Acne may be mild (few, occasional pimples), moderate (inflammatory papules), or severe (nodules and cysts). Treatment depends on the severity of the condition.
What Causes Acne?
Acne is primarily a hormonal condition driven by male or ‘androgenic’ hormones, which typically become active during the teenage years. Sensitivity to such hormones, combined with bacteria on the skin, and fatty acids within oil glands, cause acne. Common sites for acne are the face, chest, shoulders, neck, and back -- the sites of oil glands.
Acne lesions include whiteheads, blackheads, small bumps, and nodules and cysts.
Though acne is essentially a normal physiologic occurrence, certain conditions may aggravate the condition, including:
- Fluctuating hormone levels around the time of menses (women)
- Manipulating (picking/prodding) acne lesions
- Clothing (for example, hats and sports helmets) and headgear
How Is Acne Treated?
Only four types of drugs have proven to be effective for the treatment of acne -- antibiotics, benzoyl peroxide, and retinoids. Most people require at least one or two agents, depending on the severity of their acne.
- Benzoyl peroxide, available as an over-the-counter product (for example, Clearasil, Stridex) and by prescription (for example, Benoxyl, PanOxyl, Persa gel), targets surface bacteria, which often aggravate acne. Irritation (dryness) is a common side effect.
- Retinoids (vitamin A derivatives), for example, Differin, Retin-A, Tazorac, treat blackheads and whiteheads, the first lesions of acne, as well as inflammatory papules and pustules. Trifarotene (Aklief) can be used to treat severe acne called acne vulgaris. With all retinoids, the most common side effects are dryness, irritation, and an increased risk of sunburn. While most are prescription only, there is an over-the-counter version of Differin now available.
- Antibiotics, either topically applied to the skin (clindamycin, erythromycin), or taken orally (tetracycline and its derivatives, trimethoprim-sulfamethoxazole) control surface bacteria and reduce inflammation in the skin. Antibiotics are more effective when combined with benzoyl peroxide or retinoids. The oral retinoid isotretinoin (Absorica, Amnesteem, Claravis, Myorisan and Zenatane) is reserved for people with severe (nodular or cystic) or widespread disease. Isotretinoin shrinks the size of oil glands, the anatomic origin of acne. Without active, plump oil glands, acne actively diminishes. Side effects can include dry skin, elevated cholesterol and triglycerides, and birth defects. Women of childbearing age must practice birth control before, during, and after treatment (about one month) with isotretinoin. The use of isotretinoin requires rigorous testing (cholesterol, pregnancy, triglyceride, cholesterol, liver function and bone marrow function) and follow-up for the prescribed period (5 or more months). It is reserved for the most severe or widespread types of acne that do not respond to other treatments.
- Hormone therapy may be helpful for some women with acne, especially for those with signs and symptoms (irregular periods, thinning hair) of androgen (male hormone) excess. The hormone therapy consists of low-dose estrogen and progesterone (birth control pills) or anti-androgen medications such as aldactone (Spironolactone) - oral or clascoterone (Winlevi) - topical. WInlevi can be used in both males and females as it is a local skin androgen blocker.
How Can Acne Be Prevented?
To prevent acne and reduce its damage to your skin, follow these tips.
- Choose a cleanser specially formulated for acne. These products often contain salicylic acid or benzoyl peroxide, which help to clear acne sores.
- Clean your face gently, as trauma to the acne breakouts may worsen the acne or cause scarring. When washing your face, use your hands or cotton pads, as any terry cloth or other scrubbing material may cause acne sores to rupture.
- If you need to use a moisturizer, use only light, non comedogenic moisturizers, which do not aggravate acne.
- If you are a woman, use an oil-free foundation. Heavy makeup or other cosmetic products that block pores may cause a flare-up of acne.