Acne

Acne is a skin condition caused by plugged pores (blackheads and whiteheads), inflamed pimples (pustules), and deeper lumps (nodules). Acne occurs on the face, as well as the neck, chest, back, shoulders, and upper arms. Although most teenagers get some form of acne, adults in their 20's, 30's, 40's, or even older, can develop acne. Acne often clears up after several years, even without treatment. Acne can be disfiguring and upsetting to many patients. Untreated acne can also leave permanent scars. These scars may be treated by your dermatologist in the future, but to avoid acne scarring, treating it is important.

Types of Acne and How Acne Forms

Acne is not caused by dirt. Testosterone, a hormone which is present in both males and females, increases during adolescence (puberty). It stimulates the sebaceous glands of the skin to enlarge, produce oil, and plug the pores. Whiteheads (closed comedones), blackheads (open comedones), and pimples (pustules) are present in teenage acne.

Adolescent acne occurs before the first period in females and is called prepubertal acne. When acne is severe and forms deep "pus-filled" lumps, it is called cystic acne which may be more common in males.

Adult acne develops later in life and may be related to hormones, childbirth, menopause, or stopping birth control. Adult women may be treated during their period and at ovulation when acne is especially severe, or throughout the entire cycle. Adult acne is not rosacea (persistent redness), a disease in which blackheads and whiteheads do not occur.

Cleansing

Acne has nothing to do with not washing your face. However, it is best to wash your face with a mild cleanser and warm water daily to remove excess oil buildup. Washing too often or too vigorously may actually make your acne worse. After washing, it is recommended you apply a moisturizer to prevent dryness.

Diet

Acne is not caused by foods either. However, if certain foods seem to make your acne worse, you should try to avoid them.

Cosmetics

Wear as little cosmetics as possible. Oil-free, water-based moisturizers and make-up should be used. Choose products that are "non-comedogenic" (should not cause whiteheads or blackheads) or "non-acnegenic" (should not cause acne). Remove your cosmetics every night with mild soap or gentle cleanser and water.

A flesh-tinted acne lotion containing acne medications can safely hide blemishes. Loose powder in combination with an oil-free foundation is also good for cover-up.

Shield your face when applying sprays and gels on your hair.

Treatment

Control of acne is an ongoing process. All acne treatments work by preventing new acne breakouts. Existing blemishes must heal on their own, and therefore, improvement takes time. If your acne has not improved within two to three months, your treatment may need to be changed. The treatment your dermatologist recommends will vary according to the type of acne.

Occasionally, an acne-like rash can be due to another cause such as make-up or lotions, or from oral medication. It is important to help your dermatologist by providing an updated history of what you are using on your skin or taking internally.

Many non-prescription acne lotions and creams help mild cases of acne; however, many will also make your skin dry. Follow instructions carefully.

Topicals

• Your dermatologist may prescribe topical creams, gels, or lotions with vitamin A; acid-like drugs; benzoyl peroxide; or antibiotics to help unblock the pores and reduce bacteria. These products may cause some drying and peeling. Your dermatologist will advise you about correct usage and how to handle any side effects.
• Before starting any medication, even topical medications, inform your doctor if you are pregnant or nursing, or if you are trying to get pregnant.

Special Treatments

• Acne surgery may be used by your dermatologist to remove blackheads and whiteheads. Do not pick, scratch, pop, or squeeze pimples yourself. When the pimples are squeezed, more redness, swelling, inflammation, and scarring may result.
• Microdermabrasion may be used to remove the upper layers of the skin to improve irregularities in the surface, contour, and help generate new skin.
• Light chemical peels with salicylic acid or glycolic acid help to unblock the pores, open blackheads and whiteheads, and stimulate new skin growth.
• Injections of corticosteroids may be used for treating large red bumps (nodules). This may help them go away quickly.

Oral

• Antibiotics taken by mouth such as tetracycline, doxycycline, minocycline, or erythromycin are often prescribed.

Birth Control Pills

• Birth control pills may significantly improve acne, and may be used specifically for the treatment of acne. It is also important to know that oral antibiotics may decrease the effectiveness of birth control pills. This is uncommon, but possible, especially if you notice break-through bleeding. As a precautionary measure, use a second form of birth control.

Other Treatments

• In cases of unresponsive or severe acne, isotretinoin may be used. Patients using isotretinoin must understand the side effects of this drug. Monitoring with frequent follow-up visits is necessary. Pregnancy must also be prevented while taking the medication, since the drug causes birth defects.
• Women may also use female hormones or medications that decrease the effects of male hormones (testosterone) to help their acne.
• Photodynamic therapy using the blue wavelength of light can be helpful in treating acne as well.

Your dermatologist will evaluate you and suggest the appropriate treatment regimes considering your age, sex, and the type of acne you have.

Treatment of Acne Scarring

The dermatologist can treat acne scars by a variety of methods. Skin resurfacing with laser, dermabrasion, chemical peels, or electrosurgery can flatten depressed scars. Soft tissue elevation with collagen or fat-filling products can also elevate scars. Scar revision with a microexcision and the punch grafting technique can correct pitted scars, and combinations of these dermatologic surgical treatments can make noticeable differences in their appearance.

Proper Care is Necessary

No matter what special treatments your dermatologist may use, remember that you must always continue proper skin care. Acne is not curable, but it is controllable. Proper treatment can help you to feel and look better, and may prevent scars.

To learn more about acne and acne treatments, please call 782-2930 in Blackfoot or 233-4455 in Pocatello and speak with our dermatology providers at Bingham Memorial Hospital.