People commonly associate acne and acne scars with adolescence and puberty, but it can really be present at any age. Essentially all boys and most girls will suffer some form of acne during puberty. Although most outgrow acne problems by their early 20’s, approximately 3/4 of middle-age adults have occasional acne flare-ups. Such flare-ups are known to be associated with stress, menstrual periods, use or disuse of birth control pills, menopause, pregnancy, and the use of certain skin care products.
Acne presents in many forms and variations. While the most common type of acne is acne vulgaris, it has many variations. Classification of the former includes: comodonal, papular, pustular, or cystic. These range from mild to severe. Other types include: infantile and neonatal acne, acne rosacea, perioral dermatitis, drug induced acne, hidradenitis suppurativa, keloid acne, acne scars and Favre-Racouchot syndrome.
What causes acne?
Acne results from clogged sebaceous glands. Oil production by the glands clogs the pores, which makes it bulge, forming white heads. This plug may become darkened, causing a blackhead. Also, we find a bacterium called Proprionibacterium Acnes in these clogged follicles. When the bacteria forms pus, this, along with inflammation process, initiates the formation of pimples.
Sometimes teens avoid seeking treatment because many believe acne will just go away with time. Unfortunately, acne can become so severe that acne scars can eventually form. At the bottom of this page we will give you options on the treatment of acne scarring. While the stigma of having active acne can be over-whelming to the teenager, acne scars can be a life-long problem. Accordingly, it is important to seek an expert opinion as early as possible to both get control of the problem and prevent long-term scarring.
What are my acne treatment choices?
Acne treatment requires a tailored daily skin care regimen consisting of topical and sometimes oral treatments. Experienced physicians, such as Dr. Atkins, best manage these treatments. After an evaluation, Dr. Atkins will suggest products or prescribe medications based upon the physical exam.
Acne treatment options:
- Benzoyl Peroxide – Antibacterial, decreases free fatty acid formation. Represents a common and ideal first-line treatment.
- Salicylic Acid – Unplugs follicles and causes the skin to exfoliate.
- Azaleic Acid – Antibacterial and normalizes the keratinization or overgrowth of skin process.
- Retinoids (Tretinoin, Adapalene, Tazarotene and others) – Frees the cells of acne and increases cell turnover while stimulating collagen to keep the skin looking great during the treatment.
- Topical Antibiotics (Erythromycin, Clindamycin and others) – Anti-bacterial in nature. Many times we like to start with a topical agent to prevent the unwanted effects of the oral antibiotics. However, many need the oral forms to control their acne and prevent acne scarring.
- Benzoyl Peroxide plus Antibiotics – Dual Antibacterial and anti-sebum effect.
- Microdermabrasion with or without chemicals – Done in the office to extract the blackheads, unclog the pores, and give you an opportunity for personalized skin care advice.
- Antibiotics (Minocycline, Doxycycline, Erythromycin, Bactrim and others) – Bactericidal reduction and sebum production. These are present as oral or topical medications. In our office we really like to start with topical salicylate acid and benzyol peroxide to begin your acne treatment. Many medications can be purchased over the counter at your local drug store or you can visit our web page www.flawlessskinonline.com to purchase directly. Oral medication may be vital to the treatment of acne, but we try to minimize prescription for extended periods of time in order to reduce side effects.
- Isotretinoin – Normalizes keratinization, decreases sebum production, changes the texture of the skin and comes in both a topical and oral form. Topically, the name commonly includes isotretinoin and it requires a prescription. The oral versions are Claravis, Amnesteem, Absorica, Zenatane, and Myorisan. The drug most commonly known is Accutane and it has been discontinued. Similar drugs that are taken orally require close monitoring through Ipledge, a computer based risk-management program, and are highly regulated and effective.
- Oral Contraceptives – Decrease sebum production and control the fluctuations of hormones.
- Nicomide – this is over the counter vitamin and it works as an anti-inflammatory agent toward acne.
- Blu-U Blue Light treatments – a modality known to be highly effective on treating acne.
Does diet effect acne?
Though there is no concrete scientific evidence that diet has a direct effect on acne, our experience has led us to find patterns that do effect it. During periods of stress, it is important to control your diet, because we have seen a direct correlation between acne and a pro-inflammatory diet. In order to avoid this, we recommend you limit high simple sugars, processed foods, and carbohydrates.
Rosacea usually presents as redness of the skin on the face, most commonly in the cheeks, forehead, and nose. It usually starts after age 30 as people notice flare-ups before periods without any redness. Rosacea tends to worsen with further aging, often becoming more persistent. Small blood vessels can become more visible in more advanced stages, as well as skin thickening and infections. It is more common in women and with increasing age.
While there is no specific cure for rosacea, symptom specific treatment can be quite helpful when properly administered by an experienced physician. After an evaluation, our doctors will make recommendations that may include topical agents and laser light therapies.
Acne Scars – Are there options?
Yes, and it is important to start treating the scarring as soon as the acne clears up. As one ages the collagen production slows down. Therefore, so does the results of treatments.
Things that we like in our office:
- Bellafill™ is a FDA approved permanent treatment for acne. It is a collagen in an acrylic (PMMA) base that is placed directly in the acne scar. Other hylauronic acid fillers, such as Juvederm Vobella, are not permanent and can be removed any time if desired. Bellafill treatment involves a needle injection with a subcision approach, which allows the acne scar base to be released and the filler to be inserted after lifting up the scar.
- Microneedling with Radio Frequency is a process that creates channels in the skin and places energy at the base of the scars. This breaks down the scarring and stimulates collagen. This releases that bound down look of the scar and creates a smoother, cleaner refreshed look to the skin. This does take a few treatments and tends to be a permanent result.
- Fraxel lasers work the same as the microneedling. However, this laser is a much quicker procedure and frequently requires fewer treatments.