The pesky zits and acne bumps we associate with teen years are almost a right of passage, so much so that bothersome pimples signify young adulthood. However, for many, acne can persist later in life. Adult acne is more common in women and can continue well into maturity. Acne is more than just a cosmetic nuisance – it is a disease that can have significant dermatologic and psychological consequences. Thankfully, there are numerous treatment options to control and in some cases cure acne.
Acne is not a sign of poor hygiene. Dirt and oil do not cause acne, the true cause is multifactorial. To understand how acne forms, a brief discussion of skin anatomy is warranted. “Pores” are a colloquial term for the pilosebaceous unit of the skin. The pilosebaceous unit is composed of a hair, the hair follicle, and the sebaceous gland. Sebaceous glands produce sebum. Sebum is an oily secretion that in normal amounts helps maintain your skin’s moisture.
Teenagers often experience acne because the increased hormones secreted during puberty cause the sebaceous gland to produce increased amounts of oily sebum. Sebum and skin cells clog the outlet of the hair follicle, and this obstruction, a “clogged pore,” causes acne. In addition, the bacteria that worsens acne thrives in the blocked follicle or “pore,” causing inflammation and redness. Propionibacterium acnes is the main bacterial culprit for exacerbating acne.
The physiologic process that causes acne produces two types of acne: non-inflammatory acne and inflammatory acne. Non-inflammatory acne lesions are blackheads and whiteheads, medically called open comedones and closed comedones, respectively. Inflammatory acne is a painful pink bump – a pimple, nodule, or pustule – that can cause disfiguring pigmentation and scarring.
It is a popularly held notion that certain foods influence the development of acne. Recent studies have suggested that diets high in sugar and simple carbohydrates may worsen acne. Makeup that clogs pores can worsen acne. Picking of individual bumps can also aggravate acne and even causing scarring.
There are numerous treatment options for acne. There are some over the counter products that can help. One such product is benozyl peroxide, which can help eliminate acne-causing bacteria and reduce inflammation. Benzoyl peroxide is formulated as a wash for large areas, or a gel for spot treatment of individual acne lesions.
Topical retinoids are the mainstay of acne treatment. Topical retinoids are deriviatives of vitamin A that unclog pores by promoting skin cell turnover. Essentially, they work by helping teach skin cells not to make acne and are the best form of prevention. Recently, a topical retinoid called adapalene (Differin gel) was released for over the counter sales.
When over the counter products have failed to provide significant benefit in 2 to 3 months, I recommend an office visit with your dermatology provider. For some patients, a stronger, prescription-only topical retinoid like tretinoin (Retin-A) is necessary. Topical antibiotics can also be prescribed to help shorten the duration of individual pimples. Topical antibiotic formulations are safe for long-term use. A brief course of oral antibiotics is sometimes necessary to reduce inflammation and kill acne-worsening bacteria. Oral antibiotics should only be prescribed for short-term use under the supervision of your dermatology provider. Acne that is intractable to the conventional treatments may require curative therapy with an oral vitamin A derivative.
The adage “an ounce of prevention is worth a pound of cure” remains true when treating acne. It is much easier to treat and prevent acne than it is to treat acne scarring. Broad-band light treatments and laser resurfacing can provide benefit for acne scarring. Schedule an appointment with your dermatology provider for an acne treatment regimen customized to you.
Leighanne McGill, PA-C and the team at The Dermatology & Laser Center, under the direction of Dr. Chris Adigun, offer a comprehensive dermatology practice that delivers the highest quality care through careful patient evaluation and personalized treatment.
The Center is located in The Veranda at Briar Chapel: 58 Chapelton Court, Suite 120, Chapel Hill. Contact via phone, 919.942.2922, or online at: DermatologyAndLaserCenterOfChapelHill.com