Acne: Diagnosis & Treatment

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Acne is a common skin condition characterized by plugged pores (blackheads and whiteheads), inflamed pimples (pustules), and deeper lumps (nodules). Acne occurs on the face, as well as the chest, back, and upper arms. Although most teenagers get some form of acne, adults can also develop acne. Often, acne clears up after several years, even without treatment. Acne can be disfiguring and upsetting to the patient. Untreated acne can leave permanent scars. To avoid acne scarring, acne treatment is important. 

Types of Acne and How Acne Forms:

Acne is not caused by dirt. Human hormones increase during adolescence and stimulate the sebaceous glands of the skin to enlarge, produce oil, and plug the pores, causing acne. Whiteheads (closed comedones), blackheads (open comedones), pimples (pustules), and occasionally cysts (deep pus-filled lumps) form. Adult acne develops later in life and may be related to hormones, childbirth, or stopping the pill.

Cleansing:

Acne has nothing to do with not washing your face. However, it is best to wash your face with a mild cleanser and warm water daily. Washing too often or too vigorously may actually make your acne worse. Exfoliating once or twice per week (depending on skin type) with an exfoliant is useful for opening up blackheads and whiteheads, and fading acne marks and scars.

Diet:

Acne is generally not caused by foods. However, if certain foods seem to make your acne worse, try to avoid them. In a few cases, milk/dairy or nuts may aggravate acne and low glycemic diets appear to be helpful for some patients.

Cosmetics:

To keep your skin clean from acne, wear as little cosmetics as possible. Oil-free, water-based moisturizers and make-up should be used. Choose products that are "non-comedogenic" i.e. should not cause whiteheads or blackheads. Remove your cosmetics every night with mild soap or gentle cleanser and water. A flesh-tinted acne lotion can safely hide blemishes. Loose powder in combination with an oil-free foundation is also good for cover-up. 

Treatment:

Treatment is an ongoing process and improvement takes time with acne. The best acne treatment your dermatologist recommends will vary according to the type of acne. 

Topical creams:

Your dermatologist may prescribe for your acne topical creams, gels, or lotions with vitamin A acid-like drugs, benzoyl peroxide, or antibiotics to help unblock the pores and reduce bacteria that cause acne . These products may cause some drying and peeling; if your skin becomes irritated, take breaks from your cream or add a moisturizer (e.g. apply medicated cream/gel first, and 1 minute later apply a moisturizer overtop).
Before starting any medication, even topical medications, inform your doctor if you are pregnant or nursing, or if you are trying to get pregnant.

Special Treatments:

Do not pick, scratch, pop, or squeeze pimples yourself. When the pimples are squeezed, more redness, swelling, inflammation, and scarring may result.
Microdermabrasion may be used to remove the upper layers of the skin improving irregularities in the surface, contour, and generating new skin. SilkPeel Dermalinfusion is an advanced microdermabrasion with infusion of anti-acne ingredients and can be useful to treat acne and acne marks.

Chemical peels with glycolic acid, salicylic acid, or retinoic acid can help unblock the pores, open blackheads and whiteheads, and minimize marks and acne scarring. 
Injections of corticosteroids may be used for treating large red bumps (nodules & cysts). This may help them go away much more quickly.

Oral Medications:

Antibiotics taken by mouth, such as tetracycline, doxycycline, minocycline, are often prescribed for acne. A dermatologist is an expert in using these antibiotics and other pills in terms of efficacy, proper dosing and safety issues.

Birth control pills may improve acne, and may be used specifically for the treatment of acne. Birth control pills are particularly effective in women in whom periods are irregular, or who notice flare-ups before each period, or have more lower face (e.g. around the mouth) and jawline acne. 
            
Other Treatments:

In cases of unresponsive or severe acne, isotretinoin (e.g. Accutane, Epuris, Clarus) may be used for your acne. I have used this medication for many years with great success. Patients using isotretinoin must understand the potential side effects of this drug. Monitoring with frequent follow-up visits is necessary. Pregnancy must be prevented while taking the medication, since the drug causes birth defects.
Women may also use birth control pills or medications that decrease the effects of male hormones (e.g. Spironolactone) to help their acne.
Photodynamic therapy using intense pulse light (IPL) or broad band light (BBL) or the blue wavelength of light (BLU-U) can help to get rid of acne as well.

Your dermatologist will evaluate your skin and suggest the appropriate treatment regimes considering your age, sex, type and the extent of your acne.

Treatment of Acne Scarring:

Your dermatologist can use a variety of methods of acne scars treatment. Skin resurfacing with laser (Profractional laser resurfacing), dermabrasion or microdermabrasion, micro-needling (e.g. dermaroller and dermastamp) chemical peels, or electrosurgery can flatten scars. Soft tissue elevation with dermatologic fillers or subcision can elevate scars. Brown marks left by acne can be improved with physician-grade chemical peels, microdermabrasion (preferably the advanced SilkPeel Dermalinfusion system), prescription bleaching creams and physician-grade products.

~ Dr. Benjamin Barankin, Toronto Dermatology Centre

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Toronto Dermatologic Surgeon