Acne, or Acne Vulagris, is a common skin condition affecting teens and young adults in the11-30 age group. Acne usually appears on the forehead, chest, upper back, shoulders, and face. It can vary depending on the individual, and for some people, acne can lead to emotional distress and cause scarring on the skin. A sudden onset of acne in older adults can be a sign of an underlying medical condition that should be addressed.
Causes of Acne
We all have pores all over our skin, which consists of a hair follicle and a sebaceous gland that produces an oily substance known as sebum. Sebum is great for keeping hair healthy and protecting our skin from losing water. During puberty and with certain hormonal abnormalities pores can enlarge and produce more sebum. Sebum also helps create a comfortable environment for bacteria that live on the skin. When a pore becomes plugged due to excess sebum and dead skin cells it can become infected with bacteria. Inflammation and pus may result underneath the skin, giving rise to acne.
Factors known to Aggravate Acne
- Aging
- Certain foods
- Chronic stress
- Family history
- Dead skin buildup
- Skin produces too much oil, which clogs the pores
- Hormonal changes
- Certain medications
- Excess friction or pressure on the skin
- inflammation of the skin
- Presence of bacteria (P.acnes) in pores
Is it a white head or a black head? Classifying comedones
WHITE HEAD: Hair follicle that is plugged and congested and encapsulated under the skin.
BLACK HEAD: Hair follicle that is plugged and congested but exposed to air resulted in brown color.
Types of Acne
Blackheads
Blackheads are non-inflammatory, small, dark pigmented lesions on the surface of the skin. Their dark color comes from the open pore being exposed to air.
Causes
- Increase in oil production
- Puberty
- Sweat
- Oil based cosmetics
- Humidity
- Medications
Treatments
- Cleansing twice daily with acne face wash
- Routine mechanical and chemical exfoliation of dead skin cells
- Switching to mineral based makeup
- Healthy diet
- Topical products with salicylic acid, benzoyl peroxide and glycolic acid
Papules
Papules are small, hard, tender, red dome-shaped bumps that have managed to push deeper into the skin.
Treatments
- Cleansing twice daily with acne face wash
- Routine mechanical and chemical exfoliation of dead skin cells
- Switching to mineral based makeup
- Healthy diet
- Topical products with salicylic acid, benzoyl peroxide and glycolic acid
- Topical prescription strength retinoids medication: Adapalene (Differin), Tretinoin (Retin-A), and Tazarotene (Tazorac)
Pustules
Pustules are similar to papules except that they contain a whitish-yellowish fluid inside of them. The white fluid, or pus, is a result of your body’s immune response trying fight off the bacteria that has entered the follicle. They mostly occur in areas of the body that are oilier, like the face and neck, they are often inflamed and sensitive to touch.
Treatments
- Do not POP the acne
- Cleansing twice daily with acne face wash
- Routine mechanical and chemical exfoliation of dead skin cells
- Switching to mineral based makeup
- Healthy diet
- Topical products with salicylic acid, benzoyl peroxide and glycolic acid
- Oral prescription medication: Antibiotics, Accutane
- Topical prescription strength retinoids medication: Adapalene (Differin), Tretinoin (Retin-A), and Tazarotene (Tazorac)
Nodules
Nodules are small, hard, yet painful acne lesions under the surface of the skin. When bacteria gets trapped in the pore and becomes infected, the infection is carried on underneath the skin, causing redness and swelling.
Treatment
- Do not POP the acne
- Cleansing twice daily with acne face wash
- Routine mechanical and chemical exfoliation of dead skin cells
- Switching to mineral based makeup
- Healthy diet
- Topical products with salicylic acid, benzoyl peroxide and glycolic acid
- Oral prescription medication: Antibiotics, Accutane
- Topical prescription strength retinoids medication: Adapalene (Differin), Tretinoin (Retin-A), and Tazarotene (Tazorac)
Cysts
Cysts are the most severe type of acne, they are hard, painful lesions under the surface of the skin. They form from the complete blockage of the pores causing inflammation and infection. Cysts can form anywhere in our body where there are hair follicles, typically because of hormonal changes in a person. They are a type of acne that is known to bring emotional distress and insecurities because of the skins’ appearance.
Treatments
- Cleansing twice daily with acne face wash
- Routine mechanical and chemical exfoliation of dead skin cells
- Switching to mineral based makeup
- Healthy diet
- Topical products with salicylic acid, benzoyl peroxide and glycolic acid
- Oral prescription medication: Antibiotics, Accutane
- Topical prescription strength retinoids medication: Adapalene (Differin), Tretinoin (Retin-A), and Tazarotene (Tazorac)
- Oral contraceptives
Preventing Acne
Preventative care is important to practice to avoid blemishes, pimples, whitehead and all types of acne.
- Wash your face twice a day with acne face wash
- Avoid excess scrubbing and exfoliation.
