Acne

Image related to Acne Dermatologist Washington DC Acne is a very common skin condition which is normally first seen around the time of puberty, however acne can affect humans at any age, from infancy to adult. Despite great variability in the time of onset and appearance of acne, it is essentially a genetically determined and hormonally driven disease. Luckily acne is easily treatable with both topical and oral agents. Board Certified Dermatologist Dr. Thomas Adrian is an expert in the treatment of acne, and works with each individual patient to develop a treatment plan that balances effective acne control with a minimum of medication inconveniences and side-effects. 

What Causes Acne?

During puberty, our body increases the production of certain hormones. In addition to the various physical changes our bodies undergo during puberty, these hormones also activate the sebaceous (oil-producing) glands in our skin, which are mostly dormant up until this time. During this activation period, these glands often produce excessive amounts of sebum (oil), leading to clogging of the opening of hair follicles and excessive buildup of oil within a hair follicle, which results in comedone (whitehead). Inflammatory acne occurs when a bacteria found on our skin, P. Acnes, degrades the built up sebum into smaller molecules which our body then reacts to, causing painful bumps, pustules (zits), and small cysts to form. In certain individuals these pustules and cysts can become so inflamed that scarring can occur.

Acne Treatment

Treatment for acne is generally tailored to the type of acne and the severity of the disease.  Keeping in mind that both excessive oil and a type of bacteria are the cause of acne, most treatments aim to either lower the production of oil, reduce the amount of P. Acnes bacteria on the skin surface, and prevent the blockage of hair follicles that leads to comedones (whiteheads). A common first line therapy is a benzoyl peroxide wash. Benzoyl peroxide is an antibacterial wash with mild comedolytic ability (ability to break up the plugs that begin the process of comedone formation). Another first line, and the most effective topical acne agent, are retinoids. Topical retinoids such as Tretinoin (Retin-A) act to thin the top layer of skin, reducing comedone formation, and have a secondary effect of reducing oil gland activity. For patients with inflammatory acne (pustules and cysts), a short (~3 month) course of oral antibiotics such as Doxycycline or Minocyline may be prescribed. This allows the body to reduce acne burden from the inside out, after which topical agents like those described above are normally sufficient to keep acne under control. 

Accutane Treatment

Accutane has been used for over t thirty years and is a remarkably effective treatment for cases of severe nodulocystic acne resistant to normal treatments. This is a Vitamin A-like drug which has several effects, the most prominent of which is a nearly complete shutdown of oil production in the sebaceous glands, resulting in shrinking of the sebaceous glands during the treatment period which is somewhat permanent, effectively 'resetting' the acne producing potential of skin. A 5-6 month course of Accutane usually results in dramatic and long lasting clearing of acne. While there have been many articles warning of potential dangers of accutane, in our experience accutane is an incredibly safe and effective drug for severe acne, and when required is an excellent treatment to reduce the risk of scarring from severe nodulocystic acne in both adolescents and adults. 

Adult Acne

While acne is most common in the adolescent population, over 50% of people will suffer from acne at some period during adulthood. While adult acne is generally milder than adolescent acne, it can be distressing and embarrassing. Male adult acne is treated similarly to adolescent acne, and normally topical agents are sufficient to control male adult acne. In women, adult acne is often cyclical and related to hormone surges around menstruation. Women with adult cyclical acne can benefit from both oral contraceptive pills, which regulate hormone production, as well as the prescription drug spironolactone, a mild diuretic pill which also has the effect of binding excess sex hormones, smoothing out the peaks and valleys of hormone production related to a woman's menstrual cycle. 




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