Acne

Acne is the most common skin condition affecting adolescents and young adults. It presents as pimples, white heads, black heads, cysts, nodules, and sometimes scarring. It usually occurs on the face, but can also involve chest, abdomen, back, shoulders and arms.  It can be easily diagnosed and treated with effective and affordable options, that are aimed at controlling scarring and emotional and psychological effects associated with it. Upto 90% of adolescents experience some form of acne. Sometimes it can carry into or present during adulthood. Acne is not a cosmetic condition, it is a medical condition that needs treatment. Scarring can cause physical disfigurement so it is important to get acne under control.

What causes Acne?

Acne develops when pores become clogged and inflamed. A pimple or formed when oil glands produce too much oil and bacteria overgrow causing inflammation. A whitehead is formed when a pore becomes completely blocked by oil and dead, while a black head is formed when the pore is open. Excessive oil production and inflammation can cause deep inflammation, causing cysts and nodules to develop. 

There are many causes of acne. It is believed that oil production in skin is under the influence of hormones, but can also be due to inherited or environmental factors. Environmental factors include high coverage makeup that clogs pores, humidity and certain medications. During puberty, pregnancy, and menstrual cycles, increases in certain hormone levels , can  increase oil production in skin, causing acne flares. Studies have shown that acne is associated with diet high in carbohydrates (high glycemic index diet). 

Treatment of Acne

The goal of all acne treatment of acne is to control skin shedding, oil production, inflammation and scarring. Most dermatologists will use combination of oral and topical treatment options.  It is important to be patient and compliant with the prescribed treatment plan as it can take up to two months to show benefit. Not all treatments plans work for everybody so it is important to follow up with your dermatologist regularly to individualize your treatment plan and find a plan that works for you. It is also important to avoid any known triggers and only use skin care products that are labeled 'non-comedogenic' so that they will not clog up your pores and worsen your acne. 

  • Topical Antibiotics: decrease growth of bacteria on skin that causes acne, and help reduce inflammation.

  • Oral Antibiotics: when inflammation is severe, oral antibiotics are used to get bacterial growth and inflammation under control, to help reduce scarring from nodules and cysts.

  • Benzoyl Peroxide: kills the bacteria on your skin, and also removes excess oil

  • Salicylic Acid: used for exfoliation and shedding of skin from white and black heads as well as acne pimples. 

  • Retinoids: increase the rate of skin shedding so as to flatten all existing acne lesions and prevent formation of new lesions. Most common retinoids used are tretinoin, adapalene and tazarotene.

  • Spironolactone: used in female patients with predominantly hormonal acne that fluctuates with hormone levels and menstrual cycles, and usually presents on lower face, with deep-seated pimples or nodules. It is important to let your 

  • Birth control pills (oral contraceptive): certain birth control pills can help regulate hormonal fluctuations in menstruating females and can help control acne. It is important to let your dermatologist know if you smoke, have high blood pressure, migraines or personal or family history of breast cancer, ovarian cancer, uterine cancers or blood clots.

  • Isotretinoin (Accutane): oral form of retinoids for severe cystic or scarring acne, when all other treatment options fail. It reduces oil production as well as secretion at the gland level inside the skin. Treatment with this option requires enrollment in iPledge program, a FDA regulated program. Men and post-menopausal women can be started on this program with minimal delay, but females of child-bearing potential and transgenders with functional uterus and intact ovaries, require a minimum of 4-5 weeks wait period, and two negative pregnancy tests before the medication can be dispensed. Treatment spans over 6-8 months with visible improvement within 2 months. 

Your dermatologist will assess you and recommend a treatment plan based on your age, gender, skin type, symptoms, and scarring, if any.