“You’ll grow out of it” and “That is just part of growing up” are no longer reasonable answers for an adolescent suffering with acne. Unfortunately, many teenagers will not even address their concerns regarding this common problem with their parents or their pediatricians. Many simply decide to ignore it, cover it with makeup or embark on honing their own surgical skills. Some may retreat from their social lives, lose self-confidence and become depressed in severe cases. All of these reactions are unacceptable and may lead to further problems with acne and even permanent scarring. While there are mild cases that can be treated with over-the-counter acne medicine or an improvement in hygiene, there are many more that require medical attention. Now, many new therapies available with fewer side effects and better results. 

What is Acne?

Acne vulgarisor “common” acne has been around forever with writings about it dating back to Ancient Egypt. Acne scarring has been depicted throughout history in paintings and in sculpture. Centuries ago people began to attribute this problem to impure behaviors, poor hygiene and certain foods. As acne typically worsens in the awkward years of adolescence, these misconceptions need to be clarified for patients, parents and physicians so that they can deal with it appropriately.  

No other dermatologic condition seems to carry so much mythological baggage. The idea that certain foods exacerbate acne is at the forefront of these myths. Multiple studies have proven that the usual suspects (chocolate, cola beverages and seafood) do not worsen the problem. Poor hygiene is the second most commonly overstated cause of acne. Although increased sweating, helmet chinstraps or tight fitting hats can worsen it, most patients arrive for their consultation washing far too often. Over using harsh cleansers and toners can poorly affect the skin’s appearance and make it less tolerant to good acne therapies, which are often drying. 

The cosmetic industry has added to the confusion. Many products are marketed as non-comedogenic (“non-acne inducing”). This term is typically based on a laboratory test done with the product on the ear canals of rabbits; thus, having little to do with the acne patient’s skin. Much of the makeup used to conceal acne ends up causing more pimples. The same is true of facial moisturizers, now as frequently used as soap and water. In most cases of acne, the skin already has an excess of oil. There is little need for the additional oils found in these lotions which can block the pores. Pomades, or oils applied to hair for additional sheen, are commonly used by African Americans and also clog pores. With the addition of “leave-in hair conditioners” on the market, dermatologists are now seeing this problem in all races.

The prevalence of acne in teenagers is about 85%, usually starting with less severe forms at around 12 years of age. Acne is a condition of the sebaceous skin (face, chest and back). In biological terms, it is a process involving excess oil, bacteria and inflammatory responses. Acne occurs when the sebaceous glands become overactive, producing excess oil. This sebum is a nutrient for a bacteria called P.acnes, which normally lives on the skin. The excess of sebum causes a multiplication of the P.acnes and the production of free fatty acids, substances that fill up the follicle and lead to “blackheads” and “whiteheads.” The latter can progress to inflammatory lesions, causing red bumps as well as deep-seated nodules and cysts. The nodules and cysts are capable of leaving permanent scars, which can also be produced when the patient picks at acne.

Treating Acne

No two acne patients are the same, which becomes obvious when treating identical twins. Each patient has unique therapeutic needs. Most importantly, the avoidance and prevention of physical and emotional scars must be the physician’s primary goal. Discussion of the type of acne the patient has and its cause is extremely important. The common myths and feelings of guilt surrounding acne should be dispelled. Although the parents usually ask most of the questions during the consultation, it is imperative for the doctor to speak directly to the youth. This usually results in greater acceptance of treatment and a feeling of trust between the physician and the patient. 

Most treatments take at least four to six weeks and some treatments take as long as six months to begin working. Many times patients go from doctor to doctor with the idea that they were given a bad treatment because they only used it for two or three weeks. None of the current therapies work that fast.  

Acne therapies include both topical and oral medications. Topical therapies, the mainstay of treatment for mild and moderate forms of acne, should be applied evenly and sparingly to the acne involved areas. This is different from the television commercials, which show the adolescent applying dabs of medication to the individual pimples. If one does not specifically tell the patient the proper application technique, these medications may be used incorrectly. Topical therapies include benzoyl peroxide; the retinoids: adapalene (Differin™), tretinoin (Retin-A™) and tazarotene (Tazorac™); and azeleic acid (Azelex™) and other antibiotics. They are usually used in combinations to target different aspects of the disease.

Oral therapies are used in more severe forms of acne, often in combination with topical therapy. The primary oral agents are antibiotics including tetracycline, minocycline, doxycycline and erythromycin. They are used to inhibit P. acnes and decrease the migration of inflammatory cells to lesions. Oral antibiotics are typically used for several months and gradually tapered off. Estrogen-containing oral contraceptives, which decrease sebum production, can be helpful in those women whose acne flares with menstruation. These should be used in women over age 16, as growth suppression can occur. For treatment-resistant cases, isotretinoin (Accutane™) is an extremely valuable therapy. Used alone, this medication has profound and lasting effects. With the potential for serious side effects, it should be prescribed by a physician who is familiar with its use. The most concerning side effect is the potential for causing birth defects if a woman were to become pregnant while on this medication. It has absolutely no effects on fertility or offspring after the treatment has been discontinued.

Acne should be taken seriously and treated in an effective, individualized manner. Its timely treatment can prevent emotional and physical scars on our adolescent patients. 

For a referral to a Saint Barnabas dermatologist, please call 
1-888-SBMC-DOC.