What is Acne?
Acne is the most common skin disorder in the United States, affecting nearly 85% of all people at some point in their lives. It is most common around puberty, but adults can develop acne as well. Acne appears in the form of blackheads, whiteheads, pimples, and lumps under the skin called nodules. It occurs when pores in the skin become clogged or through bacterial inflammation. Approximately 20% of acne cases are considered severe, leading to scarring.
What Causes Acne?
Acne is related to changes of the pilosebaceous unit — the hair follicle and oil gland – but there is no one single cause. The cause of acne is multifactorial and can include:
- Clogged skin pores
- Hormonal changes
- Genetic factors
- Excess oil production by the skin’s oil glands
- Environmental factors such as humidity or pollution
- Inflammation caused by the bacteria Proprionibacterium acnes
Acne breakouts appear most commonly on the face but can also appear on the chest, shoulders, upper arms, and back.
Adult Female Acne & Acne in Pregnancy
Adult female acne often has a hormonal component. It may worsen just prior to or during the start of the menstrual cycle. Oftentimes, the adult female hormonal acne localizes to the lower half of the face, jawline, and neck. The acne is often painful, red, cystic, and persists for weeks to months at a time. Both spironolactone and oral contraceptive therapy can be used in conjunction with traditional acne treatment in cases of adult female hormonal acne. Acne in pregnancy can be safely treated with a combination of topical antibiotic called erythromycin, azelaic acid (Finacea), glycolic acid, and blue light treatment.
Types of Acne
There are three distinct types of acne, ranging from mild to severe:
- Comedonal acne is the mildest form of acne and is predominated by white heads (closed comedones) and blackheads (open comedones).
- Inflammatory acne is a moderately severe form of acne that consists of pink bumps (papules), and pustules (pink bumps with white pus).
- Cystic acne is the most severe form of acne and results in large, painful, swollen, deep red bumps that may heal with scarring.
Acne Treatment Options
Early and appropriately aggressive treatment is needed to control acne. Combination treatment is usually necessary. This may consist of topical antibiotics, sulfur, alpha hydroxy acids, benzoyl peroxide, and retinoids (vitamin A derivatives). Oral antibiotics may be required for a short period of time to control inflammatory acne. Severe cases may require an oral retinoid called isotretinoin (formerly the brand name Accutane), which requires monthly monitoring and blood tests.
Other alternative treatment options for acne include laser and light therapy and chemical peels. Photodynamic therapy shrinks oil glands, decreases inflammation, kills Propionibacterium acnes (bacteria contributing to acne), and improves discoloration from old acne lesions. BBL treatments and salicylic acid peels can lessen the appearance of pigmentation following acne. Acne scarring can be addressed once active acne is under control.