Acne is a very common condition that affects many. Often during the fall we see many students who come and see us with flaring breakouts. This is usually due to back to school activities with added stressors of class work and higher participation in sports with sweating and wearing of protective gear. Some types of acne improve using over the counter treatments but persistent and deep acne does require treatment at a medical office. Let’s review why we get acne, what types of acne are possible and how we would treat each type.
There are 4 main reasons acne develops:
- Plugging of the hair follicle
- Excess oil production
- Presence of a bacteria called Cutibacterium acnes
- Inflammation
As a result of the above factors people then can develop four main types of acne: comedonal acne, hormonal acne, inflammatory acne and cystic acne. People can have a combination of multiple types of acne.
Comedonal acne is commonly described as a collection of blackheads and white heads. This leads to an overall “bumpy” skin texture, most commonly located along the forehead, temples and chin. We treat this type of acne by using gentle chemical exfoliants that help to clear out the sebum that is clogging the pores and then keep those pores clear. Over the counter products that include active ingredients such as adapalene , AHAs or BHAs can be helpful to treat comedonal acne. These types of products can irritate the skin so we recommend starting a few times per week and increasing to nightly as tolerated. Improvement of comedonal acne requires patience, many months of treatment 3-6 months is required to see improvement in symptoms. In our clinic we offer evaluation for prescription topicals that will help to improve the skin quicker, as well as chemical peels which help to open up clogged pores.
Hormonal acne is caused by an increase in androgens, a hormone that increases oil production. This type of acne is most common in women, typically along the jawline resulting in red, inflamed pimples and sometimes cysts. It can be cyclical and correlate with the menstrual cycle. This type of acne is difficult to treat over the counter. It requires adjustment to birth control methods or androgen blockers that come in the form of a prescription pill or topical cream. This type of acne typically peaks around puberty but also can occur around menopause.
Inflammatory acne usually looks like red painful pimples; these can be present anywhere along the face, jawline, chest or back. Sometimes there can be a connection to rosacea, another inflammatory condition. Inflammatory acne can be treated with over the counter products that have active ingredients like benzoyl peroxide or salicylic acid. If inflammatory acne is not well managed with over the counter treatments, dermatologists can provide many treatments both topical and oral to help manage breakouts. Topical treatments include topical antibiotics to treat bacteria on the skin and topical retinoids to help clear pores and keep them clear. Sometimes oral antibiotics are necessary; these typically are used for a number of months and then tapered off and there are long term side effects of being on antibiotics long term.
A subtype of inflammatory acne is nodulocystic acne. This presents as deep nodules and cysts that are often painful. This type of acne is considered more severe. It will not respond to over the counter products. It requires a visit with a dermatologist for oral medications such as antibiotics or often isotretinoin. Isotretinoin is an oral pill of high dose Vitamin A that addresses the four above reasons of why acne develops. Isotretinoin is the closest thing we have to a cure for acne. It does come with the possibility of many side effects so it requires many months of use with close monitoring but can provide amazing resolution of symptoms for our patients.