Profile view of a male teenager's face with acne

Acne

Acne is one of the most common skin problems in the world, affecting more than 45 million individuals in the United States alone. Although common, it is a serious, chronic disease and not just a simple adolescent condition. In fact, in 2016 the financial burden of acne was estimated to be $3 billion US dollars in healthcare costs and lost productivity. Moreover, acne carries with it not only a physical burden but an emotional and psychological one as well. It is the leading cause of visits to a dermatologist and can negatively affect your quality of life. Adolescents are at particular risk in this respect as acne can negatively impact body image, social engagement, and sexuality. In fact, severe acne is associated with increased depression, anxiety, poor self-image and poor self-esteem—even suicidal tendencies. Fortunately, our understanding of acne has improved greatly in recent years, and there are many ways to treat and manage it.

What is Acne?

Acne develops when pores—specifically, hair follicles—become clogged with oil and dead skin cells, forming what is known as comedones. These comedones eventually turn into small red bumps, or pimples, which can be characterized as blackheads, whiteheads, cysts, pustules, and more. Although acne commonly occurs on the face, it can also develop on the forehead, chest, upper back, and upper arms. Acne can affect people of any age, but it usually affects young teenagers. And while is more common and severe in males, it is more frequent and persistent in females.

What Causes Acne?

Hormones, diet, lifestyle and genetic factors are all thought to play a role in causing acne. But it is how these elements affect the hair follicle that matters. First is a change in the way that protein in the cells of the follicle is transformed into skin and nails (keratinization), which initially leads to the formation of comedones; next is increased production of sebum, an oily secretion of the sebaceous gland in the hair follicle; and finally colonization of the hair follicle by a bacteria known as Propionibacterium acnes. This bacteria activates the skin’s immune response, which leads to inflammation and the formation of papules, pustules, and cysts.

Do Foods Cause Acne?

For many years, certain foods were assumed to cause or worsen acne5. In particular, acne was linked to a Western diet high in hyperglycemic food and free fatty acids, as well as to dairy products, whey proteins, alcohol, tea, coffee, chocolate and salt. Although these foods may be triggers, further research is necessary to confirm this association. Factors other than daily food habits must also be considered, such as family history of acne, lifestyle or eating disorders, and body mass index, or BMI. Nonetheless, while the exact role between diet and acne isn’t fully understood, some foods may help prevent acne — particularly inflammation-fighting foods. Plant-based foods high in essential fatty acids may promote clearer skin. Omega-3 fatty acids may also decrease skin inflammation.

What is the Best Treatment for Acne?

Acne has recently been recognized as a chronic disease, and it should be managed as such4. But there are many treatments, which vary according to the type, stage, and severity of the acne. The most common treatments are listed below.

Dermatologists specializing in acne often recommend a combination of topical antimicrobial and retinoid therapy. These drug classes, while different, work together to target the different ways that acne develops. Benzoyl peroxide is perhaps the most common topical antimicrobial treatment. Available as an over-the-counter medication, it is found in cleansers, lotions, creams, and gels. Benzoyle peroxide reduces the amount of bacteria that causes acne and helps the skin to dry and peel. Retinoids unclog the pores and prevent further clogging by dead cells. In fact, the American Academy of Dermatology (AAD) considers retinoids to be “the core of topical therapy for acne” because they strike the problem in the bud by blocking the formation of comedones to begin with, which then reduces inflammation. This, in turn, allows other topical treatments to work better and faster. Topical retinoids are most commonly found in creams. The most common ones are:

  • Adapalene 0.1% and 0.3 %
  • Tazarotene 0.1%
  • Tretinoin 0.01%, 0.025%, 0.038%, 0.04%, 0.05%, 0.08%, and 0.1% (in the USA)
  • Isotretinoin 0.05% and 0.1% (in other regions of the world)

Although side effects of topical retinoids may include skin irritation, peeling, erythema (redness), and dryness, these tend to be mild and diminish after the first few weeks of treatment. Moreover, with time, retinoids have the further benefit of reducing scarring and changes in skin pigmentation due to acne.

While topical treatments are effective for mild and moderate acne, more severe cases may require systemic (oral) antibiotics. The antibiotics that have proven to be most effective include tetracycline, doxycycline (Vibramycin), minocycline (Minocin) and erythromycin. These drugs penetrate the follicle and sebaceous gland and block the spread of the bacteria that causes the acne. Aside from their antimicrobial effect, they also work to reduce inflammation.
Chemical peeling is effective for mild to moderate acne. There are two levels of peel, superficial and medium depth. Both kinds of peels use chemicals to basically injure the top layer of the skin (the epidermis), thereby reducing the acne and promoting healing. Medium depth peels go deeper and are used to treat acne scarring. Chemicals used in peels include various acids, such as glycolic acid and salicylic acid.
In laser treatment, a wand-like laser instrument is used to peel or resurface the upper layers of acne-scarred skin. The treatment also promotes collagen production in the lower skin layers, which helps the skin heal smoothly and evenly. Healing typically takes up to three weeks. Cost of laser treatment for acne depends on the type of laser used and the number of treatments necessary; it generally ranges between $500 and $1500.
Also called blue light, red light, or phototherapy, visible light therapy is used to treat mild to moderate acne. Blue light therapy kills the bacteria that causes acne breakouts and decreases redness. Red light therapy promotes healing beneath the surface of the skin and makes scarring less visible. While the average cost is $50 a session, usually several rounds of treatment are needed over a period of four to six weeks.
Hormonal acne occurs during times of hormonal changes such as onset of puberty and, in women, menstruation, pregnancy, or even menopause. Some of these hormonal changes are associated with an increase in androgen levels, which in turn cranks up the production of sebum—a major factor in the development of acne. One type of hormonal treatment is oral contraceptives; because they are known to reduce androgen levels, they can be helpful in treating acne in women and adolescent girls. There is currently no hormonal treatment for males; however, a new drug called clascoterone cream for use in both males and females is now under review by the FDA.

