Acne

What causes acne?

Occlusion of skin pores, sebum (oil) production, bacteria on the skin, and inflammation all play a roll in the cause of acne. “Pimples” begin in skin pores that have oil glands at the base. During adolescence, an increase in hormone levels causes oil production to increase. If the oil reaches the surface of the skin, it can cause a shiny appearance, but this alone does not cause acne. Acne occurs when oil and the tiny cells that line the pore stick together and cause occlusion (blockage) of the pore. The result is a black head or white head (called a comedone). If bacteria on the skin get trapped within a blocked pore, inflammation occurs and bigger inflammatory paputes (pimples), nodules, and cysts develop.

What makes acne worse?

We are not sure why certain people have more of a tendency to form clogged pores and acne. Hereditary and hormonal factors play a major role. Stress can also make acne worse, as can frictional forces (i.e. football chin straps).

Although significant exposure to oil and dirt (such as very dusty or oily work environments) can make acne worse, in general acne is not a cleanliness issue. Washing the face only once or twice daily is recommended. Washing more frequently can actually irritate the skin.

Foods in general do not worsen acne. Chocolate, sodas, and fatty foods do not cause outbreaks in the vast majority of people. However, if you feel that your acne is worsened by a particular food, avoid that food.

Cosmetics and facial lotions are fine to use as long as they are “non-comedogenic”. This means that the lotion/cosmetic will not clog pores. Check the label for this term.

How do we treat acne?

Several topical and oral medications are used in the treatment of acne. Some medications work better for certain people, but not as well for others. Because of this, acne medications may have to be altered occasionally. Regardless of what regimen is used, it will take six to eight weeks before significant improvement will be seen. Occasionally, your acne may actually worsen initially. Be patient.

Usually we try to use a topical gel or cream which will prevent clogged pores from forming. Ziana, Epiduo, and Aczone are medications which are used for this. In addition, an antibiotic is often prescribed to decrease the number of bacteria on the skin. These may be used topically (on the surface of the skin) or orally. For severe or persistent acne, a medication called Accutane can be used; however, because of the possible significant side effects, this is reserved for select, severe cases of acne.

How long will treatment last?

Even though acne usually goes away as one gets older, it can last for years. Each person’s course is individual. How long you will need to use medication depends on your skin.

ACNE TREATMENT

Using Topical Retinoids

  1. Wash face at night with a mild cleanser. Cleansers we recommend include Cetaphil, Neutrogena and Purpose. Other facial cleansers are fine as long as they are mild.
  2. Dab a small amount of medication on the affected areas of the face. Then gently rub a thin film over the entire area. More is not better.
  3. Wash off medication in the morning.
  4. Avoid toners, astringents, or acne washes when using any topical acne medications.
  5. If excessive skin dryness occurs, a non-comedogenic facial moisturizer is fine to use. Cetaphil, Neutrogena and Moisturel are over-the-counter lotions we recommend, but any non-comedogenic facial lotion that you prefer is fine to use.

Oral Antibiotics

Take all medications at least 1 1/2 hours before bedtime!

Tetracycline:
Tetracycline should be taken with a full glass of water or other non-dairy beverage. Try to take Tetracycline one hour before or two hours after meals. The maor side effects of Tetracycline are stomach upset and increased sensitivity to the sun (increases tendency to burn). If stomach upset occurs, you may take the pill with a small amount of food. Use sunscreen and try to avoid prolonged sun exposure.

Doxycycline (Doryx, Oracea, Acticlate) and Minocycline (Solodyn):
Doxycycline and Minocycline may be taken with or without food (if stomach upset occurs, take with food). Do not take with antiacids. The major side effects of Doxycycline and Minocycline are the same as for Tetracycline. Minocycline can also rarely cause headaches or dizziness.

Erythromycin:
Erythromycin can cause stomach upset. It can also have serious interactions with a few other prescription medications (Theophylline, anti-seizure drugs, propulsid and others). It can be taken with or without food.

Ampicillin:
The main side effect of Ampicillin is skin rash. Occasionally Ampicillin can cause diarrhea or stomach upset. It is best absorbed if taken 30 minutes before meals or 2 hours after meals.

Antibiotics and Birth Control Pills:
Theoretically, antibiotics can decrease the contraceptive effectiveness of birth control pills (BCP). In actual practice, antibiotic use probably does not have a significant impact on BCP effectiveness. However, we recommend a second form of contraception for at least six weeks after starting antibiotics. Antibiotics should be stopped if any irregularities in menstrual cycle are noted.

Bactrim (Sulfa drugs):
Bactrim should be taken with a full glass of water. The main side effects are skin rash and stomach upset. Stop if rash occurs and contact your doctor.

Cosmetic Dermatology

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