What is Acne?
The medical term for it is Acne Vulgaris. Vulgaris seems like a bad word but it really just means common and it is exactly that. It affects 80-90% of the population (by age 25 only 10% of the population is affected). It is a disease that can scar for life and could have been prevented.
What causes Acne?
Acne is caused by occlusion (clogging) of skin pores, which leads to overgrowth of bacteria, pus, inflammation and pain. Untreated acne can leave scars and persistent redness of the skin.
Acne is NOT caused by foods and does not reflect poor hygiene (in fact, aggressive soaps and scrubbing may worsen acne). The black heads are NOT dirt they are melanin and oxidized lipids. SO cleaning vigorously or picking can actually make the acne worse.
Treatment of Acne
There are many different treatments to try. The goal of treatment is quite simple:
1. To reduce plugging
2. Minimize inflammation
There are over 140 different treatments and over 250 combinations! SO what does the research show to be the most effective treatments?
Benzoyl peroxide: this is a first-line treatment for mild and moderate acne due to its effectiveness and mild side-effects (primarily an irritant dermatitis). It works against the “P. acnes” bacterium, helps prevent formation of comedones, and has anti-inflammatory properties.
Antibiotics: commonly used antibiotics, either applied topically or taken orally it is to reduce bacteria and fight inflammation. They include: erythromycin, clindamycin, and tetracyclines such as doxycycline. We do worry about over using antibiotics so it is good to take a break from them every few months to see if you still need to take them.
Hormones: In females, acne can be improved with the use of any combined oral contraceptive. This decreases hormones that cause plugging.
Topical Retinoids: these are medications that possess anti-inflammatory properties and work by normalizing the follicle cell life cycle. This class includes tretinoin, adapalene, and tazarotene. Like isotretinoin, they are related to vitamin A, but are administered topically and generally have much milder side effects.
Oral Retinoids: Isotretinoin is very effective for severe acne as well as moderate acne refractory to other treatments. Improvement is typically seen after one to two months of use. After a single course, about 80% of people report an improvement with more than 50% reporting complete remission. About 20% of people require a second course. Isoretinoin is a homerun for acne treatment.
You must use birth control as this drug can cause birth defects and in no way can a pregnant female take this drug.
**Remember it takes about 6 – 8 weeks to see if treatment is working. When we are treating acne it for the next round of acne. The success rate is not 100% according to studies it is about 40-70%. You can increase the success rate when you find something that works for you. You may have to experiment to see what works best.
Bring Acne up with your doctor, there is nothing to be embarrassed about. Cheers to a healthy emotional life through your healthy skin!
Love My Life and Your Life,
Peter Eppinga M.D.