Acne
- Clearer skin after first treatment
- Quick no-down time in office procedures
- Simple at home care
- Customized medication if necessary
- We avoid antibiotics if possible
What You Should Know
Approximately 40 to 50 million people in the United States live with acne, and it is the most common skin problem in the country. That makes it the most common skin condition that affects both adolescents & adults.
It is a chronic inflammatory condition characterized by a combination of scaly red skin (seborrhea), comedones (blackheads and whiteheads), pimples and sometimes deeper lumps (cysts, nodules, or boils) which can result in scarring.
Acne affects mostly the face, the upper part of the chest, and the back but can also be seen on the arms and shoulders. Severe acne is inflammatory, but acne can also manifest in non-inflammatory forms.
While acne occurs most commonly during adolescence, it can continue into adulthood. There is a form; however, that starts in adulthood and is usually associated with rosacea.
Causes:
Acne has many causes including the following:
- Stress
- Drugs
- Hormones
- Diet
- Smoking
Let’s look at stress. During stress the body releases many chemicals and neurotransmitters including cortisol, one of the major stress hormones. Cortisol has an effect on how testosterone is manufactured and released (in both men and women) in the body. Increased testosterone levels can result in acne in some individuals. In addition, individuals who are under a lot of stress may not have the healthiest diet; with certain food choices and micronutrient deficiencies both having effects on the skin.
Drugs like lithium, some antiseizure medications and corticosteroids can all cause acne; even in those not usually prone to the condition. In the sports world, abuse of anabolic steroids can cause acne and often be a telltale sign of use and abuse.
Fluctuating hormone levels, whether related to pregnancy, changes in birth control pills and IUD, or menopause can play havoc with skin; resulting in acne that may be cyclical or constant.
Dietary factors like high carbohydrate foods and dairy products have been blamed, exonerated and then blamed again for having a role. At the current time, the prevailing theory is food that can result in insulin surges may contribute to acne.
Finally, individuals who smoke tend to have worse acne but the exact association and relationship is still unclear. Although, in Chinese Medicine, the health of the respiratory system is represented on the skin. Who can fault the ancient Chinese for their logic and wisdom?
How We Can Help
After taking an appropriate history, doing a physical exam and analyzing your VISIA photos, we put together a plan we agree upon will reflect your unique skin type and condition, as well as your lifestyle.
Treatment
Treatment of adult acne is always interesting. As adults tend to have a higher discretionary income, more treatment options become available. I counsel all of my adults to refrain from smoking and eat a healthy whole foods diet, choosing low-glycemic index foods for health reasons, with the potential side effect that it may improve their acne. Depending on inflammation levels, I will usually prescribe Nicomide, a vitamin-mineral medication that is especially formulated for acne. It contains copper, zinc, folic acid and nicotinamide (a form of vitamin B). If I am concerned that there may be more micronutrient deficiencies, I recommend micronutrient testing and supplement accordingly.
Testing and treating hormonal imbalances may be necessary prior to considering any topical at-home and in-office treatments. If there is a component of testosterone’s effect on the skin (either from blood testing or based on stress), I will prescribe Spironolactone. This is a medication in the diuretic family that blocks the effects of testosterone on the skin. Typical doses can range from 25 mg twice a day up to 100.
A quick note about topical antibiotics, some doctors are fans of using these agents. Although they may be helpful in some situations, I generally have found other options seem to work well and avoid the possibility of antibiotic resistance.
At Home Care:
Additional treatment choices depend on a skin analysis done in the office. There are acne sufferers who tend to have a lot of bacteria on the skin; and those who don’t. Those with a lot of bacteria will need cleansers with glycolic acid, and/or salicylic acid like our Dr Josie RecommendsⓇ Squeaky Clean. Minimal acne sufferers do well with a mild cleanser, like our Dr Josie RecommendsⓇ Vitamins for the Skin cleanser.
Acne sufferers all tend to have a lot of erythema (redness) in the skin, so I put them on a vitamin C serum to be used either in the morning or morning and night depending on the degree of erythema.
Retinols are also commonly prescribed agents. They are in the Vitamin A family and will help to improve cellular turnover (helps stimulate the skin to make fresh new skin) and control breakouts. In general, I tend to start with the mildest form – Retinol and gradually introduce more potent forms. This allows the skin to gradually respond to the medication without excessive dryness and irritation. The strongest forms of retinoids are tretinoin, adapalene (Differin) and tazorotene (Tazorac).
While all acne sufferers love to expose their skin to the sun (as it does improve acne), I recommend that they wear UV protection with niacinamide in the product. Niacinamide is a B-vitamin which helps to decrease erythema.
Treatment Options May Include:
- BroadBand Light Therapy -BBL®
- Chemical Peels
- Microdermabrasion
- HydraFacial
- Bellafill (specific for acne scarring)
- Laser Skin Resurfacing (specific to acne scarring)
- Physician-Grade Skin Care products
In office treatments for acne may include any of the above treatment modalities depending on the evaluation.
An example of a treatment is as follows.
For those patients who have a lot of bacteria on their skin or who have a lot of erythema and an active breakout would benefit from a combination treatment that may including a microdermabrasion, a light treatment and a chemical peel.
We begin by cleansing the skin with an appropriate cleanser and if there is a lot of thick, flaking skin, a microdermabrasion may be performed. After which, protective eyewear (if we are treating the face) is is used to cover the eyes and the skin is exposed to full spectrum LED lights.
Full spectrum light (minus UV, of course) contains blue wavelength light which kills bacteria, red, orange and infrared to improve healing and stimulate collagen production. Afterwards a combination of agents are applied to the skin, my favorite being a salicylic/mandelic acid combination. Salicylic acid helps the skin to shed its dead layer, decreases erythema and edema, while the mandelic acid (derived from bitter almonds and hence the name) helps to improve erythema, hyperpigmentation and photoaging.
Rosacea is a condition that is very common in adults; one form of which may involve acne. Characteristics of this condition include broken blood vessels in the cheeks, chin and around the nose, generalized erythema, and in some individuals, acne. Also typical is a tendency to develop facial flushing in response to some triggers; namely stress, caffeine and exercise. Some individuals develop facial flushing for no reason at all. Rosacea is best treated with a combination of BroadBand Light (BBLⓇ) (also known as FotofacialsⓇ or intense pulse light) treatments and chemical peels. By using different wavelengths of energy, bacteria is neutralized, with both redness and broken blood vessels also being treated. With rosacea the chemical peel of choice is one with Mandelic acid.
