By Jodi LoGerfo, MSN, APRN, BC, FNP-C
“Yay! More zits,” said no one ever, upon waking up in the morning and looking in the mirror. Acne can cause a lot of anxiety and even depression depending on how bad it is. The good news is there is help and you are not alone.
Actually, acne vulgaris is the most common skin disorder in the United States and nearly 85 percent of all people have had acne at some time during their lives, according to statistics from the American Academy of Dermatology. Acne most often begins during teen years (as we can all attest), but can follow into adulthood. It occurs most often on the face, chest, and back which are areas that have a large number of oil glands.
Acne lesions are caused by a combination of overactive oil glands that produce oil, along with the build-up of dirt and bacteria and irregular shedding of dead skin cells. Contrary to popular belief, acne is not caused by chocolate or dirt or eating greasy foods. Although there is a link between the amount of oil produced in the skin and acne, the amount of oil is not created by food. Instead it is caused by changing hormone levels like those during puberty or cyclical hormonal changes in a female’s menstrual cycle.
How a simple pimple forms
When an oil gland opening (called a pore or hair follicle) becomes clogged with skin’s natural oils, dirt, dead skin cells and bacteria, a comedo forms. We often call those blackheads (open comedo) or whiteheads (closed comedo). Additionally, the surrounding skin can respond by becoming red and inflamed, appearing as small red pimples (pustules or papules) or it can get infected and cause deeper, large and more painful nodules and cysts. These larger, deeper cysts and nodules can cause scarring, so you always want to get treatment from a dermatologist to avoid permanent pits and discoloration.
How you can make pimples worse
While you can’t “cause” your own acne, there’s lots you can do to make it worse:
- Oily, moisturizing products, cosmetics and many sunblocks can further clog up pores causing excess oil to get trapped. Look for formulas that say, “non-comedogenic” on the label, which means, “non-pore-blocking” or use cosmetics that are oil-free.
- Heat, humidity and excessive sweating amplify skin inflammation. Be sure to wash off excess sweat, dirt and oil after excessive activity, especially after exercising or in the summer months.
- Picking or squeezing acne lesions with fingernails or other objects causes acne to look worse and may result in further infection and deeper, permanent scarring. Lesion removal (called acne surgery) should only be done by a medical professional.
How your dermatologist tries to stop your acne in its tracks
There are various approaches dermatologists use for effectively treating acne. Often, we use a combination of methods at the same time to attack acne in different ways. These include:
- Acne Surgery (including corticosteroid injections) performed in a dermatologist’s office to extract blackheads and to open and drain whiteheads. This helps prevent pustule and cyst development, which are the main causes of acne scarring. Inflammatory lesions (pustules, pimples and cysts) are often injected with low potency cortisone to decrease inflammation and help an acne lesion disappear quickly. These intra-lesional injections also help decrease the remaining discoloration that can occur when acne is resolving.
- Isotretinoin, an oral prescription medication can permanently help severe or troubling cystic acne (you may remember it by the brand name Accutane®) or poorly responsive acne that improves less than 50% after 6 months of combined traditional treatment. About 85% of patients treated with isotretinoin see permanently clear skin after just one treatment course.
- Chemical peel (e.g., TCA) is a non-toxic chemical (trichloroacetic acid) that is applied to the skin. It has been used for over 20 years and works by drying up the top layers of skin cells, causing them to peel off. The old skin is removed and a new undamaged layer is revealed.
- Oral antibiotics can help manage the severity and frequency of acne outbreaks. There are a number of oral antibiotics used depending on the type of acne you have.
- Topical lotions, creams or gels containing benzoyl peroxide, antibiotics (e.g., clindamycin and erythromycin) or salicylic acid are known to kill bacteria, unplug pores, exfoliate and decrease inflammation.
- Topical retinoid medications help other acne medications absorb better, have an anti-inflammatory effect and also speed up cell turnover so pores can’t clog. These include Retin-A® (tretinoin), Differin® (adapalene) and Tazorac® (tazarotene).
- Laser or light treatments (e.g., Blue Light, Infrared Light) are designed to target and eliminate acne-causing bacteria and decrease inflammation.
- Androgen blockers (e.g., spironolactone) have been used in acne for years. They decrease the amount of oil that is produced by oil glands and are also effective in those female patients who also have excess hair growth.
- Oral contraceptives have been shown to improve acne by normalizing hormonal spikes and reducing testosterone and progesterone, the hormones responsible for hormonally-induced acne. This may be especially helpful in women with acne along with menstrual irregularities or hirsutism (facial hair growth).
How you can help your acne regimen work better
- Read and follow any label, package or doctor’s instructions exactly for any acne product or medication you are using. If medications are to be applied at different times of the day or in a particular order, follow the regimen exactly because that’s how it is designed to work.
- Treat the acne-affected area (e.g., face) entirely, not just individual pimples (don’t spot treat), so the medication can prophylactically prevent future breakouts.
- Never pick, pop or squeeze your pimples because that often causes more damage to the pore resulting in permanent scars, pits and discoloration. A dermatologist can offer you acne surgery done properly by a medical professional in the office.
- Keep your hands (and the bacteria on your hands) away from your face. Constantly touching your face can cause more infection to inflamed, irritated or open skin.
- Reduce the amount of oily face makeup. Try to use a makeup that is oil-free and always wash it off at night before going to sleep.
- Gently cleanse the acne-affected area; scrubbing inflamed skin (whether from acne itself or as a side effect to acne treatment) can be more irritating.
- Use a cleanser your dermatologist recommends for your specific skin type twice per day and use warm (not hot) water.
- Avoid using over-the-counter alcohol-based astringents, which strip your skin of it’s natural oils, and stick to only products and medications your dermatologist recommends.
- Avoid excessive sun exposure as many acne medications (including Retin A®,oral antibiotics and isotretinoin) make your skin more sun-sensitive. Always use a non-comedogenic, broad spectrum sunscreen recommended by your dermatologist daily to prevent your acne lesions from becoming darker and pigmented.
- The most recent research on acne and inflammation found that people with acne (and more severe acne at that) had lower levels of antioxidants in their bloodstreams and that both oral and topical antioxidants can potentially be used in treating acne. That means a more nutritious diet of fruits and vegetables is more important to acne patients than we thought, and can only help.
Finally, acne treatment regimens usually require 6-8 weeks of treatment before results are noticeable. Don’t give up and stop treatment if you do not see faster results and don’t stop treatment if you notice some preliminary clearing. After 8 weeks, if you see no improvement, your dermatologist will adjust your treatment or suggest different therapies to try.
Keep it up!
Jodi LoGerfo, MSN, APRN, BC, FNP-C is a Family Nurse Practitioner
Board-Certified in Family Medicine and Dermatology at the Orentreich Medical Group in New York City. She runs a patient Question & Answer blog at Orentreich.com/blog.