What is acne?
Acne is an inflammatory disease that requires acute and long-term maintenance treatments. Acne is a multifactorial inflammatory disease of the hair follicle that involves the skin cells, hormones, sebum or oil gland production and bacteria. Acne commonly appears on the face and neck, chest, and upper back. Risk factors include a family history of severe acne, PCOS, metabolic syndrome and some genetic conditions.
Acne can manifest as non-inflamed comedones (blackheads and whiteheads), and inflammatory lesions like small red, painful papules (bumps), pustules (pimples with pus), large, painful lumps called nodules, and pus-filled lumps called cysts. Severity varies widely.
What causes acne?
Acne is initiated by hormonal changes in puberty that overstimulate the release of sebum or oil. Excess oil production and dead skin cells plug the hair follicles or pores causing a whitehead or blackhead. The plugged follicle expands and bacteria (P. acnes) colonize the hair follicle. This results is an inflammatory response. The lesion turns red and inflamed. When the lesion is near the skin’s surface it is called a pustule. If it goes deeper in it is a pimple. When it goes deeper it is a cyst.
Several factors contribute to the development of acne, such as genetics, hormones, bacteria, and clogging of pores. Many times, acne flare ups are caused by:
- Hormone imbalance (androgens or testosterone) in adolescents and in patients with PCOS (Polycystic Ovarian syndrome)
- Medications such as steroids, B vitamins, and anticonvulsants
- Occlusive cosmetics or moisturizers
- High environmental humidity (such as flares with travel)
Diets high in dairy, animal fats, and high glycemic foods
How is acne diagnosed?
Diagnosis is typically made by clinical evaluation. Dr. Anna Chacon will ask about your family history, symptoms and signs that may suggest an underlying medical condition.
What are the treatment options?
The goal of treatment is to control the progression of the inflammatory process and prevent scarring. This means that treatment is directed to decrease acne bacteria, unclog pores, reduce oiliness and decrease inflammation. Effective treatments are available but don’t work in everyone or all the time. So, treatment often involves trial and error.
Treatment guidelines from the American Academy of Dermatology recommend first line treatment to include good hygiene including physical or chemical exfoliation, topical benzoyl peroxide, an antibacterial cleanser to kill topical bacteria. Retinoids are used to promote skin peeling.
Topical or systemic antibiotics may be recommended. To reduce oil production the drug Accutane (Isotretinoin) may be prescribed in serious cases. Aldactone is a drug that blocks hormone receptors and may help with resistant acne. Cortisone injections in acne cysts can flatten them and stop inflammation.
Light therapy may be recommended for mild to moderate acne when other treatments fail to improve the condition. Phototherapy may include the use of blue light to kill the acne causing bacteria. Photodynamic therapy or PDT uses light therapy with a medication to make the acne more sensitive to the light. Studies report that blue light therapy is effective with multiple treatments.
Laser therapy is often recommended to treat acne scarring. However, there are specific lasers designed to treat acne. Discuss this with Dr. Chacon during your appointment.