Bothered by breakouts? Options can help battle acne

Learn about types of treatment, skin care and when to make an appointment

Concerned about acne: Young woman looking to the side applies cleanser to her chin.

Acne.

The word itself doesn’t look or sound pretty. It’s a variation of the Greek word for “point” — too visually suggestive of a pimple.

The condition itself isn’t pretty for the 85% of us who experience it by the age of 24, according to the American Academy of Dermatology.

And for those of us still struggling with acne at the same time wrinkles start creasing our face? Vexing — and definitely not pretty.

The good news for teens of today is that they have more options than their parents had at their age for waging a good battle against breakouts. And if their parents are still in the fight, they can take advantage of those options now, too.

What causes acne?

When new patients come to see Sanford Health physician assistant Brianna Strube, who specializes in dermatology and particularly acne, she reassures them that they likely aren’t doing  anything to cause their skin condition. “It’s usually not their fault,” she said.

Find a doctor: Dermatology at Sanford Health

Dispelling common myths people may hear about eating greasy foods or touching the face, Strube said: “Although diet and hygiene can contribute, a lot of the time, it’s genetic and hormonal.”

So, as a result of inherited tendencies and fluctuating hormones, dirt and oil can clog a pore, sometimes with bacteria trapped inside. Most of us know from experience what comes next: comedonal acne, which is the self-explanatory whiteheads or blackheads; or the more deeply infected cystic acne, which is much less common and causes large red inflamed bumps.

Acne usually occurs on the face, chest and back.

People may experience any combination of the types of acne at any age. But most of Strube’s patients are teenagers — sometimes even a little younger — because of the hormonal component.

Acne affects up to 50 million Americans each year, the American Academy of Dermatology estimates.

It is the No. 1 reason why people visit a dermatology provider, Strube said. The emotional distress or scarring from acne can undermine people’s confidence, self-esteem and social life if they’re bothered by it.

“If it’s affecting a person’s confidence or their daily life, then we want to see them,” Strube said.

That’s part of what drew her to acne as a specialty. She works with the patient to manage a physical condition that can be challenging to treat. And that in turn helps heal the insecurities acne created.

How should you start treating your acne?

Drugstore shelves are full of products promising to help with acne. And some over-the-counter products can be very effective, Strube said. Not everything will work with every person, though, so be prepared to experiment.

Topical treatments, applied to the top of the skin, are the safest treatments for mild to moderate acne, Strube said. They have minimal absorption into the skin and minimal side effects.

“Topical retinoids, in my opinion, are good for everyone’s skin, and they have a lot of benefit for acne-prone skin,” Strube said.

Retinoids, which are vitamin A derivatives, increase the pace at which skin cells turn over. “It also purges pores of dirt and oil,” she added.

Several years ago, drugstore shelves added the retinoid Differin 0.1% gel, or adapalene, when the product received approval from the FDA to switch from prescription to over-the-counter.

“We love that,” Strube said. “That makes it very accessible.”

She cautions that there’s a break-in period to using Differin, which is used by spreading a thin layer of gel all over the face. She recommends starting with an application at night twice a week for a month. Then increase to every other night for a month, then every night.

Differin can cause dryness and peeling, but the break-in period will help the skin tolerate the new pace of cell turnover. And if breakouts still occur, a stronger prescription version could be the next step.

Strube also finds benzoyl peroxide an effective over-the-counter treatment for red, painful breakouts. Benzoyl peroxide, available in a variety of brands and products, helps kill the acne-causing bacteria.

How should you take care of your skin?

When Strube sees a new patient, she goes over some skin basics, including gentle cleansing, makeup use and precautions to take.

“Simply washing your skin and moisturizing twice a day improves acne,” Strube said. Moisturizer helps keep the skin in balance; otherwise, dry skin could trigger more oil production, which then can clog pores.

Here are several other skin care tips she offers:

  • Avoid harsh cleansers, and especially avoid harsh exfoliants. Don’t scrub your skin.
  • Be sure that makeup is oil-free. Strube prefers mineral-based makeup.
  • Make sure you follow these two steps if you wear makeup: Remove makeup every night, then follow that up separately with washing the skin.
  • Don’t pick or pop acne. That can lead to scarring.
  • Wear sunscreen; some acne products can lead to sun sensitivity.
  • Eat healthy and care for your whole body.

When should you make an appointment?

