For teenagers and others with acne, looking at their reflection in a mirror can be an emotional jolt. And, notes Dr. Gregory Wilmoth of the Southern Dermatology and Skin Cancer Center in Raleigh, acne can cast a very broad net. “There’s a form of toddler-age acne,” he notes. “It’s not very common, but it does occur. Most young girls that we see may experience the first emotional pain of acne at age nine or ten, and for boys it’s several years later.
“This is a difficult experience for many youngsters, who generally by the age of 12 or 13 have enough hormones making their presence known that there can definitely be acne issues.
“The good news is that we do have effective treatment options for clearing acne. The challenging news is that, to be effective, these options take time and require diligence and compliance.
“And it’s important to note,” Dr. Wilmoth says, “that while acne is often the scourge of kids, especially teenagers, it is often an adult issue, as well. I see more women from age 20 to 40 with acne than I do females from age 10 to 20. A lot of women have acne throughout their reproductive years into their fifties.
“And there’s an opposite view. It’s interesting how many women I see for acne who say, ‘I’ve never had acne in my life and now I’m 35 and I just don’t understand where this is coming from.’ I’ll ask if there is anything else going on, and they’ll say, ‘Oh, yes, I’m getting ready to have my family, and I just stopped using my oral contraceptives. And now I’ve got acne.’ They don’t always put these two facts together. Many women who stop using oral contraceptives come to realize that they have had acne they’ve been treating for years, but didn’t know it.”
What causes acne?
Acne results from a clogging of the oil glands under the skin. No one knows why this clogging action happens for some people and not for others—although there is clearly a genetic factor involved. Hormonal changes play a significant role, and inflammation is a factor. The condition eases or typically ceases for men by their early twenties, but a good many women— perhaps one out of ten—continue to have acne well into middle age.
Acne is not an infection per se, but there is a problem with proper functioning of the pore complex—where instead of fine little pieces of skin that lie on the pore breaking off and coming out, the way they are supposed to, they tend to not separate. Rather, they hold together and make a plug—and that’s the blackhead that you see. When that plug stays in place long enough, it creates an environment where oil is backing up, triggering inflammation and initiating the entire acne process.
So you have comedonal or blackhead acne, and you also have inflammatory acne—usually in that sequence. Often we will begin with surface treatments, which are antibiotics that help change the environment of the pore. They include benzyl peroxide and the retinoids. We may also use salicylic acid to help the skin shed or soften the plugs that are at the root of the problem. There are several classes of retinoids and several different antibiotics available. One new antibiotic called Aczone, for example, has strong anti-inflammatory properties. It doesn’t necessarily change the environment of the pore, but it has the ability to decrease inflammation in and of itself.
Over time, use of these topical medications tends to return the shedding function of the pores of the skin to normal As long as we continue to use these medicines, the skin remains in a normal condition. If we stop using them, the acne may and often does return.
Some of the basic treatments for acne work because they maintain the good health of the skin—without necessarily addressing the underlying problem.
Killing the bacteria that cause inflammation is another important treatment goal. In a second level of treatment, we may use antibiotics applied to the surface of the skin, and in more severe cases, systemically, to kill acne bacteria in the skin and decrease inflammation. This is often a highly effective treatment.
Another level of treatment for young women involves the use of anti-male hormone medications, or the use of birth control pills. When it’s appropriate, we offer oral contraceptives to women with acne. By blocking the receptors for male hormones on the oil glands, we prevent testosterone from activating the acne and also prevent progesterone from acting like testosterone. For some young women, this is very good acne therapy—take a birth control pill and their acne is gone! I’ve used these therapies successfully with women who have had less success with other approaches.
Light therapy is another level of treatment for acne, and it is often effective (see photos). One way to use light is to direct specific wavelengths to activate compounds within the acne bacteria that in turn attack and kill the bacteria.
Compliance within a treatment plan is a critical ingredient for success. We encourage our acne patients to develop a compliance routine. We try to make it as simple as we can. We know that the growth hormones and sex hormones gain strength in the adolescent years, and contribute to acne, and there’s not much you can do about that. But we also know that stress hormones contribute to acne.
A lot of teenagers lead stressful lives that exacerbate their acne. They need to take care not only of their skin and their acne condition, but of their whole body. A proper diet is very important. It isn’t the oil in the pizza or the caffeine in the soda that contributes to acne, but if you’re living off pizza and soda, that’s harmful to your body. If you’re not getting sufficient exercise and you’re sleep deprived, your acne will reflect the overall condition of your health. And stress reduction is a key factor. Acne and stress often co-exist.