Acne is common, especially in adolescents and young adults, affecting approximately 85% of teenagers. However, acne can occur in most age groups and persist into adulthood. When dealing with acne, it’s important to understand why it forms and how to treat it.
Acne is a multifactorial inflammatory skin condition affecting the pilosebaceous follicles (a unit consisting of a hair follicle and oil producing gland) of the skin. Key factors that play a role in the development of acne are the build up of skin cells around follicles, bacterial colonization with Propionibacterium acnes, oil production and complex inflammatory mechanisms. In addition endocrine mechanisms, diet, and genetics may also contribute to the multifactorial process of acne.
MAIN TYPES OF ACNE
Acne does not just affect the face. It may appear on the neck, chest, upper arms, back and shoulders. There are different types of acne:
- Comedonal acne most often affects the forehead, nose and chin. It consists of small bumps under the skin and consists of closed comedones (white heads) and open comedones (black heads). These lesions are formed when the follicles are blocked by debris.
- Inflammatory acne includes painful, small, red, inflamed bumps (papules), pimples (pustules) or deep painful lesions (cystic) in the skin. These lesions usually occur from inflammation and rupture of a comedonal lesion. This type of acne can cause scarring.
- Hormonal acne occurs when hormones over-stimulate the oil glands and alter the development of skin cells that line hair follicles in the skin. Hormonal acne can occur anywhere but often affects the lower 1/3rd of the face, neck and chest. The majority of women with acne have normal androgen levels, but hormone testing is recommended for females who have acne accompanied by excess facial or body hair, deepening voice, or irregular or infrequent menstrual periods.
Depending on the type of acne you have, Dr. Kittridge may recommend one or more of the following treatment options:
- Topical retinoids and retinoid-like medications help with most forms of mild to moderate acne. Retinoids help unclog blocked pores and decrease inflammation and bacteria in the skin, therefore working to treat the many different components of acne. Retinoids should be incorporated into most acne regimens as they help prevent and treat acne and also help to reduce the post-inflammatory pigment changes and scars left behind in the skin after an acne lesion has resolved.
- Topical antibiotics such as benzoyl peroxide and sodium sulfacetamide/sulfur help to decrease bacteria and inflammation in the skin. They are often combined with retinoids.
- Oral antibiotics, such as doxycycline or minocycline may help the inflammation of a moderate to severe flare. However, they don’t cure acne and acne may recur upon discontinuation. Dr. Kittridge usually prefers minimal antibiotic use to prevent risks of resistance to antibiotics and unwanted side effects.
- Oral contraceptive pills (OCP) may be an option to help female hormonal acne in the appropriate clinical context.
- Spironolactone can be used in some patients in combination with an OCP to treat female hormonal acne.
- Isotretinoin, or Accutane, is the most effective treatment for severe cystic acne. Though most people benefit from this treatment, the medication needs to be taken with close guidance by Dr. Kittridge to avoid potential side effects.
- Surgical drainage and steroid injections can be used to shrink painful cystic lesions when other treatment options have failed.
- Peels are a very effective way to treat acne AND acne scars. Dr. Kittridge has completed specialized training by the International Peels Society and has experience with many unique peeling agents/techniques.