Acne is a common and chronic condition that affects 80% of teenagers. It is often one of the first signs of puberty. Hormones released during puberty cause the oil glands to enlarge and make more oil. The oil then combines with skin cells to block pores. Bacteria that normally live on the skin thrive on the increased oil and release enzymes and other factors that lead to inflammation. Contrary to popular belief, acne is not caused by eating chocolate or fried foods.
There are several types of acne. Blackheads, or open comedones, are clogged pores that are open at the top making the blockage visible as a black spot. The dark color is not due to dirt so scrubbing it will not help. Whiteheads, or closed comedones, have smaller openings and because of this can lead to inflamed pimples more often than blackheads. Larger pimples called pustules or nodules develop when the pimple breaks open and the skin around it reacts by becoming inflamed, red and tender. How deep the inflammation occurs will determine whether it is a pustule (closer to surface) or a nodule (deeper).
To keep skin looking its best, do the following:
- Wash one or two times per day with a gentle soap.
- Anything that is applied to the face, like make-up or a moisturizer, should be labeled “non-comedogenic or non-acnegenic,” meaning that it will not make acne worse.
- All make-up should be washed off before bed.
- A soft headband can be used to keep hair off of the face during sleep.
- Do not pick or pop pimples as this can make them worse by causing inflammation and can lead to scarring.
- Many acne treatments can make skin more sensitive to sun so wear at least SPF 15 daily.
The first treatment used for acne is typically benzoyl peroxide. This is available over the counter in various forms like creams, washes and lotions and in concentrations from 2.5% to 10%. This is used once daily in the evening. A small amount is used for the entire face, not just on the pimples themselves.
Any acne treatment takes at least 4-8 weeks to see results so be patient and consistent! If your acne does not respond to over the counter treatments, then talk to your pediatrician about prescription treatments. The next step is usually a topical medication. Retinoids (brand names Differin, Retin A, Tazorac) help unclog the oil glands. Topical antibiotics, often times combined with benzoyl peroxide, are used to reduce the bacteria that can lead to inflammation.
The next step in treatment for acne that does not respond to topical medicines is typically an oral antibiotic. An oral antibiotic is also often needed for acne that is predominantly nodular, or is particularly severe on the chest or back. The antibiotic is taken daily for at least one month and possibly longer. Oral contraceptives (birth control pills) are also sometimes prescribed.
If acne cannot be controlled by any of these treatments, then a dermatology consultation is recommended to discuss other options, including Isotretinoin (brand name Accutane). Accutane is a powerful medicine that is effective against acne; however, it requires regular blood tests to monitor for side effects and can cause birth defects if taken during pregnancy.
Acne cannot be cured, but it can be treated. Be sure to talk to your doctor if you are not happy with your skin.
For more information, visit www.essehealth.com.
By Lora Collier, M.D., Esse Health Pediatrician
Esse Health Creve Coeur Pediatrics
11630 Studt Avenue, Suite 200
Creve Coeur, MO 63141