Acne is a common condition that affects many people of all ages. It is a myth that acne only affects teenagers. Acne is caused by multiple factors, but the primary problem is the formation of blackheads and whiteheads (comedones). These clog the follicle. This process is often driven by hormones, such as growth hormone, testosterone and progesterone. Levels of these hormones rise during puberty which is why acne occurs most commonly at that time. Diet may also contribute primarily through increased levels of insulin-like growth factor 1 (IGF-1) Increased oil production, bacterial overgrowth and inflammation follow and result in the other lesions of acne including papule, pustules, and nodules. The inflammation can result in scarring, both short term and longer term. Some may even be permanent. Discoloration after acne either red marks or dark marks can be common. These do typically fade over time, but it may take many months. Acne most commonly occurs on the face, chest, back and upper arms. Most acne is mild and does not cause permanent scarring. The majority of people do outgrow acne, but many people do require or desire treatment for this condition. There are many effective treatments.
Treatments for acne target each of these different processes. We use a variety of treatments to clear acne. The mainstay of treatment is a good cleansing regimen and a topical retinoid medication: Retin-A (tretinoin), Differin (adapalene), or tazorac. These medications are applied to the entire affected area daily to help to clear the comedones and to prevent new ones from forming. Another excellent medication is benzoyl peroxide, which can be purchased over the counter. This kills bacteria, decreases inflammation, and helps to dissolve comedones. Care must be taken since benzoyl peroxide can bleach fabrics. The downside of retinoids and benzoyl peroxide are that they can be very drying. For people with sensitive skin there are alternative treatment options, which may not work as quickly, but can also be very effective. Aczone , Finacea and sulfur/sulfacetamide products are excellent.
Antibiotics can be tremendously helpful in treating acne, particularly, inflammatory or cystic acne. The concern with chronic use of antibiotics is that it may be contributing to the epidemic of antibiotic resistant bacteria that are developing. For short term use up to 12 weeks, it is acceptable. Longer term use is discouraged by the American Academy of Dermatology and the Infectious Disease Society of America. Isotretinoin (Accutane,Claravis, Zenatane, Amnesteem, Sotret) is a powerful medication with many side effects which is regulated by the federal government, primarily due to its association with severe birth defects if it is taken by pregnant women. This medication although is safe when closely monitored and has a 90% cure rate for severe, nodulocystic acne resistant to other treatments. Hormonal therapy such as an oral contraceptive pill or spironolactone, a diuretic blood pressure medication, which is used off label for acne, can be extremely effective in women.
Procedures We Offer
There are procedures we offer for the treatment of acne as well. Unfortunately, these are not covered by insurance. Salicylic acid peels are relatively gentle and well tolerated by the majority of acne patients. These are performed in a series of 3-6 peels at 3-4 week intervals. Blu-U treatments are also performed as a series of treatments. 2 treatments a week for 4 weeks or 1 treatment per week for 10 weeks. Generally, these treatments require less frequent maintenance treatments to stay clear. Typically we recommend continued use of topical acne medications to keep the acne clear as well.
Research on diet and acne has been inconclusive in the past because it was difficult to pinpoint particular foods that would trigger acne. Recently, research has shown that a standard American diet including many processed foods is not good for acne. Eating fresh foods, primarily natural sugars and whole grains is the best diet to control acne. Generally following a “clean eating” type diet, but excluding dairy is best. Dairy specifically milk, has been linked to increased acne. Whether the milk is organic is irrelevant. It appears to be due to the insulin-like growth factor found in milk. Whey protein which many people take as a health supplement or meal replacement option can also increase incidence of acne or worsen existing acne. Chocolate also may exacerbate acne.