What is Acne?
Basal cell carcinoma is the most common form of skin cancer. It arises from cells residing in the deepest layer of the epidermis and develops more readily when a person is exposed to UV radiation. These cancers tend to be slow-growing and rarely spread (metastasize).
To properly diagnose and treat acne we perform a thorough history followed by a skin exam. Then, once diagnosed, a treatment protocol is determined. Treatment is geared towards an individual’s skin type and level of inflammation as well as skin sensitivity.
Acne appears on the skin as:
congested pores ("comedones"), also know as black heads or whiteheads,
tender red bumps also known as pimples or zits,
pustules, and occasionally as
cysts (deep pimples, boils).
Several products are available that do not require a prescription. However, for cases which do not respond to over-the-counter therapies, medications may be a helpful addition to a good skin care regimen to treat and prevent further flares. Some therapies involve drugs with the risk of serious side effects and should be carefully considered before initiating treatment. Although normal skin bacteria play a role in acne, the use of antibiotics is not for everyone.
Types of acne
This type of acne involves blackheads and whiteheads. It forms because your skin’s natural oils, along with old skin cells, block the pores of the skin. Comedonal acne appears most often on the forehead, nose, and chin.
The most severe form of acne, cystic acne is deeper. Cystic acne may run in families. It’s often very painful and can result in disfiguring, permanent scarring.
This form of acne occurs when the area just under the “plug” (the blackhead or whitehead) becomes reddened and inflamed.
This is one of the toughest types of acne to get rid of because it is caused by an imbalance of your hormones such as elevated cortisol levels, low levels of progesterone, hypothyroidism, insulin resistance and even polycystic ovarian syndrome.
Over-the-counter topical treatments
These may decrease oil production, kill bacteria and promote sloughing of dead skin cells. Over-the-counter lotions and creams are generally mild and may contain benzoyl peroxide, sulfur, resorcinol, alpha hydroxy acid, salicylic acid or sulfur as active ingredients. These products can be helpful for very mild acne.
Topical treatments available by prescription
If your acne doesn't respond to over-the-counter treatments, we may prescribe topical prescriptions based on vitamin A that work by promoting cell turnover and preventing plugging of the hair follicles. Topical antibiotics that destroy excess skin bacteria may also be prescribed. Often, a combination of such products is required to achieve optimal results.
For moderate to severe acne, you may need a short course of prescription oral antibiotics to reduce bacteria and fight inflammation. Depending on your type of lesions, you may use topical medications and oral antibiotics together.
For deep cysts, antibiotics may not be enough. Isotretinoin (Amnesteem, Claravis, Sotret) is a powerful medication available for scarring cystic acne or acne that doesn't respond to other treatments. This medicine is reserved for the most severe forms of acne. It's very effective, but people who take it need close monitoring because of the possibility of severe side effects. Isotretinoin is associated with severe birth defects, so it can't be safely taken by pregnant women or women who may become pregnant during the course of treatment or within several weeks of concluding treatment. In fact, the drug carries such serious potential side effects that women of reproductive age must participate in a Food and Drug Administration-approved monitoring program to receive a prescription for the drug.
Oral contraceptives may improve acne in some women.
Laser and light therapy
Laser and light based therapies reach the deeper layers of skin without harming the skin's surface. Laser treatment is thought to damage the oil (sebaceous) glands, causing them to produce less oil. Light therapy targets the bacteria that cause acne inflammation. These therapies can also improve skin texture and lessen the appearance of scars. However, more research is needed to understand the most effective use of light and laser therapies in acne treatment. We do not offer this type of acne treatment at the Dermatological Center for Skin Health but will be happy to provide referrals.
Chemical peels and microdermabrasion may be helpful in controlling acne. These cosmetic procedures, which have traditionally been used to lessen the appearance of fine lines, sun damage and minor facial scars, are most effective when used in combination with other acne treatments. They may cause temporary, severe redness, scaling and blistering, and long-term discoloration of the skin. We do not currently offer microdermabrasion at the Dermatological Center for Skin Health but will be happy to provide referrals.