Acne
For more information on acne and other skin conditions visit our
Patient Education Center.
Acne is a very common condition that tends to be hereditary, usually beginning during adolescence and subsiding by the late twenties. In some cases, however, acne may also begin later in life and last well into middle age.
The years of adolescence are full of changes, and living with acne need not be an accepted rite of passage to adulthood. When acne is present early, effective medical intervention will greatly improve the outcome and prevent scarring. Adolescent acne can be controlled with proper skincare and regular use of appropriate medications or treatments, such as the OmniLux Revive; any treatment will take patience and persistence.
Acne Treatments available at Van Dam Dermatology and Laser Center & Versa Medi Spa
Acleara Acne Therapy
A breakthrough acne treatment that combines a vacuum with pulses of specially-filtered light to help clear your pores and treat acne outbreaks. The Acleara device is cleared by the FDA to treat a wide range of acne in all skin types. The treatment generally takes about 15 minutes depending on the size of the treatment area. Current acne outbreaks begin clearing up in as little as 2 days.
OmniLux Revive
This exceptional technology utilizes a panel of hundreds of LEDs to flood your skin with a single wavelength of light, destroying acne-causing bacteria. Successful clearing of acne can be seen after just one treatment, without the need for prolonged use of oral prescription medication. A series of 2 treatments per week over four weeks is recommended to offer clearing of nearly one year or more. LED treatments are non-invasive, no-downtime procedures that treat large areas at one time. Although not covered by insurance, OmniLux offers proven results with a great value.
Acne surgery, extractions and aesthetician treatments
Dr. Van Dam or his assistants my remove comedones. When performed carefully, no scarring results from this procedure. Microdermabrasion treatments are often beneficial for acne because of the ability of this treatment to help remove plugs from pores. Our Versa Medi-Spa estheticians can help improve the results of medical treatment with procedures such as comedo extraction and microdermabrasion.
How Acne Begins
Hairs grow out of tiny pores in the skin called follicles. Acne occurs in hair follicles and in the sebaceous (oil) glands attached to the follicles. The sebaceous glands secrete a waxy, oily substance called sebum that helps keep the skin moist and supple. Because sebaceous glands are most concentrated on the face, chest and back, most acne is concentrated in these locations.
Sebum usually passes to the skin's surface through the opening of the follicle in small, unnoticeable amounts. The hair follicles are lined with layers of dead skin cells. In people with acne the dead skin cells that line the pores stick together abnormally and accumulate within the follicle and block the opening of the pore. This blockage consists of a collection of sebum, dead skin cells, and bacteria and is known as a comedo:
- A "whitehead", or closed comedo, has a small or normal sized pore at the skin's surface.
- A "blackhead," or open comedo, is nearly identical to a whitehead except that the pore opening is expanded by the size of the plug. The dark color of a blackhead is not the result of dirt or other matter that has accumulated in the pore but is the result of a chemical reaction between the mixture of sebum and dead skin cells and oxygen in the air.
When a pore becomes plugged, there is further accumulation of debris in the follicle beneath the plug. Eventually, the wall of the follicle may burst from the increasing pressure of the substances building up within it. The sebum, dead skin cells and bacteria are very irritating to the tissue beneath the surface and produce redness, swelling and pain (the inflammatory papule or pimple).
Why Acne Develops
Genetics
The basic cause of acne is still unknown. The predisposition to develop acne is often hereditary but a combination of factors has been shown to contribute to the acne process. A parent who had a severe case of acne during his or her teenage years is more likely to have children who will also have acne. Parents who had a smooth complexion tend to have children who also have acne-free skin.
Hormonal Changes
During puberty, the body undergoes a great number of changes that are the result of rising levels of sex hormones in the body. Both males and females experience an increase in the levels of hormones called androgens (mainly testosterone in both sexes) that increase the size of the sebaceous glands, promote the production of sebum and contribute to acne.
Skin Bacteria
Bacteria that live on the skin surface are normally "friendly" because they check the growth of more dangerous (disease-causing) microorganisms. These friendly bacteria play little or no role in acne. It is a specific type of bacteria that lives inside the hair follicle and sebaceous gland that is responsible for acne. These germs are not present on the surface of the skin. These tiny organisms inside your pores alter the chemical nature of sebum turning it into a more irritating substance. In addition, these bacteria cause abnormalities in the cells that line the follicles that lead to obstruction of the pore and rupture of the follicle wall.
Diet
Until recently, dermatologists believed there was no connection between acne and diet. New research has provided convincing evidence that diet may, in fact, play a role in acne:
- It turns out that "bad carbs" are bad for acne and a reduction in "bad carbs" of 15-20% may significantly help reduce acne severity. The problem foods are those that can be said "to start out white", foods that contain ingredients like flour, sugar, and starch.
So, in the greasy hamburger, it is not the burger but the bun and the sugar in the ketchup that are the problem. It is the starch in the potato, not the grease in the French fries. Try to cut back on "bad carbs" if you have acne.
