Acne Vulgaris: The Good, the Bad and the Scarring…

Acne Vulgaris is what you commonly call…acne.  It is a chronic inflammatory disease of the pilosebaceous follicles and is characterized by comedones (closed comedo or white heads and open comedo or black heads), papules, pustules, nodules, and often scars.  The comedo is the primary lesion of acne.

Acne primarily involves the face, neck, upper trunk and upper arms.  On the face acne occurs most commonly on the cheeks and to a lesser degree on the nose, forehead and chin.

Acne typically begins at puberty and is often the first sign of increased sex hormones production.  Acne between the ages of 8-12 years of age is frequently comedonal in character, affecting primarily the forehead and cheeks.  It is usually a disease of adolescence with 85% of all teenagers being affected to some degree.  For most patients acne clears as they mature into adulthood.  However, it is a disease that can strike at any age and some of the most unhappy patients are those that develop acne in their 20s, 30s and 40s.

Neonatal and infantile acne may also occur and can be very difficult to treat.  The child in the photograph above developed deep abscess that were very difficult to manage.

Untreated and undertreated acne can produce much scarring.  Many forget that in teenage populations acne used to be one of the more common causes of teen suicide and remains so even today.  Maybe even more so today due to the prevalence of social media.  To read more about this click HERE and HERE.

TREATMENT:  Needless to say, we have tremendous treatment options today and they all have their place in managing acne vulgaris.  Over the counter options can be useful, but in more moderate to severe disease prescription medications are often required and provide the best results.  My comments here are not meant to replace a clinic visit and are not specific recommendations to treat your acne.  These are general comments to give you an idea of my approach to treating acne.  Here we go…

The Basics:

  1.  Spot treatment.  The medications work by suppressing the formation of comedones, the progenitor of all forms of acne.  It does you no good to “spot treat” your acne–those lesions have to mature and run their course.  You need to treat the surrounding areas to prevent new lesions from  forming.  That’s how you get better.  A few medications, like retin-A, can accelerate the clearance of acne and when starting out some patients might think they are actually getting worse when they are not.  The medication is simply clearing the lesions faster.
  2.  Treating acne is not a short term affair.  It takes 4-6 weeks to assess a clinical response to treatment…so it is very, very…very important that you are regular with your medications.
  3.  Many of the acne treatments can be drying, so it is very important that you don’t use other products that are going to dry your skin further.  Avoid astringents, alcohol, over the counter acne products, scrubs and exfoliating products if you are on prescription topical medications.
  4.  Compliance…compliance…compliance.  It is so very important to be consistent with your treatment.

Stages of Treatment:  I generally have 3 major stages of treatment, based on severity.

  1.  Mild Acne–Begin with topical treatments.  Many products today have multiple active components…such as Veltin, it contains retin-A and clindamycin…so you are actually using two treatments with a single application.
  2.  Moderate Acne–Combination topical treatment with an oral antibiotic.  The patients will be on oral antibiotics for a number of months to promote maximum control.  Once control is reached the oral antibiotic can be discontinued to see if it can be controlled just with topical care.
  3.  Severe Acne–Accutane is a marvelous drug and has saved many lives throughout the years.  It is the only drug that can permanently affect your acne.  Some patients with a single 4-6 month treatment course never have problems with acne again.  For more information on accutane click HERE.

CAVEAT:  Treating acne in Nevada has some challenges, mostly related to the environment.  Nevada has a desert environment and this frequently results in dry skin issues.  For this reason I rarely use more than one topical acne treatment at a time.  I try to maximize the topical and would rather switch to a different topical over adding a second one.  If you are using two topical agents and you develop a complication, such as it’s too dry, then you are stuck with trying to figure out which one of the medications is really the problem.  Also, there is a lot of sun here, so you have to tell patients on certain antibiotics to be careful with sun exposure, since some of the tetracycline derivatives can cause sensitivity to sun exposure promoting sunburn.

To read more about acne click HERE and HERE.