The number one question I get from my family and friends is, “How do I treat adult acne?” My friends (doctors and non-docs alike!), my coworkers, myself, even my Dad who is in his 60’s still struggle with acne from time to time. So what’s the deal with these pimples and how do we get rid of it?
First of all, what causes acne? Turns out it’s a mix of things. Skin cells called corneocytes are usually shed into hair follicles, but in acne, you get overproduction of skin cells that like to stick together as well as excess production of sebum, an oily substance that protects the skin. It’s a small opening in the hair follicle but a lot of gunk backed up beneath it, so this creates a bottleneck and a comedone forms (open ones are called blackheads, closed ones whiteheads). As more gunk accumulates at the bottom of the hair follicle, pressure builds up until the comedone walls under the skin rupture, resulting in inflammation and unfortunate pimples. Propionibacterium acnes is a bacteria that lives in the hair follicle that also worsens pimples by increasing inflammation and contributing to rupture of the comedone wall.
As far as treatments go, there’s a bunch! Here is an infographic I made about the power ingredients we use in dermatology to target those troublesome pimples.
We really approach acne in a step-wise fashion. In general, topical creams and medications are first-line, and oral medications are for more severe cases that do not respond well to just topical treatments.
If you have acne and haven’t tried anything before, try starting with a benzoyl peroxide wash or a product with salicylic acid in it. These are available over the counter and have a small side effect profile. Benzoyl peroxide and salicylic acid are actually the main active ingredients in Proactiv! Also make sure to use non-comedogenic makeup, meaning makeup that does not clog your pores and cause pimples. Make sure to really clean off your makeup at the end of the day too.
If the washes alone don’t work, I’d suggest seeing a dermatologist for some prescription strength medicine. A benzoyl peroxide wash plus a topical antibiotic like clindamycin and a topical tretinoin is a great combination to bring your acne fighting regimen to the next level. If you have inflammatory acne (more pustules than comedones) your doctor may choose to swap in an oral antibiotic instead of a topical one.
If you tend to get acne flares around your period or if you tend to have acne around the jawline or around the mouth area, then you may have a hormonal component to your acne. This can be improved by birth control pills or a pill called spironolactone, which helps to counter androgens (male hormones) that promote acne formation. These require prescriptions from a doctor, as there are side effects associated with each.
If nothing topical works and oral antibiotics don’t work either and you still have severe acne, your doctor may consider Accutane, which is an oral medicine derived from vitamin A. Accutane majorly decreases the size of your sebum-producing glands which in turn also kills bacteria that depend on sebum to thrive in your skin. Accutane is usually taken in a 4-5 month course and ~85% of patients get clearance of acne after using this medication. Know that there are many side effects associated with Accutane though, including but not limited to birth defects, depression, elevated cholesterol, abnormal liver enzymes, etc. Because of these severe side effects, you will need frequent blood tests, pregnancy tests, and close follow up with your dermatologist. This may sound cumbersome but it’s worth the effort if you really have troublesome acne that hasn’t worked with any other treatments.
Hope this post helps in clearing up some of the confusion around how best to treat these pesky pimples! What have you found works for you?