Drugs and Industrial Chemicals
Acne-like conditions may infrequently result from the use of certain drugs, primarily bromides, iodides, corticosteroids, androgens, and drugs used to treat epilepsy or depression. Industrial substances, including coal tar and petroleum oil, may cause some cases of acne. Therefore it is important that Dr. Van Dam be aware of all medications and supplements that you regularly take or have been recently prescribed.
Local Factors
Pressure on the skin from clothing, backpacks, football shoulder pads, headbands, sport masks and helmets can aggravate acne by friction. Similarly, the friction caused by resting of the chin or cheek on a hand while doing homework, playing a musical instrument, or talking on the telephone may also aggravate acne. Excessive perspiration can also result in worsening of acne in some people.
Cosmetics
Available evidence does not show a connection between acne and the use of cosmetics. However, if your skin seems to break out when you use certain products, you should avoid them as it may be a sensitivity to certain ingredients within the cosmetic that is causing your breakouts. Any cosmetic products that are expired, smell or look odd, or have lost consistency should be immediately discarded.
Picking or Squeezing
Although many people think that picking or squeezing pimples will help make pimples go away, it may actually make the condition worse and lead to long-lasting red marks or even scars. It is much better to treat pimples with topical agents as directed by Dr. Van Dam or our staff than it is to pick or try to extract a pimple on your own. No matter how tempting it may be to squeeze -- do not pick your pimples!
Acne Myths
While the foregoing factors may promote acne or worsen an existing acne condition, other factors that are widely believed to cause acne have no scientific basis at all. Special "cleansing" diets, vitamin supplements and so-called "health foods" invariably prove to be useless in the treatment of acne. Sexual activity does not prevent or clear acne. Also, although good hygiene is recommended, surface dirt and oils on the skin do not exclusively cause acne. As explained previously, acne starts deep within the follicle.
Treatment
Although acne usually passes with adolescence, a variety of treatments are available to prevent the development and spread of acne pimples. Prevention or early treatment of acne tends to be much more successful than attempts to eliminate scars later.
- Washing your skin gently with mild cleanser once or twice a day can help remove excess sebum and surface oils. It is important that you not scrub the skin too vigorously, since friction may damage the delicate hair follicle openings through which the sebum must flow. In fact, the friction of scrubbing the skin has been shown to increase the buildup of dead skin cells inside the hair follicle, thus leading to increased plugging of the pores. So, while cleanliness is important, it is also important that skin cleansing be performed gently and not more frequently than necessary. You cannot "wash away" acne.
- For mild acne there are many over-the-counter topical preparations that may be helpful. Ingredients such as benzoyl peroxide, salicylic acid, and sulfur, induce shedding of dead skin cells and surface debris, open the pores, and allow the sebum to escape to the surface. Benzoyl peroxide is considered the most effective of these agents. It is available in creams, gels and lotions in a variety of strengths. Benzoyl peroxide helps remove comedones and kills bacteria. However, benzoyl peroxide can be irritating to the skin.
- Stronger is not always better when treating acne. Do not use a higher strength of benzoyl peroxide than your skin will tolerate. Also, nearly all acne therapy is aimed at the prevention of new lesions rather than making existing lesions disappear. Acne products work best when used on a regular basis on all acne prone areas in order to prevent new lesions. As pimples and comedones disappear the skin clears because new lesions do not take their place.
Prescription topical agents
If over-the-counter preparations do not help, Dr. Van Dam may suggest prescription medications for your condition. Tretinoin, tazarotene and adapalene are all related to vitamin A. These topical agents help remove comedones and interfere with the formation of new ones. They also help prevent pimples. These products should be used only when prescribed or recommended by Dr. Van Dam. Topical antibiotics, such as sulfacetamide or clindamycin, are particularly effective against the bacteria living within the follicle, and are commonly used to treat mild to moderate acne.
Oral prescription medications
Topical therapy may not be enough to eradicate inflammatory acne. In cases of moderate to severe acne, oral antibiotic therapy is sometimes necessary in order to achieve better penetration of medication into the hair follicle. Antibiotics help because they kill the specific bacteria involved in acne and because they also help reduce inflammation (redness, swelling and accumulation of pus) in skin lesions. There may be restrictions, such as when or with what foods or vitamins the antibiotic should be taken, and it may take several weeks of treatment before its desired effect is seen. Unfortunately, the benefits of antibiotics last only as long as you continue taking them. Unless you have "outgrown" your acne, cessation of antibiotics results in reappearance of acne lesions. The use of antibiotics in treating acne is an established and routine measure. We now have over fifty years of experience that has clearly established an excellent track record of safety and effectiveness for the use of oral antibiotics in the treatment of acne pimples, nodules, and cysts, even when used for extended periods of time.
Some females who do not respond to other therapies may benefit from the use of oral contraceptives or a male hormone blocker like spironolactone.
Injection of a diluted cortisone solution into an enlarged acne lesion is sometimes indicated. These injections speed the healing of most larges pimples.
While a suntan may temporarily camouflage the redness of inflamed skin, the long-term harmful effects of ultraviolet radiation must be weighed against the limited, short-term benefits. Since ultraviolet radiation causes skin cancer and accelerates the aging process by causing wrinkles and age spots, dermatologists cannot endorse the use of tanning as a tool for the treatment of acne.