- Avoid touching your face
- Do not pop or pick at blemishes
- Wear loose clothing if suffering from body acne
- Avoid oil-based make-ups and skincare products
- Avoid excessive sun exposure leading to excess sweating
- Eat a healthy diet
- Use topical retinoids in improve dead skin cell turnover
- Consider more aggressive therapy prescribed by a Dermatologist if conservative preventative measures do not work
Treatment of Acne
Topical Treatments
Topical creams and serums are designed to decrease sebum production and to increase dead skin cell turnover. Topical products that contain salicylic acid, glycolic acid or benzoyl peroxide, can reduce breakouts by decreasing and removing excess sebum. Topical retinoids, such as tretinoin and tazarotene, help remove dead skin cells and reduce inflammation.
Isotretinoins
Isotretinoin, are a class of vitamin A derived medications that have the ability to target every step responsible for acne pathogenesis: inflammation, sebum production, abnormal keratinization and colonization with Propionidbacterium acnes.
Accutane
Accutane is a prescription medication indicated for recalcitrant and/or severe acne. Recalcitrant acne refers to acne that has not responded to multiple other therapies, including antibiotics. Severe acne is when many red, tender nodules (bumps or lumps) form in the skin – this type of acne can lead to permanent scarring. Accutane works to prevent the development of acne lesions by shrinking the sebaceous or oil glands in the skin to prevent the development of clogged pores. Treatment with Accutane typically lasts 4-5 months of monthly visits with laboratory monitoring a few times during treatment. It is important to note that Accutane has been associated with serious side effects including birth defects. For this reason, treatment is monitored through the iPLEDGE program (can link to website). However, the most common side effects are skin redness, dryness and peeling, dry eyes and dry mouth/chapped lips and occasionally, nose bleeds. It is important to see a board certified dermatologist to determine if you are a candidate for this treatment and to provide careful monitoring during treatment. While on Accutane, other treatments with laser, microneedling and some other cosmetic surgery are contraindicated.
Chemical Peels
At The Naderi Center we offer a chemical peels specifically designed for patients with acne. The VI Purify peel contains a combination of Benzoyl Peroxide, Kojic acid, Hydrocortisone, TCA, Salicylic Acid, Retinoic Acid, Phenol, Vitamin C and a proprietary mineral blend. The VI Purify peel is a light chemical peels that targets acne, large pores, pigmentation irregularities and discoloration. This light peel has little downtime but has proven to improve skin clarity and acne scarring. We also offer a variety of TCA concentration peels for both spot treatment total face treatment of acne and acne scaring.
Steroid Injections
Steroid injections are done to treat nodular and cystic lesions. These injections improve appearance, decrease pain and shorten the course of the acne lesion. Often times these treatments are done if the patient needs to quickly remove an acne lesion for an upcoming special event. Additionally, if it is felt that the acne lesion may leave a bad scar, steroid injection can help to minimize this scar formation. Steroid injections however may also leave a depression in the skin.
Comedone extractions
Mechanical comedone extractions are also options that may help to improve skin clarity, preferably done by a dermatologist to decrease the possibility of scarring and further acne damage. A special comedone extractor is utilized to remove the acne lesion.
Antibiotics
Antibiotic therapy of acne is one of the older tools that often times dermatologist would use to help treat acne. Typically antibiotics such as erythromycin, doxycycline, clindamycin were given for a course of 2-3 months to fight the acne causing bacteria. This therapeutic modality is falling out of favor in light of new research that shows antibiotic therapy helps create antibiotic-resistant bacteria. Even when antibiotics are used they are never used as the sole modality for improving a patient’s acne.
Hormone Therapy
If it is felt that your acne is hormonally regulated your physician may prescribe a form of oral contraceptives that can help regulate the hormones that are stimulating acne production. They may also suggest you start on a birth control to regulate your androgen type hormones. Currently the FDA has approved the following birth control for treatment of acne: Ortho Tri-Cyclen, Estrostep and Yaz.
Light Therapy for Acne Treatment
Based on clinical observations and research studies it has been noted that patients’ acne improves after exposure to natural sunlight. The exact mechanism for this observation is still uncertain however we think that light-based therapies do help to decrease the Propionibacterium acnes levels and decrease the size and activity of the pilosebaceous glands. The blue light spectrum specifically, is agreed upon as being the most effective at reducing bacterial levels as well as having an anti-inflammatory effect on the skin, specifically the keratinocytes. At The Naderi Center we offer blue light therapy for our acne patients. The treatments are typically performed once a week for a series of 6-8 weeks. Patients are also placed on a topical skincare regiment to complement the light therapies.
Medical Grade Skincare
At The Naderi Center we offer our patients only medical grade skincare that are more effective than over the counter products in fighting acne.
ZO SkinHealth
Designed by Dr. Zein Obagi, ZO SkinHealth has developed an acne treating protocol that is utilized effectively at The Naderi Center to help our patients clear their acne. These products when used correctly and based on clinical protocols are designed to:
- Slow sebum production
- Exfoliate skin cells to unclog pores
- Tighten pores
- Neutralize bacteria-causing acne breakouts
- Reduce redness
- Revive dull looking skin
Specific product recommendations for acne include:
Exfoliating Cleanser
Exfoliating Polish
Complexion Renewal Pads
Sulfur Masque Acne Control
Enzymatic Peel
Exfoliation Accelerator
Correct + Conceal