Acne seems to be a part of growing up and becoming a teenager! Although acne is not seen in all adolescents, it is commonly seen in some degree during the teenage years and often extends into the early 20's for many patients. Acne is seen in approximately 85% of adolescents and can be a source of significant psychological effects, including anxiety, embarrassment, and depression.
What causes acne?
Acne is a problem caused by inflammation of the pilosebaceous unit of the skin. Just before puberty many hormones develop, some of which stimulate the sebaceous gland to produce more sebum. Sebum can block the opening of the ducts which open to the skin, causing a closed comedone (whitehead). As the gland expands, the duct opens and can become clogged with a dark material causing an open comedone (blackhead). When bacteria fill the ducts of the sebaceous glands, there can be inflammation that causes pustules and nodules. As the inflammation increases, there can be larger nodules and cysts which can lead to scarring.
To some extent acne can be caused by heredity but can also develop in adolescents who have no family history of significant acne. Stress can make acne worse. Many studies have now shown that certain foods once thought to cause acne (chocolate, sodas, caffeine, oily foods) DO NOT cause acne in the vast majority of cases. Acne is NOT caused by poor hygiene.
How do we treat acne?
The type of treatment for acne depends on the severity of the acne. Mild comedonal acne (mostly blackheads and whiteheads) is treated with exfoliating cleansers (salicylic acid, glycolic acid) and topical retinoids (adapalene, tretinoin, tazarotene). As more inflammation develops with pustules, papules (red bumps) and nodules, more anti-inflammatory medications are typically added to the regimen. These medications include benzoyl peroxide cleansers and gels, topical antibiotics, and oral antibiotics. Many of our patients will stay on oral antibiotics while they continue to have inflammatory lesions.
When acne is caused by hormonal factors, treatment is often geared toward controlling hormone production. In these circumstances, treatment often includes birth control medication for females or anti-testosterone medication for females (spironolactone).
Isotretinoin is an oral medication used for persistent or resistant acne that doesn't respond well to more conventional oral and topical therapy. In some cases, acne is so severe with nodules and multiple cysts that Isotretinoin is a first line therapy for adolescent acne.
Do's and Don't in Adolescent Acne
- Wash your face with a gentle cleanser twice daily
- Eat a healthy diet and drink plenty of water
- Use your medications regularly
- Be patient! Acne does not clear up in 1-2 weeks!
- Call our office if you are having a side effect from a medication we prescribed
- Use oil-free make-up
- Wash the sweat off your face after exercise
- Pop pimples! This will increase the risk of scarring
- Scrub your face with a wash cloth
- Treat acne with tanning. This causes premature aging and increases the risk of skin cancer
- Try to spot treat acne. Most acne medications are used over the entire face for prevention of acne lesions
1 in 5 adults between the ages of 25 and 44 and nearly half of all adult women experience mild to moderate acne. Research has proven that most adult acne is not caused by your diet, stress, or surface dirt and oil.
What causes Adult Acne?
No one factor causes acne. Acne happens when oil (sebaceous) glands start to grow around puberty due to stimulation by hormones from the adrenal glands of both boys and girls. Oil is a natural substance which lubricates and protects the skin: Under certain circumstances, cells that are close to the surface block the openings of sebaceous glands and cause a buildup of oil underneath. This oil stimulates bacteria, (which live in everyone’s skin and generally cause no problems) to multiply and cause surrounding tissues to become inflamed resulting in acne.
If the inflammation is near the surface, you get a pustule; if it’s deeper, a papule (deeper pimple); deeper still and it’s a cyst. If the oil breaks through to the surface, the result is a “whitehead.” If the oil becomes oxidized (that is, acted on by oxygen in the air), the oil changes from white to black, and the result is a “blackhead.”
- Heredity in relation to acne: with the exception of very severe acne, most people do not have the problem exactly as their parents did. Almost everyone has some acne at some point in their life.
- Food in relation to acne: All over the world, parents tell teens to stay away from pizza, chocolate, greasy fried foods, and junk food to avoid acne. While these foods may not be good for overall health, they don’t cause acne or make it worse.
- Dirt in relation to acne: Some individuals have more “oily” skin than others. “Blackheads” are oxidized oil, not dirt. Sweat does not cause acne, therefore, it is not necessary to shower instantly after exercise for fear that sweat will clog pores. Excessive washing can dry and irritate the skin, making acne worse.
- Stress in relation to acne: Some people get so upset by their pimples that they pick at them and make them last longer. Stress, however, does not play much of a direct role in causing acne.
- Hormones in relation to acne: Some women break out cyclically, but most women (and men) don’t. Some oral contraceptive pills may help relieve acne, but unless a woman has abnormal menstrual periods and excessive hair growth, it’s unlikely that hormones play much of a role in causing acne.
- Cosmetics in relation to acne: Most cosmetic and skin care products are not pore-clogging (“comedogenic”). Of the many available brands, those which are listed as noncomedogenic or nonacnegenic are recommended.
In occasional patients, contributing factors may be:
- Pressure in relation to acne: In some patients, pressure from helmets, chinstraps, collars, and the like can aggravate acne.
- Drugs in relation to acne: Some medications may cause or worsen acne, such as those containing iodides, bromides, or oral or injected steroids (either the medically prescribed prednisone or the steroids bodybuilders or athletes take). Most cases of acne, however, are not drug-related.
- Occupations in relation to acne: In some jobs, exposure to industrial products like cutting oils may produce acne.
What can I do to help prevent adult acne?
As an adult with mild to moderate acne, you need an acne treatment that is specifically formulated for your skin. Using acne products designed for teenage skin can lead to irritation and dryness.
It is recommended that you consult your provider to find out which acne treatment or combination of acne treatments is best for you.