Caring for acne

Posted: June 24, 2013

By Rima Himelstein, a physician with Crozer-Keystone Health System.

In medical school we had a joke: What is the biggest organ in the body? The answer, "skin," made us chuckle. Little did I know that skin would end up being the cause of so much distress to my teenage patients.

Why do teens get acne? My 16-year-old son sums it up: "It's a ball of pus caused by hormones going crazy."

He's right. The "ball of pus" is a pilosebaceous unit (sebaceous gland and hair follicle) that has become blocked with sebum (an oily substance), dead skin cells, and the microbe Propionibacterium acnes. Puberty induces these changes with the rise of testosterone in boys and girls.

Acne is common in teens: 80 percent have it at some point. That doesn't make them feel better about it. One study found teens with severe acne were two to three times more likely to think about suicide than those with little or none.

We classify acne as mild, moderate, or severe and plan care accordingly. Some people may be genetically predisposed to severe acne, with nodules and cysts that can cause scars.

Patience is a virtue with acne. Improvement can take weeks even with care.

Last month, an expert panel recommended acne care:  

Topical (applied to the skin) retinoids help with mild or moderate acne. Chemically related to vitamin A, retinoids clear up acne and prevent new lesions. Side effects are dry skin and sunburn if exposed to the sun. Tretinoin, adapalene, and tazarotene are by prescription. Benzoyl peroxide is a topical antimicrobial. It can be used alone for mild acne or with other drugs for moderate or severe acne. Benzoyl peroxide kills bacteria that cause acne. Side effects may include peeling, dryness, and skin irritation. It's Some are sold over the counter, others by prescription.

Antibiotics can be used topically or taken orally. They reduce bacteria in acne lesions and ease inflammation. Topical antibiotics are for mild inflammatory acne; oral antibiotics are for moderate or severe acne.

Acne bacteria can grow resistant, so long-term antibiotic use is not recommended. Using topical benzoyl peroxide with antibiotics can limit resistance. Oral antibiotics may cause upset stomach and photosensitivity.

Topical combination treatments combine two skin treatments and help with mild, moderate, or severe acne. They are convenient, making it more likely that teens will keep using them as directed. They have the same side effects as the single medications. All topical drugs should be applied in a pea-sized amount to the entire face - not just the pimples - because it is key to treat the invisible early lesions, called microcomedones.

Birth control pills with an estrogen and a progestin can help female patients with moderate or severe acne. The pill lowers the testosterone involved in acne production. Birth control pills must be prescribed (except for emergency contraception) and may have minor side effects.

Oral isotretinoin, or Accutane, is like an antibiotic. It is only for severe acne that fails to respond to other treatments, and it can prevent scarring. It lowers sebum production, normalizes peeling, reduces inflammation, and kills bacteria. Side effects include dry, cracked skin at the corners of the mouth, high cholesterol, and depression. Accutane can cause birth defects if taken when pregnant.

Do certain foods cause pimples? Maybe. But doctors agree high-glycemic diets (with lots of carbohydrates that break down quickly and raise blood-sugar levels), dairy foods, chocolate, zinc, and iodine need further study.

Does stress cause acne? Yes! Stress can trigger acne. So here's my prescription:

Exercise every day.

Eat a healthy diet.

Sleep well.


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