How Can I Clear Up Acne Fast?

There is no shortage of conventional wisdom on how to clear, shrink, stop, or kill pimples. You may read about applying ice, applying heat, or using natural herbs. Applying ice may temporarily reduce inflammation, and applying heat can encourage the pimple to “come to a head” and thus heal faster. But remember, acne is a complex skin condition. Picking at or popping lesions may aggravate the blemishes even more, as can overuse of products.

Are There Natural Remedies for Acne?

Many people distrust medications and prefer to turn to alternative acne treatments or herbs to treat acne. Often recommended are aloe vera, tea tree oil, witch hazel, manuka honey, tannins (fruit acids), and antiseptic, anti-inflammatory herbs such as calendula, chamomile, lavender, and rosemary. Some people may find such remedies effective, but professional dermatology groups advise caution. There can be unpleasant or harmful side effects to some remedies, including irritation, blisters, rashes, and more serious and long-lasting allergic reactions. Unless you are experienced in using herbal remedies, be sure to refer to credible sources on legitimate websites. Even better, discuss all potential treatments with your doctor or dermatologist.

Final Word on Acne

Acne is not to be taken lightly, and you do not have to wait until you “grow out of it.” If you or someone you know suffers from acne, remember that early intervention is the best way to treat and manage the condition. At Saguaro Dermatology, we understand the impact that acne can have, not just on your skin but also on your self-confidence. Our board-certified dermatologist, Dr. Dathan Hamann, and our caring and experienced staff are here to help.

1. Bhatia A, Maisonneuve J-F, Persing DH. Propionibacterium acnes and chronic diseases. In: The Infectious Etiology of Chronic Diseases. Washington DC: National Academies Press; 2004. Accessed April 19, 2020 at https://www.ncbi.nlm.nih.gov/books/NBK83689/

2. Leyden J, Stein-Gold L, Weiss J. Why topical retinoids are a mainstay of therapy for acne. Dermatol Ther (Heidelb.) 2017;7(3):293-304. Accessec April 20, 2020 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574737/

3. Acne Vulgaris: The Psychosocial & Psychological Burden Of Illness. In: The Dermatologist. Volume 21, Issue 9, September 2013. Accessed April 20, 2020 at https://www.the-dermatologist.com/content/acne-vulgaristhe-psychosocial-and-psychological-burden-illness

4. Dréno B. The changing faces of acne. Brit J Dermat 2015;172(Suppl. 1):1-2

5. Claudel JP, Auffret N., Leccia MT, et al. Acne and nutrition: hypotheses, myths, and facts. European Academy of Dermatology and Venereology 2018;32:1631-1637

6. Johnson BA, Nunley JR. Use of Systemic Agents in the Treatment of Acne Vulgaris. Am Fam Physician 2000;62(8):1823-1830 Accessed April 20, 2020 at https://www.aafp.org/afp/2000/1015/p1823.html

Saguaro Dermatology Reviews

Itaro Elaisa
Itaro Elaisa

“I totally recommend this place to anyone who’s looking for a dermatologist who’s professional, informative, respectful and very helpful. They are quick to solve your problems and get you home.”

Wendy L.

I had an awesome experience with Dr Hamann and staff. I was very comfortable and i was able to have all my questions answered without feeling rushed. The staff was courteous and welcoming.

Kristin Ulrich-Uhles
Kristin U

“Dr Dathan and the team were very helpful, kind and knowledgeable. Plus, there was no wait time so I was able to get back to work faster than expected. I would highly recommend.”

Robert P.

Staff was friendly, & on time. office is super clean!! Doctor was awesome, felt like a family member taking care of me.

Sally Shepstead
Sally S.

“Very friendly and professional. I had a great experience, Dr. Hamann was very good at answering my questions and concerns. I will certainly come back for another visit.”

Amanda C.

Great doctor and friendly, professional staff. The doctor spends time listening and answering questions, something rare to find anymore. The office is beautiful and very clean. I love all the artwork with saguaros.

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Kylin L.

“The office was recently renovated–it is a beautiful, clean, and calm environment. I would highly recommend this practice for anyone who is looking for a general dermatologist.”

L

Dr. Hamann is very knowledgeable, nice, and professional. You can tell that he truly cares about his patients by the way he operates. He took the time to listen to all of my concerns then address them with good, well-informed answers.

Saguaro Dermatology | Phoenix Dermatology

About Saguaro Dermatology

Our comprehensive dermatology clinic is dedicated to providing you with the highest quality of care, innovative practices, helpful resources and state-of-the-art technology to prevent and treat a multitude of skin disorders. Led by Medical Director, Dathan Hamann, MD, FAAD, our passionate team looks forward to serving you with respect and compassion.

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