Skin condition has different causes, treatments
Acne is a skin condition characterized by clogged pores (blackheads and whiteheads), inflamed pimples (pustules), and deeper lumps (nodules). Adults in their 20s, 30s, 40s or even older can develop acne. Adult acne may be related to hormones, childbirth, menopause, stopping “the pill” and other medications.
In adult females, hormonal acne presents as acne cysts in the lower face around the chin and mouth. We often check hormone levels and may even diagnose underlying PCOS (polycystic ovary syndrome) along with the patient’s OB-GYN physician. Hormonal acne may occur despite normal lab values. I ask patients if they have recently stopped birth control pills/oral contraceptive pills (OCPs) or have an intrauterine device (IUD), progesterone implanted device (Implanon), progesterone shots (Depoprovera) or if they are on any hormone replacement therapy.
Dermatologists treat female hormonal acne with oral contraceptive pills (OCPs), four of which are FDA-approved to treat acne. Many of our female adult acne patients do not want to take OCPs for various reasons, so another treatment option is spironolactone, which helps to block the effects of male hormones (that all females have).
Male adult acne typically presents on the face, chest or back. The first thing I ask male adult patients with new onset acne is, “Are you on exogenous testosterone?” Whether testosterone supplements are in the form of a gel, the injectable or the implant, they may all cause acne, even if the testosterone levels are in normal range. We will work with the primary care doctor or urologist to decrease the dose if necessary or we can treat the acne with traditional acne treatments.
When treating adult acne, the more common acne treatments are often used first or in conjunction with above treatments.
• Oral antibiotics (doxycycline, Bactrim)
• Topical antibiotics (clindamycin, erythromycin)
• Topical retinoids (Retin-A, Tazorac, Differen)
• Topical dapsone (Aczone), topical sulfur (Avar, Prascion, Plexion)
• Topical salicylic acid (Neutragena oilfree acne wash and salicylic acid spot treatment)
• Topical benzoyl peroxide (Panoxyl, Clearasil) Some newer dietary supplements which contain nicomide and zinc (Nicazel) can be used in patients who do not want to take traditional oral acne medication.
When adult acne is severe or not responding to other acne treatments, I prescribe oral isotretinoin (Accutane, Absorbica), which is monitored with monthly follow-up visits and lab work. The patient typically stays on this medicine for five to six months, so it is important to patients to understand the side effects. It is high-dose vitamin A and works extremely well by drying up the oil glands of the skin.
My partners and I also use a variety of chemical peels to treat acne and the dark spots left behind from acne. My favorite for acne is a 20 percent or 30 percent salicylic acid chemical peel. We also use microdermabrasion and perform many extractions on hard-to-get “blackheads.” We use Blu-light alone or in combination with aminolevulanic acid to treat acne. Our doctors also inject acne cysts with dilute corticosteroids.
Our goal is always to treat acne before it scars, but when patients come in with acne scarring, we use our Fraxel Restore laser to resurface the skin. This is really the gold standard to treat acne scars. Medical microneedling, with or without PRP (platelet rich plasma), is also helpful for scarring. If a pitted scar revision is necessary, it can be excised and sutured with a small punch removal. We can fill in acne scars with hyaluronic acid dermal fillers such as Juvederm, Restylane or Belotero. Recently, a much longer lasting filler, BellaFill, has been approved for the treatment of acne scars.
Anyone who is struggling with acne, whether an adult or teen, should visit a board-certified dermatologist.
Dr. Glorioso is a board-certified dermatologist at Ark-La-Tex Dermatology, a part of the WK Physician Network.