Acne
Ugh, I Can’t Get Rid of This Acne!
What should I do?
Acne is one of the nearly-universal frustrations in our lives, at some point. Nearly all of us experience acne to some degree while we go through puberty - in fact, acne affects nearly 50 million people across the United States. For some it can be more than a simple embarrassment though, leading to scarring and changes in pigmentation.
Why Do I Have Acne?
There are four major issues which cause acne: inflammation, bacteria, abnormal shedding of skin, and oil production. These are affected by hormonal levels, stress, and genetics. Some foods that are sugary have been shown in small trials to worsen severity. The treatments that are used to treat acne do so by attacking one or several of these mechanisms.
What Can I Do Before I Go to the Doctor?
There are actually a few different things! For simple acne, it’s important to build a basic routine from which you can add on more treatments.
Wash your face. This sounds basic, because it is - use a washcloth and cool water, without anything else (other than gentle soap if you wish). Do this once to twice per day.
Use a form of Benzoyl Peroxide wash. There are many brands available over the counter: Neutrogina, Clearasil, and Proactive are three examples. This will help to strip the oils from your skin.
Be aware that this may dry out your skin! If you notice irritation, flaking, or sun sensitivity then you may need to switch to using this every OTHER night instead of every night.
The last step before you go to the doctor is to try a topical retinoid which is called called “Adapalene.” Currently the most popular brand name for this is Differin Gel, which is 0.1% concentration.
Again, be aware that this is likely to dry out your skin and make it more sensitive. Switch to every OTHER night usage if this happens, or even every THIRD night!
This is safe during pregnancy, but is only approved for those more than 12 years old.
What Will My Doctor Do?
Your doctor will review what has been tried already, and look to see what the most appropriate next step will be. They may prescribe a short course of antibiotics, either through a cream/gel or as a pill. This will be for no more than 12 weeks, because it can lead to antibiotic resistance if used for longer.
They will likely have you continue washing your face, using a benzoyl peroxide wash, and may prescribe a medication in addition. Sometimes there are combination medications which include several of these steps. For women, they may recommend birth control to manage hormonal causes of acne. Lastly, if none of this works they may use a stronger medication we’ll discuss below.
Finally...What About Accutane?
Accutane, now known as Absorica, Zenatane, or by the generic Isotretinoin, is a Vitamin A derivative which acts on all four main mechanisms of acne formation. It is a very powerful medicine which can help to treat even the most resistant acne. Not all doctors can prescribe it due to the specialized nature, so you should ask your doctor whether this is an option, or if you need to be referred to a dermatologist for this.
Unfortunately, it also has side effects which must be closely monitored. It can cause dry skin, dry lips, and dry eyes. It can occasionally cause headaches, and rarely it can cause liver enzyme problems. For these reasons you need to see your doctor regularly, and get labwork to check and make sure everything is going well. Most importantly, since it can cause problems with pregnancy and fetal development, it is necessary for anyone who can get pregnant to get regular pregnancy tests, and have conversations about birth control use during isotretinoin therapy.