Acne is the most common skin condition in the United States. Acne occurs when your hair follicles become plugged with oil and dead skin cells. Acne typically appears on your cheeks, chin, forehead, neck, chest, upper back, shoulders, and buttocks…
- Whiteheads (closed plugged pores)
- Blackheads (open plugged pores)
- Papules (small red, tender bumps)
- “Pimples” (aka pustules), which are papules with pus at their tips
- Nodules (large, solid, painful lumps beneath the surface of the skin)
- Cysts (painful, pus-filled lumps beneath the surface of the skin)
Acne appears when a pore in your skin clogs. Normally, dead skin cells rise to surface of the pore, and the body sheds the cells. When the body makes oil, called sebum (see-bum), the dead skin cells can stick together inside the pore. Instead of rising to the surface, the cells and oil become trapped inside the pore, causing it to clog.
If the pore remains open, the clogged material that is exposed to air will turn black over time, coining the phrase ‘blackhead’. This is a result of a chemical reaction. Blackheads are not dirt. If the pore pinches at the top and air is not allowed in, a small white lesions will appear, named a ‘whitehead’. If inflammation occurs around the clogged pore, a red ‘pimple’, nodules or cyst may form.
Sometimes bacteria that live on our skin, p. acnes, also get inside the clogged pore. Inside the pore, the bacteria have a perfect environment for multiplying very quickly. Heavy loads of bacteria can cause lesions to become more inflamed. If the inflammation goes deep into the skin, an acne cyst or nodule appears.
Men and women both produce hormones called androgens. Androgens stimulate oil glands to produce more oil. These increase oil production and can increase the likelihood of follicles becoming clogged.
Overall, four main factors cause acne:
- Excess oil production
- Hair follicles clogged by oil and dead skin cells
- Excess activity of a type of hormone (androgens)
Myth #1 “It’s all from my diet.”
There are many food myths surrounding acne. For example, eating greasy food has little to no effect on acne. But working in a greasy area, such as a kitchen with fried food, can cause acne because the oil splashed onto the skin can clog pores. In some studies, milk, especially skim milk, has been linked to worsening acne, but it is not a major cause for most people. A more clear link is found between simple sugars and acne. This may be the reasoning behind the chocolate myth. While chocolate alone does not cause acne, eating regular sweets and drinking sugary beverages has been well proven to increase total body inflammation and can worsen acne.
Myth #2 “I just need to wash my face more.”
Acne isn’t caused by dirty skin and lack of adequate hygiene is rarely a problem. In fact, scrubbing the skin too hard or cleansing with harsh soaps or chemicals irritates the skin and can make acne worse. Your face only needs to be washed 1 to 2 times a day, with a facial cleanser and your fingertips, not with a harsh detergent or wash cloth. This should take place after sweating or vigorous exercise, at the end of the day to remove make-up, or after being exposed to greasy environments, such as fry kitchens. If you wish to exfoliate, only very gentle, low abrassion polishes should be used on the skin, and only 2 to 3 times a week.
Myth #3 “I should not wear make-up if I have acne.”
Cosmetics don’t necessarily worsen acne, especially if you use oil-free makeup that doesn’t clog pores (“noncomedogenic”) and remove makeup every night. Do not feel the need to quit all foundation or powders. Simply check the label. Do make sure you clean your make-up brushes on a regular basis so you do not increased the spread of acne causing bacteria. The same is true for sunscreens, moisturizers, and even hair care products. Select oil-free products only for use on or around your face or acne prone areas.
Acne Can Cause More Than Blemishes
Studies show that people who have acne can have:
- Low self-esteem: Many people who have acne say that their acne makes them feel bad about themselves. Because of their acne, they do not want to be with friends. They miss school and work and absenteeism can become a problem because of their acne.
- Depression: Many people who have acne suffer from more than low self-esteem. Acne can lead to a medical condition called depression or cause worsening of already existing depression. A team approach with your dermatologist, primary care physician, or even psychiatrist may be needed.
- Dark or red spots on the skin: Some skin tones are prone to dark or red spots that appear when the acne heals. It can take months or even years for discoloration to slowly fade and disappear.
- Scars(permanent): Some individuals are prone to scaring from their acne lesions. This is more common with severe acne. Another frequent cause of scaring is picking at blemishes. These scars can be prevented with early treatment and a strong commitment to your acne regimen. If you notice pitting scars when your pimples heal, if your child develops acne at a young age, or if someone in your family had scaring acne, be sure to see a dermatologist early. Treating acne early can prevent scars.
