Acne comes in many forms and can affect different people are various times in their lives. Yet they often get lumped together when evaluated and treated by physicians.
Here, I would like to separate some of the different types of acne, their causes, and the most appropriate treatments for each.
Causes and Treatments
Most acne is caused by bacteria, sebum (the natural oil of the skin), hormonal influences, and the stickiness of the skin cells as they move through the surface of the skin.
Dermatologists break acne into a few basic groups: open comedones (blackhead), closed comedones (whiteheads), pustules (pus bumps), and cysts. In addition to these, we use the term rosacea and/or perioral dermatitis to describe different types of “adult acne.”
Blackheads are clogged pores in which the oil has been oxidized to change colors. Eliminate them by cleaning the skin with products that have salicylic acid in them, chemical peels that exfoliate, tretinoin, and lasers such as the Isolaz.
Tretinoin (Retin A) and its cousins Tazorac and Differin help the skin cells become less sticky and minimize the formation of new blackheads. Whiteheads are blocked hair follicles with closed surfaces. These may be cleaned up the same treatments but may also require antibiotics.
Pustules and cysts usually require oral medications such as antibiotics. Antibiotic usage with acne usually begins with something in the tetracycline family (tetracycline, doxycyline, and minocycline). There are some novel differences between these drugs and some have once-a-day formulations. Side effects may include increased sensitivity for sun exposure with doxycycline, headaches from minocycline, and a range of others.
Accutane is a medication that, when used correctly, has dramatic results not only on the skin but also on the self-esteem and self-confidence of the person using it. Over the past 15 years, I have seen countless cases of teens who have been withdrawn and depressed and become more confident and outgoing once their skin clears. To be sure, there are risks associated with this drug but under the right circumstances it can be a life-changing drug. (Accutane is a vitamin A derivative that is being withdrawn from the US because of what I consider disproportional attention from the trial bar).
Battling Adult Acne
Hormonal acne is common in women. For some, the acne is associated with hair loss and other symptoms that indicate excessive male hormones. Simple blood tests can help to identify these patients and medications can correct the problems.
Many women have a slight excess of male hormone that contributes to their acne. For these patients I prescribe an oral contraceptive (such as Yaz) or a diuretic (such as aldactone). Both of these agents block the activity of male hormones and they can have dramatic actions.
Adult acne is a frequent reason patients seek help from dermatologists. We usually can identify a few types of rosacea and have many ways to fix it. Some of the best include using lasers to minimize the redness.
I use a pulsed dye laser which sends light into the small blood vessels, effectively sealing them. For people with ruddy complexions, this can work wonders.
Rosacea may also involve pus bumps and overgrown oil glands. Both of these can be treated with antibiotics and lasers.
Some types of rosacea involve the areas around the mouth. This subtype is frequently misdiagnosed and thus, treatment fails. It is known as peri-oral dermatitis and one sign of it is a rim of normal skin around the lips. I tell patients to avoid tartar-control toothpaste and switch to Tom’s Of Maine. This helps minimize the outbreaks.
Acne has many different manifestations, causes, and treatments. If you have an acne problem, it is worthwhile to find a dermatologist who can figure out what type you have and prescribe a regimen that will help.
To learn more about Dr. Beer, visit www.idealskin.com and www.palmbeachcosmetic.com.
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