Getting Rid of Your Teenage and Adult Acne
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Acne is a centuries old disorder that affects people of all ages (even newborns). Recent developments in acne have uncovered new approaches to the causes and differences in severity of acne as well as new treatment possibilities.
Acne is a disorder that affects the pilosebaceous unit-this is oil gland/hair unit in the skin. Normally oil is produced in an oil gland and it empties into the hair shaft and is carried to the surface of the skin. In acne, the shaft gets blocked, forming white heads or black heads. Next, the oil backs up and is attacked by bacteria forming pustules or papules. This causes inflammation and the hair shaft can burst into the surrounding skin causing cysts and sometimes scarring. The commonest sites for acne are on the face, chest and back.
Frequently Asked Questions about Acne
I have heard that acne is a hormonal disease, so how can men, women and even babies get acne?
Acne is most often due to the affect of androgens (the male hormone component) that is present in men and to a lesser extent in women. Newborns can actually have an increase in hormones that affect their oil glands, as a result of placenta transfer from the mother. Some women have an excess of androgens or sensitivity to normal levels of androgens and this can be associated with an increase amount and rate of growth of body hair, irregular menses, an oily complexion and difficulties conceiving. A condition called Polycystic ovarian syndrome (PCOS), encompasses these changes and may also be associated with diabetes, obesity, elevated lipids and infertility. For this reason, hormone testing is often a part of the initial assessment of women being seen for acne treatment or laser hair removal at Cosmedix MD.
How do women know if their acne is caused by a hormone?
The onset of acne or excessive body or facial hair growth in children may indicate a hormone alteration. In adults, the sudden appearance of cystic acne, especially on the jawline that may be associated with the development of irregular menses or excessive body hair and an increase of oiliness of the face and scalp, should be an indication that hormone levels should be checked.
Why do some people have scarring with acne while others have even worse acne and get no scars?
This is an excellent and very complex question. There is a genetic predisposition to develop acne and this is partially related to the tendency for the mouth of the sebaceous gland to be blocked. Once, however the mouth of the gland gets blocked, bacteria called Proprionobacteria acnes mixes with the oil and can produce inflammation. The genetic makeup of the person helps to determine the severity of inflammation. If there is a mild response, the blemish heals with temporary pinkness or pigmentation. However, if there is a brisk response, scarring can form resulting in ice pick surface scars or wider depressed scars.
Are there new approaches to acne treatment and what effect does diet have?
While some people do notice that acne blemishes, can be caused by certain foods, this is not applicable to everybody and therefore most Dermatologists don’t give people lists of food to avoid. Nevertheless, if you notice that certain foods, do cause you to flare, it would be best to avoid these. In addition, occlusive skin preparations, hair sheens, certain conditioners and some medications (e.g. some mood altering and fertility drugs) can cause acne in predisposed people and these should be avoided where possible. Newer topical treatments include combination Benzoyl Peroxide/retinoid gels and Dapsone and other antibiotic containing creams.
Photodynamic Therapy using the topical application of delta amino levulinic acid or its prodrug can be used in combination with blue or orange light to help kill the P. acnes and reduce inflammation in acne. While isotretinoin (formerly Accutane) is still often a treatment of choice in severe scarring or persistent acne, anti-androgen medications can also be helpful in women. These anti-androgens include spironolactone as well as the oral contraceptive pills, Diane 35 ™ or Yasmin ™. Regular facials, glycolic acid exfoliations and microdermabrasions can do an excellent job at preventing the development of acne lesions. In skilled and experienced centers, resurfacing lasers resurfacing lasers and fillers fillers (we use the Juvederm ™ brand), are important in repairing scars.