Yes, adults get acne. Some adults continue to get acne well into their 30s, 40s, and even 50s. It is even possible to get acne for the first time as an adult. Dermatologists call this “adult-onset acne.” It is most common among women going through menopause.
Women tend to get adult acne more often than men do. If you’re getting acne as an adult, it is likely due to one or more of the following reasons:
Fluctuating hormone levels: An imbalance can lead to breakouts.
Women often experience fluctuating hormones:
- Around their periods
- During pregnancy, peri-menopause, and menopause
- After discontinuing (or starting) birth control pills
Stress: Researchers have found a relationship between stress and acne flare-ups. In response to stress, our bodies produce more androgens (a type of hormone). These hormones stimulate the oil glands and hair follicles in the skin, which can lead to acne. This explains why acne can be an ongoing problem when we find ourselves under constant stress.
Family history: Does a close blood relative, such as a parent, brother, or sister have acne? Findings from research studies suggest that some people may have a genetic predisposition for acne. People who have this predisposition seem more likely to get adult acne.
Hair and skin care products: If you have adult acne, you should read the labels on your skin care and hair care products. Make sure that you see one of the following terms on every container:
- Won’t clog pores
You want to make sure your moisturizer, cleanser, sunscreen, and all other products contain one of these terms. These products are least likely to cause acne.
Medication side effect: Acne is a side effect of some medicines. If you suspect that a medicine is triggering your acne or making it worse, continue taking the medicine — but talk with the doctor who prescribed it. Ask if acne is a possible side effect. If acne is a possible side effect, ask if you can take a different medicine. If you cannot take another medicine, you may want to see a dermatologist who can help you control the acne.
Undiagnosed medical condition: Sometimes, acne is a sign of an underlying medical condition. Once the medical condition is diagnosed and treated, the acne often clears.
More Than 80% of Teenagers Will Develop Some Degree of Acne
When you hit puberty, there’s an increase in sex hormones called androgens. The excess hormones cause oil glands to become overactive, enlarge, and produce too much oil, or sebum. When there’s too much sebum, the pores or hair follicles become blocked with skin cells. The increase in oil also results in an overgrowth of bacteria called Propionibacterium acnes. Teens who’s parents had acne are more likely to also develop acne. For some, acne will resolve by the your early 20s, but for others it can continue will into adulthood.
Having any type of acne (pimples, whiteheads, blackheads, or acne cysts) can feel devastating for a teenager. Just when our appearance becomes so important and we want to look our best, acne can begin. Some teens seem unfazed by acne. For most teenagers, however, this especially visible skin problem can be upsetting.If your teenager seems upset by acne, here’s how you can help:
Take acne seriously. Telling your teen that the pimples, blackheads, and other blemishes will eventually clear on their own may do more harm than good. While waiting for acne to clear on its own, your teen’s self-esteem could plummet. Many studies show that having acne tends to lower self-esteem. Kids who have acne can also be bullied. Bullying can also lower self-esteem. Studies show that self-esteem rises when acne clears. Treatment can help clear acne.
Treating acne now can also prevent acne from worsening. Without treatment, acne sometimes becomes severe. When severe acne clears, it can leave permanent acne scars.
Be Cautious About Reminding Your Teen to Use Acne Treatment
For treatment to work, your teen must use it. To help, you may want to remind your teen to use the acne treatment. Do this cautiously. In a small study, dermatologists found that when parents reminded their teens every day to use their acne medicine, the approach backfired. The teens said the daily reminders felt like “nagging.” This caused the teens to use their acne treatment less often. Rather, encourage your teen to take responsibility. Having your teen keep their medications in a visible place, use post-it notes or dry erase reminders on the bathroom mirror, or having your teen set alarms in their own phone may be a better approach. What may also help is to keep all of your teen’s dermatology appointments. Studies show that most people, including teenagers, are more likely to follow a treatment plan right before — and after — an appointment.
Try to reduce stress. During the teenage years, just about everything can seem stressful. That said, anything you can do to reduce stressful situations can help. Stress can cause acne to flare.
