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Expert Q and A: Avoiding the Angst of Acne at Any Age

An interview with Jenny J. Kim, MD, PhD.
By
WebMD Feature
Reviewed by Laura J. Martin, MD

An estimated 40 million to 50 million Americans are affected by some form of acne, and not just teenagers. Although up to 80% of people aged 11 to 30 say they've been affected, it turns out that many of us, particularly women, have acne in our late 30s and even into our 50s, says Jenny J. Kim, MD, PhD, associate professor of dermatology at the University of California, Los Angeles, David Geffen School of Medicine.

"Sometimes it is hard for patients dealing with acne to understand why, even with ongoing treatment, they cannot get rid of their symptoms forever," Kim says. "I explain that it's similar to having any chronic disease, like diabetes -- there is no cure yet, but we can control the symptoms," she says.

At the recent meeting of the American Academy of Dermatology in Miami Beach, Fla., Kim discussed new treatments for acne and how to care for your skin.

Why is acne so hard to treat?

Because there are so many different factors involved: plugging of pores and oil production for starters. Inflammation is really critical; studies are showing that even on the skin of acne patients where one doesn’t see acne, there are inflammatory factors on a molecular level. Bacteria called P. acnes, or Propionibacterium acnes, are also responsible, as well hormones, particularly androgens (the male hormones present in men and women). They overstimulate the oil glands and hair follicles in the skin, causing hormonal acne flares.

What's new in acne treatment?

In the last 10 or 20 years, there's been very slow movement. People are really concerned about being on antibiotics for a long time, as that can increase the resistance of bacteria. So one change has been [the use of] low-dose oral antibiotics that have anti-inflammatory effects but not antimicrobial effects. Also, we have some slow-releasing antibiotics so you’re not getting a high dose of antibiotics all at once.

Recently, a new drug that works a little bit differently was developed. It’s a topical dapsone (a gel applied to the skin). It's mainly an anti-inflammatory agent.

We're seeing more combination therapy. Since there are five different things going on, we use two or three treatments. It’s really hard for patients to take three different things in the morning and three different things in the evening, so drug companies are developing [medicines] where you have two actives, such as an antibiotic and retinoid (vitamin A derivative that can unplug follicles and pores) in one drug.

The latest studies say diet may play a role in acne, particularly a high gylcemic (high-carb) diet and perhaps skim milk. We need better research in this area, but in the future we might see diet used for regulating and treating acne patients.

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