effective acne treatments coupled with a gradual shift towards individualized care has resulted in superior skincare regiments being prescribed which ultimately enhances each and every patients quality of life.
What exactly is acne?
One common misconception people have is thinking of acne and “pimples" as being one in the same. Rather, acne is an umbrella term under which many types of blemishes fall such as:
- Blackheads (known as open comedones)
- Whiteheads (known as closed comedones)
- Papules (red bumps)
- Pustules (red bumps with white centers, what many people call “pimples”)
- Nodules Acne commonly appear on the face, back, chest, neck, shoulders, and upper arms.
What causes Acne to form?
Acne first appears when a pore in the skin clogs. This clog begins with dead skin cells adhering to one another within a pore, gradually accumulating as time goes by. Dead skin cells, which are routinely shed from the skins surface daily, often find themselves unable to part ways when high levels of Sebum are introduced. The glue holding dead skin cells together is known as Sebum — an oily, waxy substance produced by your body’s sebaceous glands. At normal levels, it plays a protective role in coating and moisturizing the surface of your skin which prevents dehydration or dry skin.
What do puberty, pregnancy, menopause, and stress all have in common? They impact hormonal activity, which, simply put, drives an upregulation in the production of Sebum. An upregulation in the amount of Sebum being produced by your body leads to the excess secretion of this otherwise beneficial oil which causes dead skin cells to tightly adhere to one another within skin pores. This ultimately results in obstruction or clogging of skin pores which in turn provides an ideal environment for acne-related blemishes to emerge.
One type of bacteria that lives on everyone’s skin is called Propionibacterium acnes, or P. acnes for short. Inside the pores, the bacteria have a perfect environment for multiplying very quickly, especially if there is a lot of oil in the pores. When hormones change at puberty, oil production and secretion on the surface of the skin undergoes an upregulation, or increase, which results in an increased probability of pores becoming clogged. The combination of increased levels of surface bacteria and an increased rate at which oils are being secreted is a recipe for clogged pores to thrive. Once pores become clogged, they often cause localized irritation which results in the inflammation or raising of an impacted area of skin (red and swollen). In some cases the inflammation can damage the lining of the pore so much that a deeper breach occurs — this is how acne cysts or nodules first appear.
What are the Benefits of Acne Treatment?
Treatment has many benefits. If you have severe acne, which consists of deep and often painful lumps called cysts and nodules, effective acne treatment may prevent acne scars. Clearing acne usually improves a person’s self-esteem. Some patients say they feel happier and more confident.
If you want to treat acne, it is important to have realistic expectations. Misinformation about acne treatment is widespread. Here are five important facts about acne treatment that you should know:
- It takes time to see results (at least 4 to 8 weeks).
- “Overnight results” or an “immediate cure” is not possible.
- Treatment may help to clear existing acne faster, but works best to prevent new breakouts.
- To continue seeing results, you must continue treating acne even after your skin has cleared.
- When red acne bumps go away, they often leave red or brown flat marks which will gradually go away over several months. These are not necessarily permanent scars.
How is Acne Treated?
Dermatologists customize acne treatment for each patient. Before creating a treatment plan for you, a dermatologist must know some important information about you. Be sure your dermatologist knows if you are:
- Trying to become pregnant
- Allergic to any previous treatments you may have tried for acne To get your acne under control, you may need to use more than one acne treatment. This approach is called combination therapy and can produce the best results. These are some treatments that may be included in your plan:
Treatment Applied to the Skin
Your dermatologist may refer to this as “topical treatment.” Medicines that are applied to the skin help treat mild to moderate acne. These treatments work best to prevent new blemishes, so it is important to apply them to the entire area affected by acne, not just the acne spots. Some treatments unclog pores and prevent whiteheads and blackheads. Others reduce the amount of acne-causing bacteria on your skin. Some reduce the redness of your spots. Some of the active ingredients in these topical acne treatments can include retinoids, salicylic acid, benzoyl peroxide, or azelaic acid, and antibiotics such as dapsone, clindamycin or sodium sulfacetamide. You may receive a prescription for a topical acne medicine. Some effective topical medicines do not require a prescription. Your dermatologist will know what will be most effective for you.
Medicine that works throughout the body
Also called “systemic treatment,” this medicine helps to treat moderate to severe acne. You may receive a prescription for an antibiotic like minocycline, doxycycline, tetracycline or another medicine. These antibiotics can treat acne that covers a large area of the body.
Some women who have acne see their skin clear when they take hormonal therapy (birth-control pills with estrogen or spironolactone). Your dermatologist can help you decide whether this is a good treatment option for you.
Most acne treatments have little effect on deep and often painful cysts and nodules. When other treatments do not work, isotretinoin may be an option. It is the only medicine approved by the U.S. Food and Drug Administration (FDA) to treat severe acne. Acne will improve in about 85% of patients after one course (4-6 months) of treatment with isotretinoin.
Isotretinoin is not for everyone. The medicine cannot be prescribed to a female patient who is pregnant. The risk of a baby developing severe birth defects is high, even if taking this medicine for a short time. Women who can become pregnant must follow strict rules to prevent pregnancy. Future pregnancies are not affected by isotretinoin.
Because of the high risk of birth defects, both male and female patients must enroll in a program called iPLEDGE, before they can start taking isotretinoin. This program collects anonymous medical information about patients who are using isotretinoin. This information is used to determine if education to prevent birth defects is effective. If you decide to take isotretinoin, your dermatologist will monitor you closely. You should immediately report any possible side effect to your dermatologist.
It is rare for a procedure to clear acne. Dermatologists include procedures in their acne treatment plans because a procedure may improve the overall results you get from other acne treatments.
Acne is not caused by dirt and cannot be washed away. Your dermatologist can create a skin care plan that helps prevent breakouts. Follow these dermatologist tips on how to care for your skin:
- Be gentle with your skin. Avoid skin care products that feel rough on your skin.
- Wash twice a day and after sweating. Excessive washing and scrubbing will not prevent or treat acne. Too much scrubbing can irritate your skin and make acne worse.
- Keep your hands off your face. Do not pop, squeeze or pick at your acne.
- Look for the words “non-comedogenic” on cosmetic or sunscreen labels. These products should not cause blackheads, whiteheads or red pimples. You also may see the term “non-acnegenic” or the phrases “won’t cause acne” or “won’t clog pores.”
- Do not seek a tan to “treat” your acne. Tanning does not “dry out” acne. In fact, it damages your skin. In addition, some acne medications make the skin very sensitive to ultraviolet (UV) light which can make your acne worsen.
Does My Diet Affect My Acne?
There may or may not be a link between diet and acne. Researchers are studying certain foods and beverages, like milk, to find out whether they worsen or trigger acne. Foods that cause high blood sugars, such as white bread and sugary snacks may worsen acne. Studies have shown that smoking also makes acne worse. Tip: Avoid getting oil from very greasy foods on your face. Working in a greasy environment, such as a fast food kitchen, may worsen acne. When some vegetable oils touch the skin, acne can worsen.
How can Existing Acne Scars be Treated?
Once your acne is under control, your dermatologist can treat your acne scars. Dermatologists use lasers, chemical peels, microdermabrasion, fillers, and other procedures to diminish the appearance of acne scars. Like treatment for active acne, a successful outcome often comes from a customized treatment plan. A board-certified dermatologist is a medical doctor who specializes in diagnosing and treating the medical, surgical, and cosmetic conditions of the skin, hair and nails.
All content solely developed by the American Academy of Dermatology. Copyright © by the American Academy of Dermatology and the American Academy of Dermatology Association. Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides American Academy of Dermatology