Acne is the most common skin condition in the United States and affects up to 50 million Americans each year. It is an inflammatory condition that causes “comedones” (blackheads and whiteheads), small reddish bumps or pustules, often called “pimples”, or deeper cystic lumps on the face, neck, chest, back, shoulders, and upper arms.
The condition usually starts in puberty, but can occur at any stage of life. More than 80 percent of people between the ages of 12 and 24 experience at least minor acne. Causes include overactive sebaceous oil glands that combine with skin cells to plug pores. When this happens, normal skin bacteria can multiply, causing the skin lesions. Heredity, hormones, and menstruation can bring on acne. Some individuals find that stress can aggravate the condition. High glycemic foods such as white grains found in white grains (bread, rice, pasta) and sweets have been linked to acne, though there is controversy over the extent of that role.
Basic Acne Care
Affected areas should be gently washed once or twice per day with a mild soap that does not dry the skin. Aggressive washing and scrubbing should be avoided, as this can actually worsen acne. Shampoo hair regularly, especially if it is oily. Cosmetics and sunscreens should be “noncomedogenic” (does not clog pores), and astringents that excessively dry the skin should be avoided. To prevent scarring, do not “pop”, squeeze, or pick at your acne lesions.
Because acne can lead to scarring, poor self-image, depression, and anxiety, knowledge of treatment options is critical. For mild acne, over the counter products containing benzoyl peroxide or salicylic acid can be helpful. Seek treatment from your health care provider if these measures don’t lead to improvement within 2-3 months. Prescription-level protocols most commonly used include topical retinoids (vitamin A derivatives), topical or oral antibiotics, often in combination with benzoyl peroxide. Oral antibiotics are typically recommended for cases resistant to topical therapy, or for more severe cases, especially when large body surface areas are involved. However, even these treatments (or the others mentioned below), can take 2-3 months to take effect.
Some women benefit from hormonal therapies, including oral contraceptives that contain estrogen, if other measures do not work. In addition, an oral medication termed “spironolactone” is increasingly used alone, or in combination with oral contraceptives, as it has hormone-blocking effects and large studies have been reassuring regarding its safety when used properly.
For the most severe, treatment resistant cases, oral isotretinoin has been the treatment of choice for three decades. It will improve the condition in more than 80 percent of patients, often permanently, after one course of treatment — approximately five months of continuous use. Any women of child-bearing age must not become pregnant while taking this medication.
The American Academy of Pediatrics, in conjunction with the American Acne and Rosacea Society has published recommendations on the diagnosis and treatment of acne.
Joseph Pierson, MD, is a dermatologist at The University of Vermont Medical Center and assistant professor at the Larner College of Medicine at UVM. He is also residency program director for dermatology.