Acne Information

Some things to know about acne – Daniel Summers, M.D., F.A.A.P

There are lots of things about being a teenager that can be kind of a pain. (Finals, for example.) For some people, acne break-outs are right at the top of the list. Thankfully, acne is something your medical provider might be able to help you with. (Sadly, we are unable to offer much to help with finals.) Here is some information you might find useful if this is a problem you’re dealing with.

Why is this happening to me?

As you’ve probably already heard countless times, adolescence is a period of rapid growth and change. As you enter your teenage years, your body is going to being producing a lot more hormones, which are proteins your body uses to make different things stop or start. Many of these hormones amp up your body’s growth.

This isn’t just limited to you bones and muscles. Your skin is another part of the body that goes through lots of changes. Some of the changes include increased hair growth, and sweating differently. And increased oil production is another change.

Sometimes your skin produces enough oil to block up your pores. When this happens, it can form dark plugs, called blackheads. The built-up oil also is a good environment for bacteria to overgrow, which can lead to the redness, swelling and white material in pimples.

But I clean my face all the time! Why is this still happening?

Washing your face with a gentle cleanser once or twice a day is a good part of keeping your skin healthy. It can help remove some of the excess oil and dirt that lead to the bacterial overgrowth already mentioned. However, it’s important not to overdo it. Washing too often (particularly with harsh cleansers or soaps that aren’t meant to be used on the face) can strip the face of the oil it needs to be healthy, as can astringents. If your skin gets too dried out and irritated by chemicals, it will produce yet more oil, and things can actually get worse.

One product that works well to clean the face without too much drying is Cetaphil. Other products that are available over-the-counter that sometimes help contain salicylic acid, which helps the skin shed surface layers, allowing blocked pores to clear and healthy skin to emerge. It’s commonly found in many acne washes. Keep in mind that it may cause your skin to be irritated, and if the irritation gets worse with repeated use you should stop using it.

I’ve tried every over-the-counter treatment I can find. Nothing helps! Now what?

If you’ve had no luck with non-prescription treatments, your medical provider has other things that might work for you.

Benzoyl peroxide Benzoyl peroxide is found in both over-the-counter and prescription products. (For example, it’s the primary active ingredient in Proactive.) It’s not entirely clear exactly how it works. It does prevent some bacteria from growing. It also probably helps the skin to shed layers (similar to salicylic acid) and may also slow down oil production. Your medical provider may prescribe benzoyl peroxide or recommend a non-prescription formulation. As with almost all acne medications, it can be irritating, so it’s important to pay attention to how your skin is responding and keep follow-up appointments to check your improvement with treatment.

Topical retinoids A retinoid is a chemical similar to vitamin A, which your body uses to keep skin healthy (among other things). The most well-known topical retinoid is probably Retin-A, but there are many others. Just like with benzoyl peroxide, the exact way Retin-A works isn’t known, but it also probably helps skin surface layers shed. Sometimes benzoyl peroxide and a topical retinoid are used in combination, so your provider may try one or both of them (though they need to be used at different times of day.) And like benzoyl peroxide, topical retinoids can be irritating.

Antibiotics As already mentioned, the redness and swelling of pimples is due to bacteria on the skin. Another way of treating acne is to kill the bacteria that cause the inflammation. There are both oral antibiotics (such as minocycline) and topical antibiotics that you apply to the skin itself. Sometimes antibiotics are used in combination with other treatments.

Hormonal treatment Because the production of oil is related to hormones, controlling those hormones can lowering the amount of oil produced. For teenage girls, an oral contraceptive pill can sometimes help. (Sorry, there’s no equivalent treatment for guys.)

The medication I got at my appointment isn’t working. What’s wrong?

Many times acne medications don’t seem to work because they aren’t being used correctly, or aren’t given enough time.Because many of them work by causing the surface layers of skin to shed and healthy skin to come through, it can take several weeks to see an effect. Often the skin looks more irritated during this period, and people stop the medication before the improvements appear. It should be given at least a three-week trial before considering it ineffective.

Also, it’s important that the medication isn’t just applied in a “spot treatment” manner. It doesn’t work well to clear up individual pimples. A pea-sized amount should be spread in a thin layer over the entire area
where break-outs occur. If you’re using both a retinoid and benzoyl peroxide, you have to use them at different times of day, or they neutralize each other. And you have to use the medications as often as prescribed; they don’t work well if you only use them every so often.

I’ve tried lots of these methods, and none help. Is there anything else that might?

For patients with severe acne, particularly acne that has failed to improve with numerous other medications, sometimes a referral is made to a dermatologist for a mediation called isotretinoin (known more commonly by the brand name Accutane). It is a very potent medication that changes the skin’s oil production and may also lessen bacterial growth. It has lots of side effects, and patient’s who take it need to have routine blood tests done every few months. All women of childbearing age must be on a hormonal method of birth control(such as the pill or Depo) before they can take it, because the birth defects it causes are horrible. Because of these side effects, doctors must join a registry if they want to prescribe it. (None of the providers at CMO are on this registry). While the potency and side effects of this medication make it an inappropriate treatment for a lot of people, for patients with severe acne that is badly affecting their quality of life, it can make a big difference. However, patients with acne that severe should be referred to a dermatologist, who can prescribe the medication if indicated.

As always, your providers at CMO are always happy to discuss your questions, and to come up with the best treatment possible for you.