Acne is the most common skin disorder in the United States affecting 85% or greater of the population. It most often first appears during puberty and can often persist well into adulthood. The most common and earliest forms of acne is called comedonal acne which refers to the clogged pores. Patients will often experience these as tiny white- or blackheads. This can either evolve into or accompany inflammatory, acne which people more frequently know as the painful red white heads that are occasionally filled with pus. A more advanced and severe form of inflammatory acne is cystic acne which can cause significant pain, swelling, and scarring. These cysts are often found deeper in the skin.
While the exact cause of acne is not exactly certain, there are often multiple factors that contribute to acne in any one person: genetics/family history, clogged pores, bacteria (Proprionibacterium acnes) and it’s by-products, and hormones. Any one of these factors may be more or less active in any given individual. Assessing each patient individually is of critical importance in order to properly tailor the most appropriate therapy for each patient’s type of acne.
Common first-line medications include topical retinoids (I.e. tretinoin, adapalene, tazarotene) and topical antibiotics. Occasionally, if someone’s acne is more inflammatory additional topical medications such as topical dapsone or short-courses of oral antibiotics. At Skin Wellness Physicians, we understand the role oral antibiotics play in the treatment of acne, but believe in doing our best to limit the length of time we have our patients taking these medications, attempting to control one’s acne with topicals. Not infrequently, women will present with acne heavily influenced by hormones. Occasionally hormonally acting medications such as oral contraceptives or spironolactone are quite helpful. Lastly, oral medications (i.e. Accutand and Photodynamic therapy) can provide clinical control and occasionally cure in even the most severe cases.
Despite medical intervention, acne can at times cause permanent complications such as scarring. This can include rolling scars, box-car scars, distensible scars, and ice-pick scars. The latter being the most challenging to treat. There are many options for acne scars and they include lasers, chemical peels, and even excisional surgery.
Ultimately, patient’s should come to our clinic at Skin Wellness Physicians for a medical consult to determine the best care for their acne.