Acne is one of the most common conditions seen by dermatologists today. It is, of course, commonly seen in teenagers. In fact, 95 to 100% of adolescent boys and around 85% of adolescent girls are affected. In up to 20% of adolescents, acne persists into adulthood. Acne can create self-consciousness and social isolation, as well as scarring, so prompt and effective treatment is warranted. There are many factors which contribute to the formation of acne. Hormones certainly play a role, causing an increased size of the sebaceous glands and increased sebum production. In acne patients, the skin cells (keratinocytes) stick to the sides of the follicle, causing a blockage. Bacteria called Propionibacterium acnes, which live deep in the follicle, secrete proinflammatory factors and enzymes which then leads to rupture of the follicle. The surrounding skin reacts by bringing in inflammatory cells which leads to the clinical appearance of redness and ‘pus.’ Acne ranges from mild blackheads to severe inflammatory lesions, nodules and cysts. Fortunately, most acne patients can be managed with topical or oral medications very effectively. The goal of treatment is to prevent scarring and improve the patient’s appearance and self-image. 

Acne treatments come in all shapes and sizes, from over the counter products containing benzoyl peroxide and salicylic acid, to prescription creams, pills and Accutane. Generally, after a patient has tried over-the-counter medication without success, a prescription regimen is begun. Most regimens include a topical retinoid, such as Retin-A. These types of drugs prevent follicular plugging and improve blackheads (in addition to improving fine lines, wrinkles and diminishing brown spots). Other topical treatments such as antibiotic gels, benzoyl peroxide washes and combination products are often used as well. For more inflammatory lesions, oral antibiotics are often used. They work by decreasing inflammation and killing the bad bacteria in the follicles. There is concern about overuse of these medicines leading to antibiotic resistance, so minimal dosages and short courses are advised. Also, some of these medicines can lead to increased sun sensitivity, so they aren’t a good idea for people who spend a great deal of time outdoors.

In cases of severe nodulocystic acne, the drug of choice is Accutane. The manufacturer of the branded drug recently withdrew it from the market, however, generic alternatives are still available. Accutane is teratogenic, meaning that if it is taken by a pregnant woman, birth defects are likely. For this reason, prescribers, pharmacies and patients are required to register with the ‘I-Pledge’ program. As a part of this program, women of childbearing age are required to use two forms of contraception and receive monthly pregnancy tests. There are other concerns with the drug, including its propensity to raise triglyceride and cholesterol levels and reports of depression and inflammatory bowel disease. It is an extremely effective drug for people with severe acne, but both the patient and physician must be aware of its risks and limitations. Acne is an extremely common condition that can cause significant distress in those afflicted...it is crucial to start treatment before scarring occurs. Additionally, it is important to not downplay the psychological effects of acne, which can lead to unseen scars.

For females with acne, especially adult women with lesions on the lower face and neck, hormonal treatments for acne are very effective. Oral contraceptives work by blocking both ovarian and adrenal production of androgen (the male hormone that contributes to acne formation). Other medications, such as Spironolactone, which works by blocking the androgen receptor, are also sometimes used. Surgical treatments of acne include extraction, injection of steroids and chemical peels. Extraction involves the use of a special tool to express the contents of the comedone or blackhead. This enables the topical medicines to work better and improves appearance immediately. Steroids can be injected into a particularly large or painful inflammatory nodule and work rapidly to improve the lesion. Chemical peels work by decreasing the ‘stickiness’ of the skin cells, thereby decreasing the number of blackheads.

Acne is an extremely common condition that can cause significant distress in those afflicted. It is crucial to start treatment before scarring occurs. Additionally, it is important to not downplay the psychological effects of acne, which can lead to unseen scars.