Acne Treatments

Acne Free

Our Long Beach dermatologists will help you become acne free. Acne vulgaris is a chronic, inflammatory disorder of the sebaceous (oil) glands and follicles of the face, anterior chest and back. Approximately 90% of the individuals in the United States at one time or another are affected by acne. It may have its onset during childhood, teenage years, or later in life. The severity of acne varies from a few papules, blackheads, and pustules to the severest form, which is cystic and results in scars and disfigurement. Acne is a disease that occurs in all races. There is no cure, but it is possible to become and remain acne free.

Genetic Factors

Family history of acne has a strong correlation with one’s susceptibility to acne and has been confirmed by the high degree of concordance among twins. Most importantly, the pattern and severity of acne can be inherited as well. For instance, if your parents or siblings have cystic acne with scarring you are more likely to be at risk for similar patterns in your acne.

Follicular Plugging

A major component of acne is the abnormal plugging of pores and follicles, which leads to the formation of blackheads and whiteheads (comedones); this is the primary lesion in acne.

Sebaceous Activity (Oil Glands)

Another acne-causing factor is the activity of the sebaceous glands. It is well known that during puberty, the sebaceous glands, which are the oil-producing glands on the face, begin to produce more sebum (oil and grease) as a response to an increase in hormone levels. The excessive sebum tends to correspond with the severity of acne and is more predominant in the “T-zone” or mid-face region. This increase in sebum production is the result of hormonal action as demonstrated by its onset at puberty and not the result of dirt or uncleanliness.

Bacterial Factors

In addition to an increased production of oil and grease in acne patients, there is a higher concentration of bacteria (Propionibacterium acnes) on the face. The bacteria on the skin break down the oil, causing irritation and inflammation.

Inflammation

The accumulation of comedones, sebum, and bacteria leads to the release of pro-inflammatory cells in the skin; this results in the formation of the red bumps, pustules, and cysts that prevent you from being acne free.

Diet

The role of dietary factors in acne is controversial and is still undergoing investigation.

Climate

Climate may influence acne, since ultraviolet light has been shown to have beneficial actions on acne. Therefore, acne is generally better in summer and worse during the coldest months of the year. This is good news for our Southern California and Long Beach patients who desire to be acne free.

Psychological Factors

Critical and objective evaluation suggest that emotional stress plays only a minor role in the causation of acne, but in many cases, exacerbation or flaring of existing lesions can be related to stressful episodes. The premenstrual aggravation of acne in healthy females has not been adequately explained. However, many women note an exacerbation of their acne prior to, during, or after their periods.

Chemical Factors

Acne is strongly correlated with plugged pores; therefore, heavy use of oily cosmetics and moisturizers can promote plugging of pores leading to acne lesions. Look for cosmetics that are labeled as being “noncomedogenic.”

Clinical Features

The characteristic lesions of acne are the comedones; these may be open (blackheads) or closed (whiteheads). Acne is also characterized by papules, pustules, and cysts. Scars can often result if acne is not treated in a timely manner. Typically the onset of acne is at puberty due to the upsurge in hormones; patients will present with a variety of lesions in various states of formation and resolution. The acne lesions occur most commonly on the face, but may also be present on the neck, chest, and back.

Treatment

Acne is not curable, but it is controllable. Acne should never be dismissed as being inconsequential. Oftentimes, it is casually treated and patients are told that they will out grow it. However, not optimizing acne treatment in a timely manner can result in permanent disfigurement and scarring of the face. Not only can patients suffer physical damage from their acne, but they can also suffer emotional trauma.

As stated earlier, acne is a multifactorial disease with its main problem being the plugging of the pores. One of the main targets of treatment is to normalize the growth of skin around the follicular pores so that they remain open; if this can be maintained patients will experience an 85% to 100% improvement in their acne.

Treatment in this office consists of an initial consultation to assess your history and severity of acne, followed by a customized program that typically includes the following: a mild abrasive agent to help degrease and unplug pores, topical retinoic acid (or vitamin-A-derived drugs) to normalize the skin proliferation around the follicles, which will prevent the formation of comedones, and to decrease oil production; topical or oral antibiotics to treat the bacteria and to decrease inflammation. Other treatments include chemical peels and light therapy, which decrease inflammation and help eliminate bacteria.

Depending on the severity of your acne, isotretinoin (Accutane®) may also be used. Isotretinoin is an oral retinoic acid that is the most potent and effective medication for the treatment of acne. It acts on the follicles to prevent plugging and shrinks the sebaceous glands to decrease oil production. This medication requires routine blood work and pregnancy tests as it can cause birth defects. Please refer to the Isotretinoin handout for further details.

There are several things that can aggravate acne and should be avoided, including: resting the chin, cheeks or forehead on the hands, picking or “popping zits,” using oily or heavy cosmetics, and being severely stressed.

Although there is no cure for acne, our goals are to provide the highest level of treatment in order to prevent scars and to educate you so that your results can be maintained. During your office visit acne surgery will be performed to open the plugged pores and the pustules and cysts may be injected with a low dose of Kenalog which will immediately decrease inflammation and reduce the chance of scarring. Your treatment course will depend on the severity of your acne. Typically, you will see improvement in 4-6 weeks, with maximal improvement by 4-6 months; at that point a maintenance program will be initiated to help you maintain your acne-free state.

In Summary:

Acne is cause by:

Abnormal follicular plugging (whiteheads and blackheads)
Increased sebaceous gland activity
Increase in sex-related hormones (estrogen and testosterone)
Propionibacterium acne on the surface of the skin

Treatments include:

Mild exfoliation with sulfur soap and buff puff
Careful extraction of comedones in the office
Intralesional injection of Kenalog (mild steroid) to decrease inflammation and prevent scarring of the deep cystic lesions
Topical Retin A®, Tazorac®, or oral Accutane® (these drugs aim to open pores and shrink sebaceous glands)
In women, certain oral contraceptive pills can normalize hormones, which help improve acne.
Spironolactone acts to antagonize and normalize hormones
Topical and/or oral antibiotics
Blue light and photodynamic treatment target sebaceous glands and bacteria on the skin
Avoidance of picking and squeezing of pimples, as this can lead to more scarring

Since acne is a multifactorial disease, combination therapy is necessary for treatment and maintenance. Our commitment is to make your acne better and with teamwork and compliance we will achieve this goal.