Let’s talk about probably the most common skin condition there is, acne! It’s reasonable to say that nearly all of us have had some acne in life, whether bad breakouts during your teenage years or a few blemishes that may arise on a rare occasion. It is a condition that affects men and women of all ethnicities and is a chronic inflammatory disease that arises from the pilosebaceous unit, which consists of the hair follicle and its associated oil gland. The most common sites involved are the face, neck, and upper trunk. Although most cases are seen during the adolescent years, it is not uncommon for individuals in their adulthood to develop new onset acne. Several types of acne spots occur, often at the same time. They may be inflamed papules, pustules and nodules; or non-inflamed comedones and pseudocysts. Scarring may also occur as a result of acne.
What causes acne?
Multiple factors may contribute to acne, which can include genetics, increased hormones, environmental factors (i.e. dirty helmets), and medications. Essentially, the overproduction of oil from the sebaceous gland clogs the pores of the skin which traps bacteria and other debris. This leads to a continuous cycle of inflammation and eventually growing into the acne papules, pustules or cysts in which we see. The organism Propionibacterium acnes (P. acnes) is the bacteria which contribute to the majority of acne development. This bacterium is found in abundance on the surface of the skin. This is why it takes a multistep approach in order to treat acne properly, by maintaining your regimen, to prevent it from coming back.
What are treatment options for acne?
Acne treatments vary depending on the severity of the acne; most options include topical retinoid, topical antibiotics, and/or oral antibiotics. Topical therapy is the most common form of acne treatment and generally where your medical provider will start if you are new to treating acne. Topical therapy is used as preventative and maintenance therapy, and consistent compliance is vital to ensuring that it stays away. It is also important to be aware that acne treatment takes time and a patient should expect to start seeing the best results typically in 4 to 6 weeks.
Benzoyl peroxide is a very commonly used topical treatment used to suppress the P. acnes bacteria. Side effects associated with this medication are irritation to the skin with mild peeling, in which case the medication can be reduced to every other day Benzoyl peroxide can also be used in conjunction with topical antibiotics, such as Clindamycin or Erythromycin. The combination of using both of these medications is a more aggressive approach to reducing the bacteria resistance and therefore improving acne.
Topical retinoids (Retin-A) play an active role in the treatment of acne. This medication is vital in the treatment of acne as it inhibits the formation of blackheads and whiteheads. Irritation, dryness, and erythema may be seen at the onset of treatment, however with time these side-effects should decrease. It should also be noted that this medication can make the skin irritated if exposed to sunlight, therefore application should be limited to nightly use.
Oral antibiotics are also a great treatment option for patients with moderate to severe acne. The most common prescribed antibiotic is a form of tetracycline which also works by killing the P. acnes. The medication is taken once or twice daily and it may be prescribed for months at a time. Side effects may include: yeast infection, nausea, photosensitivity and staining of growing teeth, which is why this medication should be avoided in pregnant women and children under the age of twelve. As with many antibiotics, individuals taking oral contraceptives need to be aware that it may decrease the efficacy of birth control.
The last form of acne treatment is Isotretinoin (Accutane). Accutane is a reliable remedy for all forms of acne; however, it is usually reserved for moderate to severe acne. This medication works by permanently reducing the amount of oil secreted by the skin, therefore stopping acne at its source. The normal course of Accutane is five months of taking one to two pills daily. Approximately 40-60% of patients remain acne free after a single course of Accutane. As with any great medication, there are side effects associated with it, with the most significant being a certainty that it will cause severe birth defects if given during pregnancy; therefore, the FDA has mandated a program, IPledge program to help prevent pregnancies during Accutane treatment. An increase in triglycerides is also a side effect of the medication; however, it is one that can be avoided or controlled with diet maintenance. The most common side effect is dry skin, which occurs in 90% of patients. This includes dry lips, eyes, and nose. Other rare side effects are mood swings and depression, especially if there is a history of any depression or psychological disorders.
Although there are many great medical therapies for acne, there are also cosmetic options in the treatment of active acne and acne scarring. Among these options are microdermabrasion. Microdermabrasion is a lunch time procedure that is performed in a medical setting that causes an exfoliation of the superficial layer of the skin which can help open the pores; therefore, topical medications are allowed to penetrate more efficiently. Microdermabrasion also helps with acne scarring by helping to reduce the pink and purple discoloration associated with scarring. The procedure takes around fifteen minutes and after the procedure you can return to your normal day, with no downtime needed.
Superficial chemical peels are also a quick lunch time procedure that can help with active acne as well as acne scarring. By applying a topical chemical solution, it causes exfoliation of the skin which allows new, healthy skin to take its place. There are a wide range of chemical peels and it each has its own strength. It is important to have the conversation with your medical provider to determine which strength is best for you.
If you suffered from acne that is now all clear but has left undesirable scarring, one of the best options available is microneedling. Microneedling is a procedure in which your medical provider guides a device over the surface of the skin that creates tiny micro-channels in the skin. The body senses this trauma and starts the repair process of bringing in a large amount of collagen, elastin and other growth factors which promote brand new skin to fill in the scars. This procedure will also treat any hyperpigmentation caused by the scarring. The process takes approximately 20-30 minutes and it is advisable to apply a topical numbing cream about 1 hour prior to the procedure to ensure complete comfort. In addition, PRP, or platelet-rich-plasma therapy, can be added onto microneedling if a patient wants even more incredible results. PRP therapy involves drawing blood from the arm which is then placed in a centrifuge to separate the platelets from the blood. These platelets contain an extremely high amount of growth factors. This solution is then placed on the skin and the microneedling is performed. Doing this exponentially increases the effects of microneedling and shows excellent results.
If you are concerned about your acne and would love to start eliminating it, please do not hesitate to call or set up an appointment here on the website. The friendly, caring staff at Kayal Dermatology & Skin Cancer Specialists are here to take care of you and would love to help you get on your away to clear skin.