Acne and acne scar treatment. Dr. Emily Altman, NJ.
Posted Oct 07 2011 12:00pm
Acne is a disease of the hair follicle, caused by a combination of both internal and external factors. Abnormal build-up of skin cells causes a plug at the opening of the hair follicle, creating a clogged pore, the first step in acne lesion formation. The clogged pore accumulates keratin, oil (sebum) and bacteria until it ruptures, releasing this mixture into the skin and causing inflammation. This inflammation can lead to painful cyst/abscess formation and scarring.
Acne with scarring
Acne lesions can be non-inflamed whiteheads and blackheads (comedones), pustules, red papules, cysts or nodules.
The first step in acne lesion formation involves an abnormal build-up of skin cells at the opening of the hair follicle, creating a clogged pore (microcomedo). The clogged pore accumulates keratin, oil (sebum) and bacteria until it ruptures, releasing this mixture into the skin and causing inflammation. This inflammation can lead to painful cyst/abscess formation and scarring.
Stages of acne
Stages of acne
Trying to squeeze out a pimple or cyst creates more even more inflammation. The lining of the hair follicle is thin. It is stretched and thinned further by the accumulation of oil, keratin and bacteria below the plugged opening. Squeezing the pimple partially releases the contents onto the surface of the skin, but also ruptures the lining of the hair follicle and lets this mixture spill out into the dermis, where the cells of the immune system mount an attack to remove it. This deep inflammation promotes scarring even more.
Sudden acne breakouts can potentially have a number of causes:
Hormones. These can be internal, meaning your body is producing more androgens (male-like hormones responsible for acne). These can be seen in conditions like polycystic ovary syndrome or pregnancy. Hormones can also be affected by medications, such as certain oral contraceptives (birth control pills), IUDs with hormones (usually progesterone-based) and depo contraception injections. Birth control medications are usually a combination of estrogens and progesterones or progesterones alone. Certain progesterones can flare acne.
Medications. Corticosteroids, such as prednisone, which are commonly used for inflammatory conditions, are well known for flaring acne. Using cortisone creams or lotions on the face can also flare acne. Other medications that flare acne include: chemotherapy medications like epidermal growth factor receptor inhibitors, dactinomycin (another chemotherapy drug), immunosuppressive mediactions, such as sirolimus, cyclosporine and tumor necrosis factor inhibitors (these are used for psoriasis, rheumatoid arthritis, Crohn’s disease, and other conditions) , certain anti-depressant and other psychoactive medications, anticonvulsants, like valproic acid and phenytoin, Other medications include antituberculosis drugs, antibiotics such as rifampin,
Anabolic steroids. Those are used medically but certain ones can be used illegally to enhance sports or athletic performance.
Diet. A diet that contains large quantities of dairy products such as milk, cheese, yogurt, ice cream, sports nutrition bars and drinks, even milk chocolate tends to cause acne breakouts. High glycemic index/load foods, such as simple carbohydrates are also associated with acne breakouts.
Sun exposure and hot, humid weather. Although sun exposure initially tends to make acne better, it eventually stimulates more oil (sebum) production leading to more acne eruptions.
Topical products such as heavy creams, oils or moisturizers that are applied to facial skin can block pores and cause acne.
Halogens, such as those in certain thyroid medications, some vitamins and minerals and others. Before discontinuing any of your present medications, please consult with your treating physician. Discontinuing prescribed medications may be dangerous.
If the acne breakout is sudden and severe, I recommend a consultation with a board-certified dermatologist to determine the cause and to start treatment as soon as possible to avoid possible scarring. If your acne resulted in some scars previously, there is a potential for scarring again.
My treatment approach to acne includes:
Diet and hormones
There are multiple androgenic, anabolic and growth hormones present in cow’s milk. Consumption of milk and dairy products leads to worsening of acne, as there is no such thing as hormone-free cow’s milk. Discontinuing consumption of milk and dairy products, such as cheese, yogurt, butter, ice cream, sour cream and even milk chocolate, and eating a diet of lean proteins, unsaturated fats and complex carbohydrates will be helpful in acne control.
For women taking birth control pills, many of those preparations have androgenic (male hormone-like) properties and can contribute to significant acne eruptions. Progestins in these medications, depot injections and intrauterine devices are the most likely to cause acne.
Superficial chemical peels or cortisone injections are sufficient treatments for many patients if they have just a few lesions.
Most of these medications are prescribed by a dermatologist after a thorough evaluation of the skin, medical history, hormonal status, allergies and other factors that go into the decision about acne treatment choices. There are some over-the-counter options that can be tried first, like benzoyl peroxide washes or gels.
Acne sometimes flares during pregnancy. There are very limited choices for acne treatment in pregnant women. Most acne medications are contraindicated in pregnancy or we just don’t have information on how they could affect the baby. If you are pregnant and seeking acne treatment, please consult with a dermatologist first, before starting any acne treatment regimen.
For mild to moderate acne:
Topical retinoids, like Retin A, Differin, Tazorac
Topical antibiotics, like clindamycin, erythromycin, sulfur/sulfacetamide combinations.
For nodular, cystic or scarring acne:
Antiandrogens, like spironolactone.
Isotretinoin may be needed for more severe or resistant cases.
Laser and Light Treatments
Intense Pulsed Light (IPL)
Fractional Laser treatments.
These therapies can be used alone or in combination with acne medications in order to achieve the best results in acne treatment.
Acne scar treatment photo before and one week after the second treatment with fractional erbium laser resurfacing
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