Watch for Signs of Depression
Having acne can affect how teens — and even adults — feel about themselves. Many studies have shown that having acne can lead to depression, anxiety, or both. The longer one has acne, the more likely these problems are to occur. Studies have also found that clearing acne can relieve depression and anxiety. Because depression can have such a devastating effect on one’s life, it’s important for parents to recognize the signs, which may include:
- Sadness that lasts for 2 weeks or longer
- Loss of interest in activities that your teen once enjoyed
- Tendency to avoid social activities, even with people their own age
If you notice any of these behaviors while your teen has acne, it may be time to see a dermatologist for acne treatment. Thanks to advances in treatment, virtually every case of acne can be successfully treated.
Today, there are many effective acne treatments. This does not mean that every acne treatment works for everyone who has acne. But it does mean that virtually every case of acne can be controlled.
People who have mild acne have a few blemishes. Many people can treat mild acne with products that you can buy without a prescription. A product containing benzoyl peroxide or salicylic acid can clear mild acne.
Despite the claims you may see, no acne treatment clears the skin overnight. At-home treatment requires 4-8 weeks to see improvement. Once acne clears, you must continue to treat the skin to prevent breakouts.
When To See a Dermatologist
If you have a lot of acne, painful acne lesions including cysts or nodules, scaring acne, or have acne that is not clearing with non-prescription options, you should see a dermatologist. Dermatologists offer the following types of treatment:
Acne treatment that you apply to the skin: Most acne treatments are applied to the skin. Your dermatologist may call this topical treatment. There are many topical acne treatments. Some topicals help kill the bacteria. Others work on reducing the oil or helping the dead skin cell shed out of the pores. The topical medicine may contain a retinoid, prescription-strength benzoyl peroxide, antibiotic, or even salicylic acid. Your dermatologist will determine what you need.
Acne treatment that works throughout the body: Medicine that works throughout the body may be necessary when you have red, swollen, or painful types of acne. This type of treatment is usually necessary to treat acne cysts and nodules. Your dermatologist may prescribe one or more of these:
- Antibiotics- helps to kill bacteria and/or reduce inflammation.
- Birth control pills- helps to regulate hormone levels
- Spironolactone- helps to decrease hormone signaling on oil glands for women.
- Isotretinoin aka “Accutane”- the only treatment that works on all causes and all types of acne
Procedures that treat acne: Your dermatologist may treat your acne with a procedure that can be performed during an office visit. These treatments include:
- Lasers and other light therapies: These devices reduce the p. acnes bacteria. They can also reduce the redness of fading acne lesions. Your dermatologist can determine whether this type of treatment can be helpful for you.
- Chemical peels: Usually of different ingredients or strengths than can be purchased at the beauty store or medi-spa. Dermatologists use chemical peels to treat non-inflammatory up to moderately inflammatory acne. Chemical peels can also help with some types of pigmentation old acne lesions leave behind.
- Acne removal: Your dermatologist may perform a procedure called ‘drainage’ or ‘extraction” to remove a large acne cyst. This procedure helps when the cyst does not respond to medicine. It also helps ease the pain and the chance that the cyst will leave a scar. If you absolutely have to get rid of a cyst quickly, your dermatologist may inject the cyst with medicine.
Waiting for acne to clear on its own can be frustrating. Without treatment, acne can cause permanent scars, low self-esteem, depression, and anxiety.
To avoid these possible outcomes, dermatologists recommend that people treat acne. When the skin clears, treatment should continue. Treatment prevents new breakouts. Your dermatologist can tell you when you no longer need to treat acne to prevent breakouts.
Brand names: Absorica®, Accutane®, Amnesteem®, Claravis®, Myorisan®, Sotret®, and Zenatane™
Isotretinoin is a prescription pill for severe acne. This type of acne causes deep, painful cysts and nodules. As this acne clears, scars often appear. Isotretinoin may also be recommended if your acne is resistant to all other treatment options, even if nodules and cysts are not present. Treatment with isotretinoin often results in prolonged clearance of acne. Skin can remain clear for years after taking your last pill or even permanently for some patients. For this reason, it is considered the only potential acne ‘cure.’
Isotretinoin Has Several Known Side Effects That Will Be Reviewed by Your Doctor
Isotretinoin is not safe for everyone. Your doctor will review the side effects and take a detailed history to make sure this medication is suitable for you.
One course of treatment takes around 5 to 7 months. Sometimes, one course of treatment takes less time or a bit more time. Dermatologists tailor the treatment to each patient.
Due to possible side effects, your dermatologist can only prescribe this medicine if you:
- Enroll in iPLEDGE™, a program from the U.S. Food and Drug Administration (FDA).
