Acne usually starts shortly after puberty due to hormonal changes and increased oil secretion. While most cases are seen in teenage years, it is common to see patients (particularly women) in their 30s, 40s, and 50s with adult onset acne. Internal hormonal changes and starting/stopping/switching birth control pills may play a role.
Acne develops when hair follicles, the site of acne, get plugged with dead skin cells. This causes sebum (oil) to accumulate which then promotes the normal bacteria on the skin to grow. The bacterial then causes the swollen oil gland to become inflammed leading to pimples and cysts. Many factors contribute to the tendency for plugging– including hormones, genetics (esp if Mom or Dad had bad acne as a child), and stress.
Acne does not come from being dirty. Washing your face is part of taking care of your skin and will help keep your skin clear. But excessive washing will not clear up acne– many people will also need acne medication. Fortunately, these medications work really well to clear up acne when used properly.
Types of Acne Lesions:
1. Comedones (whiteheads and blackheads) are caused by oil and dead skin cells which leave a plug below the skin surface. These are best treated with comedolytics (medications that open up the pores), such as RetinA or tretinoin, benzoyl peroxide, and salicylic acids.
2. Papules (red pimples) and Pustules (white pimples): the material in the plugged hair follicle seeps through the walls of the follicle and causes redness and inflammation. A combination of comedolytics and antibiotics are helpful to clear these spots.
3. Cysts: A very deep, ruptured, inflamed follicle. Most patients with cystic acne do best with oral antibiotics or Accutane.
Acne & Diet
It is a common misconception that “fatty foods” and chocolate causes acne. In most cases, food probably plays a very small role in acne. Studies have shown that in general, soda, chips, caffeine, fried foods, and chocolate do not cause acne. So why the link between these foods and acne? Stress may aggravate acne, and it may simply be that we eat certain comfort foods (like chocolate) when we are stressed hence the link most people make between chocolate and acne.
A balanced diet is good for everyone. If you feel that some food makes your acne worse, it is best to avoid them. New studies have shown that a small group of patients may benefit from a low “glycemic diet”– less processed sugars such as sodas, candy, etc. Also, recent medical literature have suggest that excessive consumption of dairy products may exacerbate acne. This may be due to growth hormones given to cows to increase their milk production which then subsequently may trigger excessive oil gland activities in the skin. If you like to drink lots of milk/dairy products, you may want to consider switching to ORGANIC dairy products.
Acne and Cosmetics
Many cosmetics, especially some cleansing creams and moisturizers, have greasy bases that can aggravate acne. Be sure to use moisturizers and cosmetic that are labeled “non-comedogenic” meaning they are less likely to clog the pores and cause acne.
Should pimples be squeezed?
No, definitely not. Though popping a pimple may make it less noticeable temporarily, you can cause it to stay around longer. By squeezing pimples, you can actually push bacteria further into the skin, increasing the swelling and redness. In fact, more damage can be done to the skin by picking and squeezing than by the acne process itself. Picking and squeezing almost always leads to scarring.
Acne Treatment:
Therapy should help lessen the severity and reduce the amount of scarring, which could result from acne if left untreated. Different combinations of medications may need to be tried to determine which combination is best for you. It will take 8 to 12 weeks to see results in most people. Acne medications work best to PREVENT pimples, rather than make existing ones go away. Therefore, it is best to use the medicine on a daily basis rather than only when you notice a breakout. Topical therapy should be used to the entire area of the face that gets acne. Spot treatments of individual pimples do not usually help.
Topical Therapy:
1. Cleansing: Bacteria and oil on the surface of the skin do not cause acne, only bacteria and oil inside the hair follicles cause acne. Therefore, mild soap (Dove, Purpose, Cetaphil, Neutrogena) twice a day is enough to remove excessive surface oil. If you feel your skin is especially greasy, use acne wash with salicyclic acid or benzoyl peroxide (Clean & Clear). If you play sports, try to wash right away when you are done playing. Excessive washing and facial scrubs can cause irritation and likely make the condition worse.
2. Topical antibiotics: Clindamycin and Erythromycin. These help decrease or kill skin bacteria.
3. Benzoyl Peroxide (BP): These unclog pores and prevent bacteria growth, thereby decreasing the number of acne lesions. **Dr. Popkin prefers to use BP and topical antibiotics in combination to prevent antibiotic resistance (such as Benzaclin and Duac). Combination medication may be slightly more expensive but they often work better. BP can bleach towels and clothing—be careful!
4. Retinoid: (Retin A, Differin, Tazorac). These topical vitamin A preparations are particularly useful to unclog pores to eliminate blackheads and whiteheads. These may exaggerate the effects of the sun. For this reason, they are best applied in the evening. Fair-skinned patients should be careful about prolonged sun exposure.
Systemic Therapy:
1. Antibiotics: Tetracycline, Doxycycline and Minocycline are the most common antibiotics used.
2. Isotretinoin (Accutane): Accutane was introduced for acne around 1982. It is a vitamin A derivative and is the most effective anti-acne medicine we have. It is very effect for severe cases and milder acne patients who have failed other therapies.
3. For women: Hormones: Birth control pills can help women who notice worsen acne flare-ups with their period by regulating hormone fluctuations throughout the month. Certain brands such as Yaz and Yasmin have specific anti-androgen (anti-testosterone) effects which are quite effective for acne. Spironolactone is another medication that is a mild diuretic (water pill) with antiandrogen effects—it is not a birth control but is a hormone alternative for women in their 20-40’s for acne.
Rarely, severe acne in women may be associated with hormone abnormalities. If you have heavy, irregular periods and/ or excess facial hair, you should let Dr. Mann know, as lab tests may be helpful to determine if there is an underlying cause to your acne.
Acne Surgery, Peels, and Injections:
While most patient will respond to topical and systemic treatments, some patients want faster results than can be provided by these treatments. In these cases, Dr. Popkin may combine newer surgical treatments with standard therapies for quicker results.
- Injections: Acne cysts respond well to injections of a mild anti-inflammatory steroid. This often leads to rapid improvement.
- Acne Surgery refers to the removal of acne comedones (clogged blackheads and whiteheads). This prevents their evolution into more inflammatory lesions.
- Acne Peels and Dermabrasion can be helpful to exfoliate the skin and gently unclog pores. Over time, they can also help stimulate collagen formation to improve acne scarring.
Tips for managing your acne:
Here are some tips on managing your acne:
- Don’t squeeze acne: Acne treatment takes time to work. It may be tempting to sqeeze acne to get rid of it, but squeezing tends to make it worse. Sometimes it can even cause permanent scars. So don’t pick and be patient!
- Use non-comedogenic makeup: While you are waiting for your acne to get better, it is ok to use makeup to cover up your spots. But be sure to use non-comedogenic makeup that doesn’t clog your pores such as Mineral makeup.
- Be gentle to your skin: Excessive scrubbing and cleaning your face will not clear up acne. Scrubbing can irritate the skin and make acne worse.
- See a dermatologist: Thanks to the variety of treatments we have available, virtually every case of acne can be controlled. If you have not found a treatment that has worked, Dr. Popkin can help.
If you would like a consultation with Dr. Popkin to see what acne treatments are right for you, please call us for an appointment at 440-250-2450.