Acne persists, but it can be treated more effectively
Acne just won’t go away.
The skin condition characterized by unsightly blemishes remains one of the most common disorders there is, with an estimated 80 percent of all people having outbreaks at some point in their lives. Acne doesn’t discriminate by gender or race, and while it’s most common in adolescents and young adults, it can appear at later ages, especially in women. There’s no way to prevent acne, there’s no cure, and today’s over-the-counter remedies contain the same basic ingredients as those on drugstore shelves decades ago.
And acne won’t just go away on its own — not treating it can actually make things worse.
But acne can be treated effectively. Recent advances in both medications and approaches to care have significantly reduced the impact it once had on both skin and self-esteem.
“Things are so much better today because there are so many more options for treating acne,” said Dr. Sarah Taylor, a dermatologist at Wake Forest Baptist Medical Center in Winston-Salem. “While OTC products are pretty much the same as they have been for years — just different concentrations of benzoyl peroxide and salicylic acid in various forms such as cleansers, gels and creams — the prescription world has really changed in the past 10 years or so. We’re much better equipped to deal with all different types of acne.”
Acne occurs when the skin’s pores become clogged. Each pore opens to a hair follicle containing a gland that produces oil called sebum, which helps keep skin soft. These follicle-gland units are largest and most numerous on the face, upper back and chest. When the glands produce too much oil, the pores can become blocked, resulting in dirt, bacteria and dead skin cells building up in them, forming the whiteheads, blackheads, pimples and other lesions commonly referred to as zits.
What triggers this process isn’t clear. Hormonal changes are associated with the excess production of oil — thus partially accounting for acne flare-ups in teens and pregnant women — and heredity can be a factor, but research has shown that acne is not caused by dirty skin or by eating chocolate, pizza or greasy foods.
While nonprescription acne medications aren’t necessarily all that new or improved, or that different from each other, they can be effective on mild acne.
“Over-the-counter products can work in many cases,” said Dr. William Huang, another Wake Forest Baptist dermatologist. “But no matter what the TV ads may say, they take time, usually six to eight weeks. You’re not going to have that overnight, here-today-gone-tomorrow phenomenon. That can be frustrating, especially for teenagers. Acne can cause them a lot of stress and affect their emotional well-being, so they want something that works right away, but we don’t have anything like that.”
Dermatologists generally don’t treat many patients with mild acne, because those problems can be cleared up by the proper use of consumer products or measures prescribed by a pediatrician or family doctor. Instead, Taylor said, “We tend to see people whose acne is out of control and has not been helped by OTC products or prescriptions from their regular doctor.”
The National Institutes of Health recommends contacting a dermatologist if nonprescription measures don’t help after a couple of months; the acne is bad (with, for example, a lot of redness around pimples, or the appearance of cysts), getting worse or spreading; or scars develop as the lesions clear up.
Skin specialists have both the expertise and the ability to prescribe stronger medications required to deal with more severe cases. Among the most widely successful strategies they employ is prescribing different topical medications — which are frequently “coupled” in a single lotion, gel or other delivery substance — in combination with oral antibiotics to address multiple causes and effects of acne.
“Just like with any condition, there isn’t a magic bullet,” Huang cautioned. “The treatment depends on the severity of the acne, the type of acne, where it’s located and the patient’s individual preference and motivation for treatment. But these multi-layered approaches that are tailored to the individual patient do work well.”
Dermatologists also have advanced ways to treat scarring, including chemical peels, microdermabrasion and laser technologies. And they’re generally more cognizant of the psychological damage that acne can inflict.
But no matter how understanding dermatologists are, they still face the problem of getting patients to follow their instructions. To combat this, dermatologists are turning to tools such as online surveys, email reminders and text messages to increase teen patients’ proper use of acne medications.
“Consistency is the whole key to treating acne,” Taylor said. “So anything that can promote that has to be a plus.”
Common acne myths
• Only teens get acne. It’s most frequent in adolescents, but it also shows up for the first time in people in their 20s and 30s. All ages can get acne.
• Acne is caused by dirt. Acne flare-ups cannot be traced to dirt or poor hygiene. In fact, washing too frequently or scrubbing too vigorously can irritate skin and make acne worse.
• Chocolate and greasy foods cause acne. There is no such proven connection, but research does indicate a link between acne and nonorganic dairy products.
• Stress causes acne. Stress does not cause acne, but it can make it worse.
• Popping pimples makes them go away sooner. To the contrary, squeezing pimples and blackheads can lead to additional inflammation, infection and scarring.
• Getting a tan helps clear up acne. A little time in the sun won’t hurt, but prolonged exposure to ultraviolet light from the sun or tanning devices can irritate skin and result in more acne.
• Acne will go away on its own. Acne typically does not resolve on its own. Without treatment, it can often worsen.