- See your dermatologist for follow-up visits.
- Sign forms that state you know the risks of taking isotretinoin.
Patients Who Can Become Pregnant Must Take a Few Extra Precautions:
- Take required pregnancy tests before and while taking isotretinoin.
- Avoid getting pregnant.
- Declare your method of birth control to the doctor and iPLEDGE.
Patient safety is a dermatologist’s first concern. If this medicine is an option for you, your dermatologist will talk with you about how to take this medicine safely and what you can expect. You and your dermatologist should jointly decide whether this medicine is right for you.
If isotretinoin is an appropriate treatment for you, you will be under close medical supervision while you take this medicine.
Acne Scar Treatment
If acne scars bother you, safe and effective treatment is available. Treatment can diminish acne scars that cause depressions or elevations in the skin.
Treatments include laser treatments, minor skin surgeries, chemical peels, and fillers. A dermatologist or a dermatologic surgeon can perform these treatments in a medical office.
Before getting treatment for acne scars, it is important to get your acne under good control. New acne breakouts can lead to new acne scars.
There are many different types of acne scars including icepick, boxcar, rolling, and keloid.
1540 Fractional Laser Resurfacing
Our 1540 erbium glass fractional laser is the ultimate in non-ablative, non-invasive laser treatments for skin resurfacing and rejuvenation for those who want dramatically younger and smoother skin. This revolutionary laser is able to penetrate deep under the surface of the skin into the dermis to rebuild larger imperfections and improve more severe sun damage. Highly precise microscopic thermal channels induce direct collagen tightening and stimulate natural repair processes that lead to a new layer of plumper, healthier skin. This updated technology is safer, with fewer complications and minimal downtime compared to other options on the market today. It can also be safely used on dark and very dark skin tones. Treatment is ideal for those with busy schedules who still need big results. Old and new acne scars, surgical scars and stretch marks can be effectively treated and their appearance diminished. Sagging and/or pitted skin will be tighter, fuller, and dramatically smoother.
This high-intensity light technology offers safe and superior clearance of vascular and pigmented lesions that goes beyond single-wavelength lasers. This laser uses an intense but gentle beam of light to remove red and brown spots without damaging the surrounding tissue. The small spot size is able to target individual broken blood capillaries and generalized redness virtually anywhere, including the cheeks, corners of the nose, and even around the eyes. Redness can also be removed from scars and stretch marks. Bothersome brown spots including freckles and seborrheic keratosis will flake away. This treatment is an excellent addition to your antiaging and rosacea regimen to get rid of those stubborn spots.
Medium depth TCA peels are a tried and true in-office treatment targeting sun spots, melasma, acne, fine lines, rough texture, large pores and dullness. The peel intensity is completely customizable to your skin type and allowed downtime. You can expect visible peeling, redness, and heat. Downtime ranges from 5 to 14 days. This medium-depth peel results in significant peeling and very noticeable results
Also known as Collagen Induction Therapy, Microneedling is a non-surgical, minimally invasive procedure used to stimulate collagen production. When moved across the skin, the device creates thousands of microscopic perforations per second. In response, the body releases growth factors to tighten and plump collagen. With these micro-channels still open, the skin is simultaneously infused with hyaluronic acid serum rich in copper, zinc and magnesium. A Vitamin C therapy is also available. This technology increases skin elasticity and diminishes the appearance of fine lines, deep wrinkles, acne scars, surgical scars, stretch marks, poor texture and much more. The treatment can be performed on nearly any area of the body. It is ideal for men and women who want younger looking skin with less imperfections. Intensity is completely customizable. Downtime ranges from 1 to 5 days and can be adjusted to meet your needs.
These products are a clear gel formulation of hyaluronic acid, a natural sugar that is already present in your skin, and gives your skin plumpness, volume and hydration. Hyaluronic acid is biocompatible with the human body and is naturally broken down with time. Dermal fillers can be used to fill acne scars to increase fullness. Restylane® lasts for approximately 6 to 18 months. Regular maintenance injections can often prolong the life of the filler and add a building and more beneficial result. Rewards and savings are available through Galderma’s ASPIRE program as well as during sales and promotion throughout the year
Select acne scars may be surgically removed. Large depressed scars can be physically cut out and the edges of skin brought together and sealed with stitches. A new scar is formed up to the surface level of the skin, making them appear less noticeable.