By Candice Hutchins, RN at Health West Pediatrics
Acne is the most common skin condition among teenagers, but it does affect people of all ages. The four main causes of acne are excess oil production, hair follicles clogged by oil and dead skin cells, bacteria, and inflammation. It typically appears on the face, forehead, chest, upper back, and shoulders because these areas have the most oil (sebaceous) glands. It can occur in other places on the body as well. Our genes, lifestyle, and what we eat all play a role in what type of acne we develop.
The signs of acne vary depending on the severity of the condition. Whiteheads are closed clogged pores; blackheads are open clogged pores; papules are small red, tender bumps; pimples (pustules) are papules with pus at their tips; nodules are large, solid, painful lumps under the skin; and cystic lesions are painful, pus-filled lumps under the skin. There are certain things that may trigger or worsen acne. They include hormonal changes – androgens increase in boys and girls during puberty and cause sebaceous glands to enlarge and make more sebum; certain medications such as corticosteroids, testosterone, or lithium; diet can be a contributing factor including carbohydrate-rich foods (bagels, bread, etc.); and stress – it doesn’t cause acne but if you have acne it can make it worse.
The risk factors for acne are age – it is most common in teens, hormonal changes-puberty or pregnancy; family history – if your parents had acne you are likely to develop it; greasy or oily substances – if your skin comes into contact with oil or oily lotions and creams; and friction or pressure on skin from cellphones, helmets, tight collars, and backpacks. There are over the counter treatments for acne but if you have tried them for several weeks and they haven’t help you need to see your doctor or a dermatologist.
Acne medications work by reducing oil production and swelling or treating a bacterial infection. There are topical or oral medications to treat acne and you might be prescribed one or both. The most common topical medications are retinoids and retinoid-like drugs, antibiotics, azelaic acid and salicylic acid, and dapsone. Retinoid drugs are useful for moderate acne and examples include: tretinoin, adapalene, and tazarotene. They help prevent hair follicles from becoming plugged. Topical retinoids can increase skins sensitivity and can cause dry skin and redness. Antibiotics work by killing skin bacteria and reducing redness and inflammation. Most often you will use both a retinoid and antibiotic. Antibiotics are often combined with benzoyl peroxide to reduce likelihood of developing antibiotic resistance. Combination examples are clindamycin with benzoyl peroxide and erythromycin with benzoyl peroxide. Azelaic acid has antibacterial properties and seems to be as effective as many conventional acne treatments when used twice daily. Salicylic acid helps prevent plugged hair follicles. Dapsone is recommended for inflammatory acne, especially in women.
Oral medications available are antibiotics, combined oral contraceptives, anti-androgen agents, and isotretinoin. Oral antibiotics are for moderate to severe acne. The first choices are tetracycline or macrolide. They are to be used for the shortest time possible to prevent antibiotic resistance. Side effects are uncommon, but they do increase the skin’s sun sensitivity. Four combined oral contraceptives are approved for acne therapy in women who also want to use them for contraception. They are products that combine progestin and estrogen. It may take a few months to work so using other acne medications with it will help. Spironolactone may be considered in women and adolescent girls when their acne does not respond to other treatments. It blocks the effects of androgen hormones on oil-producing glands. Isotretinoin is a derivative of vitamin A and may be prescribed for moderate to severe acne that hasn’t responded to other treatments.
Things you can do at home to help prevent or control acne are to wash face daily with a gentle cleanser, try over the counter products to dry excess oil and promote peeling, avoid irritants (oily or greasy cosmetics, acne concealers, etc..), protect your skin from the sun, avoid friction or pressure on your skin, avoid touching or picking acne prone areas, and to shower after strenuous activities.
Candice Hutchins is a registered nurse and has been working at the Health West Pediatrics clinic since April of 2019.