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Highland Park, IL 60035


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Adult Acne – Causes, Treatment, and Care

Causes include Stress, Medications, Hormones, Diet and Smoking
During times of stress the body releases a whole host of chemicals including cortisol, one of the major stress hormones. Cortisol has an effect on how testosterone is manufactured and released throughout the body in both men and women. Increased testosterone levels can result in acne in some individuals.

Many medications, including lithium, some antiseizure medications and corticosteroids, can cause acne, even in people not usually prone to the condition. In the sports world, abuse of anabolic steroids can cause acne and may be a telltale sign of use or abuse.

Fluctuating hormone levels, including those related to pregnancy, birth control or menopause, can play havoc with skin and may result in cyclical or chronic acne.

Dietary factors like high carbohydrate foods and dairy products have been blamed, then exonerated, and then blamed again for having a role in adult acne. For now, the prevailing theory is that certain foods may cause insulin surges that contribute to acne.

In Chinese Medicine, the health of the respiratory system is represented on the skin. And who can fault such wisdom and logic? It’s a fact that smokers tend to suffer worse acne, although the precise mechanism of cause and effect remains unclear.

For general health reasons, I counsel all of my patients to refrain from smoking and to eat a healthy diet of whole foods with a low glycemic index. Improved acne is just one of the many appealing potential side effects!

Depending on the level of associated inflammation, I frequently prescribe Nicomide, a vitamin-mineral medication that is especially formulated for acne. It contains copper, zinc, folic acid and nicotinamide. If I find cause for concern about other micronutrient deficiencies, I recommend a micronutrient bloodwork panel, followed by a regimen of any indicated supplements.

Testing and treatment of hormonal imbalances may be necessary before any topical treatments are conducted. Where testosterone may be a factor, based on stress levels or blood test results, 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 25mg to 100mg, twice a day.

A quick note about topical antibiotics: Some doctors don’t hesitate to use them. And while they may be helpful in some situations, I have found several effective alternatives that avoid the possibility of encouraging antibiotic resistance.

At Home Care
Some acne sufferers have a lot of bacteria on the skin, while others do not. Those with a lot of bacteria require a skin cleanser with glycolic acid or salicylic acid, such as Dr Josie RecommendsⓇ Squeaky Clean. Minimal acne sufferers generally do well with a mild cleanser, like our Dr Josie RecommendsⓇ Vitamins for the Skin.

Acne sufferers tend to have a lot of erythema (redness) in the skin, so I recommend a vitamin C serum to be used once or twice a day, depending on severity. Retinoids are also commonly prescribed. They are in the Vitamin A family and help to control acne breakouts by improving cellular turnover which makes fresh new skin. In general I start with the mildest form (Retinol), then gradually introduce more potent forms if necessary. This allows the skin to respond to the medication without excessive dryness and irritation. The strongest forms of retinoids are tretinoin, adapalene (Differin) and tazorotene (Tazorac).

While most acne sufferers love to expose their skin to the sun (which 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.

In Office Care
In office treatments for acne include chemical peels, with or without LightStimⓇ light treatments – a full spectrum light (minus the UV, of course). The blue wavelength kills bacteria, while the red, orange and infrared wavelengths improve healing and stimulate collagen production. For those patients with a lot of bacteria or a lot of erythema, I recommend 20 minutes under a LightStimⓇ light during each visit. 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, decreasing both erythema and edema (swelling). Mandelic acid, which is derived from bitter almonds, helps to improve erythema, hyperpigmentation and photoaging.

Dr. Josie L. Tenore, M.D., M.Sc.,
is a board-certified family physician who became interested in aesthetics during medical school. As a result, most of her electives focused on dermatology and plastic surgery. Dr. Josie began her practice with family medicine because she enjoyed the challenge of delivering comprehensive health and well-being to people of all ages. This unique combination of family medicine and aesthetics led her to advocate a program of eating well, exercising and aesthetics for patients who want to have the best quality of life. Read full bio.

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595 Elm Place, Suite 208
Highland Park, IL 60035