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Acne

Acne is a very common skin condition that affects 40-50 million people in the US alone. Acne is an inflammation of the sebaceous sweat gland/hair follicle unit (pilosebaceous unit). Most of the pilosebaceous units in our skin are located on the face, chest and back. This corresponds with the areas in which acne is found. The inflammation of an acne lesion is a combination of dead skin cells clogging the follicle, increased oil (sebum) production, and bacteria growing within the plugged follicle. The clogged follicle appears as a blackhead (comedone). As the inflammation increases a red raised papule (pimple) appears. If enough white blood cells are attracted to the follicle a pustule is formed.

Who gets acne?

Acne begins as young as 8 years old and is most prevalent in ages 13 to 18. The average age that acne resolves is 22 but many people will have active acne through their 20’s and into the 30’s. There are occasional cases that can persist into the 40’s and older.

Why do we treat acne?

Active acne can affect a person’s self-esteem causing social awkwardness, social withdrawal and even depression. Some cases of acne can lead to permanent scars. Many can expect acne to last for at least 7 to 10 years making it difficult to wait for any spontaneous resolution. For all these reasons some form of treatment is always recommended.

Does diet affect acne?

Years ago doctors put people on strict diets to control acne. Colas, oils and chocolate were all forbidden. We now know that this was mostly incorrect. However recent research has shown that foods with a high glycemic index (simple sugars) may worsen acne through higher insulin levels. The best advice is to eat a healthy, balanced diet.

Do over the counter products work for acne?

Washing twice a day with a mild, non-irritating cleanser is necessary to remove oils and dead skin cells. It is necessary to wash gently with a soft cloth or your hands. Do not scrub as this can irritate the skin and worsen acne. Always use products that are labeled as oil-free or non- comedogenic to avoid clogging pores. Non-prescription salicylic acid and benzoyl peroxide lotions can help with mild cases of acne. Most acne patients will need prescription medications.

Is it ok to pop pimples?

Picking, squeezing, or cutting open acne pimples at home is a bad idea. This can lead to a serious infection and scarring. In a dermatology office an acne comedone can be extracted and a pustule can be opened and safely drained without causing scars. Occasionally a deeper acne nodule can be injected with a cortisone preparation that will allow the nodule to heal in about 24 hours.

How is acne treated?

There is no cure for acne. As the skin ages the factors that cause acne lessen and the acne resolves. Most cases of acne can be nicely controlled with the use of prescription topical creams and gels. These topical medications are quite effective and are very safe to use for many years. More difficult cases require the temporary use of oral antibiotics. Most dermatologists try to avoid long-term use of oral antibiotics. In the most difficult and serious cases of acne a strong oral medication called isotretinoin may be prescribed. Although this medication has some side-effects and requires blood test monitoring, it is highly effective in treating active acne.