Acne is the most common skin problem treated in the US. More than 85% of adolescents and 10% of adults struggle with acne, which can be whiteheads, blackheads, or pimples. It is common on the face, chest, shoulders, and back. Treatment can not only help resolve the issue, but also prevent permanent scarring.
What causes acne?
Acne lesions are caused by multiple factors. Hair follicles become blocked by dead skin cells as they shed and replicate. This can lay the groundwork to develop acne. Hormones also play a role, such as those that increase during puberty. Hormones increase sebum (oil that is made in hair follicles) that increase blockage and create a good place for bacteria to live. Bacteria called Propionibacterium acnes (P. Acnes) likes to grow in these blocked follicles and over time they become inflamed and form pimples and pustules – what people think of as “acne”.
What should I avoid?
Picking or rubbing at acne, or “pimple popping” usually makes things worse! It increases inflammation.
Have you heard that you need to give up chocolate or french fries to fix your acne? This is actually a myth! There has been no proven benefit to giving up sweets, chocolate, or fatty foods in relation to acne – though there are plenty of other reasons to eat them in moderation!
How is acne treated?
Treatment of acne is designed to attack the underlying causes. The recommended form of treatment that a patient should use is dependent on the severity and nature of their specific acne. Your pediatrician can help you select the right one
As general guidance:
- Always start with a mild moisturizing soap and wash the skin daily, avoid harsh soaps or medications until you speak with your child’s doctor.
- If oily skin is part of your problem, there are over the counter treatments available without a prescription – including those that have benzoyl peroxide. Be aware that this can bleach your bedding. If you are not happy with how this is working, we encourage you to came in for an appointment with your provider.
If the severity of acne is more significant, doctors will sometimes recommend a prescription cream, gel or ointment. Tretinoin (Retin A, Differin, etc.), a topical form of Vitamin A, that breaks up the blocked hair follicles and helps to decrease the overproduction of skin cells. Topical agents, like benzoyl peroxide 2.5%-10%, erythromycin, cleocin T or benzamycin, a combination of benzoyl peroxide and erythromycin, decrease the amount of P. Acnes in the hair follicle. They may be used alone or in combination with other medications. The major side effects of these medicines include skin dryness, peeling, facial redness, and sun sensitivity
In some cases, oral contraceptive pills can be used in female patients to help regulate menstrual cycle hormones that can lead to worsening acne.
If acne is more severe, oral antibiotics such as minocycline or doxycycline can be added to reduce bacteria in the hair follicles and decrease inflammation. The major side effects include stomach upset and sun sensitivity.
Finally, if acne is very severe, Isotretinoin (Accutane) an oral form of Vitamin A, can be used to address these same acne factors, but in a more potent way. This is done under the guidance of a dermatologist. This medication is highly effective, but can cause very significant side effects including birth defects in pregnant women, dry skin, hair loss, muscle aches, joint pains, headaches and sun sensitivity. If this is recommended for you/your child, your pediatrician can refer you to a dermatologist to discuss further.
Take-Away
There are many factors that influence acne including oil production and skin shedding in the skin, and hormones that create opportunities for bacteria to grow. Your pediatrician can guide you on selecting the appropriate treatment for your specific acne type!
