Acne vulgaris is the most common skin disorder in the United States and has been a nuisance to many adolescents and young adults. Those with acne can suffer from social stigmatization and even long-term scarring after acne has resolved. 85% of people between the ages of 12 and 24 suffer with acne and it persists into adulthood for 26% of women and 12% of men. Given that acne can be physically, and psychologically detrimental, severe acne should be treated aggressively to prevent scarring.
What is acne?
Acne vulgaris can manifest in both inflammatory and non-inflammatory forms. Non-inflammatory acne includes the familiar whiteheads and blackheads. Inflammatory acne are the pustules and deeper papules and cystic lesions that, as the name suggests, come with inflammation. Acne most commonly appears on the face, but can also be on the chest and back. It commonly starts in adolescence and, for many, can resolve by the mid-twenties.
What causes acne?
There are numerous factor that work in concert to produce acne: clogged pores and hormones play a big role. As hormones start to increase around puberty, the skin produces more oil (sebum). This combined with sticky dead skin cells causes our pores to clog up. Normal bacteria on our skin also get trapped in these pores, triggering an inflammatory response in the skin. Clogged pores without a large amount of bacteria give us our whiteheads and blackheads, whereas larger bacterial counts help create inflammatory lesions like pustules, papules, cysts and nodules.
These are the primary factors for acne. However, other conditions can serve to influence the production of acne. For example, a high-glycemic index diet (consuming sugary processed foods) has been shown to increase acne by causing more inflammation and sebum production in the body. Hormone imbalances can contribute to greater sebum production as well. Consequently, the presence of acne can be an indicator of other processes occurring in the body.
Primary Factors of Acne:
- Increased hormones leading to sebum production
- Sticky dead skin cells leading to clogged pores
- Increased bacterial flora
- Increased inflammation
Other Factors that contribute to acne:
- High-glycemic index diet
- Insulin resistance
- Hormone imbalance such as in Polycystic Ovarian Syndrome (PCOS)
- Medications such as steroids and anticonvulsants
- Occlusive cosmetics or moisturizers
- High environmental humidity
What are the treatment options?
Today, there are numerous effective treatments available for acne. Because of the many factors behind acne, a one-size-fits-all treatment option is often not enough. Therapies should be personalized to each patient given their unique circumstances. Acne treatments do not work overnight. Improvement can be seen over a period of four to eight weeks.
The treatment goals are to unclog pores, reduce acne-causing bacteria, decrease sebum production and inflammation. Prevention of scarring from acne is also important. A combination of therapies are often utilized. Therapies like topical retinoids are used to help unclog pores by increasing the exfoliation of dead skin cells. Chemical peels containing glycolic acid and salicylic acid can aid in exfoliation and oil reduction. Topical and oral antibiotics help to reduce the skin’s bacterial count as well as inflammation. Phototherapy can also be used to reduce bacteria and inflammation. Women with hormonally driven acne or PCOS may be candidates for oral contraceptives or other oral therapies to address hormonal balances. In severe cases of nodular and cystic acne, isotretinoin (previously known as Accutane) is effective in reduction of the skin’s oil production.
One of the common consequences of acne is something called post inflammatory hyperpigmentation (PIH). These are the pigmented spots that remain long after the acne has improved. PIH can remain for months to even years afterwards. Thankfully, there are numerous therapy options to prevent and remove these lesions.
As acne becomes more severe, the risk of scarring also increases. It is important to start therapies early in the development of acne to prevent this. However, there are numerous therapies to address acne scarring once it occurs. These include dermabrasion, chemical peels, laser therapy, and more.
Dr. Ryan Schuering is a board-certified dermatologist in Stuart, Florida. He will personalize a therapeutic approach to meet your skincare needs. This may include a combination of therapies, such as topical and oral medications, skincare products, chemical peels, and more.