There’s not a set “amount” of acne that should trigger a visit to a dermatology professional. Emotional tolerance to acne varies for each person. But here are some signs that it’s a good time to see a professional for help:

  • Over-the-counter products aren’t helping reduce your acne as much as you would like.
  • You’re using a lot of makeup to cover up the acne.
  • Acne affects your confidence or self-esteem levels.
  • Outbreaks affect your daily life and actions (withdrawing from activities or avoiding events, for example).
  • Acne leads to symptoms of depression.

Strube says if parents notice behavioral changes in their teenager, they can open up communication and ask if their teen’s skin is bothering them. Then they could make an appointment with their primary care provider or a dermatology provider. Strube also has helped connect patients with behavioral health specialists when needed, too.

What treatments are next?

Strube starts out talking with her patients about how aggressive they would like to be in treating their acne and outlining the side effects of each type of treatment.

Patients can start by trying prescription-strength topical products, including topical antibiotics that kill bacteria on the skin.

“If they’re wanting to be more aggressive, that’s when we look at oral medications,” Strube said.

Two oral medications are available for women only because they address hormonal causes of acne. They help reduce the amount of pore-clogging oil produced as a result of hormone fluctuations. They should not be used by women who are pregnant or trying to get pregnant, however.

One option for women is birth control pills, a couple of which are FDA-approved to treat acne. Another option is spironolactone, which blocks the male hormone that contributes to oily skin. Strube hesitates to use it with younger females, however, because it may cause blood pressure to lower.

Oral medications available for both males and females include antibiotics to decrease inflammation, although long-term antibiotic resistance is a concern.

What about Accutane?

“Let’s say I have a patient who has severe resistant acne. It’s not responding to topicals or oral medications,” Strube said. “Then we have the discussion about Accutane.”

Isotretinoin, formerly known as Accutane, is an oral retinoid and the only treatment that will deliver long-term results, Strube said — with a goal of “months to years of clearance.” It changes oil glands to lower oil production.

A course of isotretinoin will generally last six months. But it’s not for everyone.

There are numerous side effects and precautions patients must be aware of. For example, because the medication can cause birth defects, women capable of becoming pregnant must prove they are not pregnant with two pregnancy tests before beginning treatment and an additional test each month they take it. They also usually have to use two forms of birth control while they are taking it.

And unlike some treatments that require little follow-up with her, Strube needs to see patients who are taking isotretinoin every 30 days. That is the maximum amount of medication she can prescribe at one time. Blood draws are involved, too, to monitor cholesterol and liver enzymes, which can be negatively affected by the medication.

“It’s more of a commitment than other treatment options,” Strube said, “but patients have had very positive results from the medication.”

As their skin improves, “people are feeling better about themselves,” she said.

How does laser treatment work?

Laser treatment for mild to moderate acne works great for a woman who is pregnant or breastfeeding, Strube said, because it’s noninvasive and won’t harm a baby like some medications can. It’s available for use by anyone.

The broadband light treatment uses three separate colored lights, each with a different purpose. Blue light kills bacteria. Yellow light lessens active acne and helps prevent new flare-ups. Infrared light helps stimulate healing.

Laser treatment typically is done once every two weeks for a total of four to six treatments, Strube said. Maintenance treatments may follow every few months. Unfortunately, insurance usually doesn’t cover it.

“We see gradual improvement,” Strube said. “It’s very safe. It’s very comfortable. It doesn’t take very long, maybe 15, 20 minutes.”

How can you treat scars caused by acne?

Skin can be discolored, or red, after a breakout. That, Strube said, often “improves just with time.” Moisturizing can help.

For scarring that results in textured skin, Strube has several options for treatment — which are actually used to treat wrinkles as well.

They “smooth out the surface of the skin,” she said, and “can stimulate collagen to fill in any areas.”

Options include Profractional laser, using laser beams; microneedling, using small needles that prick the skin; and chemical peel, which applies a chemical solution to the skin. Topical retinoids  also are an option for smoothing out the texture of skin.

Strube said it’s best to ensure acne is clear or under control before embarking on an acne scarring treatment. And she recommends that people who have used isotretinoin wait at least  six months after their last dose before starting a scarring treatment because of the skin sensitivity isotretinoin causes.

When will acne clear up?

There’s no straightforward answer to when people’s acne will clear up.

For some people, acne is worse as a teenager. For many, it starts young and continues into adulthood.

But Strube wants to reassure people that their acne can be treated.

“Although they can take a while to work and be effective, there are multiple options. Regardless of age, with the right regimen, we usually notice improvement in three to four months after starting treatment.”

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Posted In Children's, Dermatology, Symptom Management, Women's

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