Acne continues to be one of the most troublesome dermatological issues in America – and the single biggest reason why people see their dermatologist
By Victor Czerkasij, MSN, NP-C
Acne continues to be one of the most troublesome dermatological issues in America. It is the single biggest reason why people make an appointment to see a dermatology provider – making up 10% of all visits.
At its most basic, acne is a combination of two products: surface oil produced by the body called sebum, and a simple bacteria that is present on the surface of the skin, and enjoys living in the sebum. This ‘simple bacteria’ is officially called Propiniobacterium acnes, or just P. acnes. So the most basic of acne treatment is to either dry the oil, kill the bacteria, or a combination of both.
But as many families have learned, it’s not that easy!
- First, oil production may be so heavy, that it is very difficult to dry consistently. Sebum is generally produced based on the action of hormonal activity: estrogen for women, and testosterone for men. And during the teen years, you can be sure hormones are front and center during this time.
- Second, patients can react poorly to topical products. They come in many forms, such as foams, gels, washes, creams and solutions. Side effects can include intense drying, scaling or even blistering reactions. Worse, some can be absorbed into the skin and consideration has to be given to those effects.
- Third, antibiotics are not candy. The side effect panel for antibiotics can include nausea, dizziness, headaches, diarrhea and photosensitivity, just to name a few. Acne is increasingly resistant to antibiotics, and new acne strains make it difficult for antibiotics to work. In addition, for some patients, once the antibiotics are discontinued, the acne returns.
It is unfortunate that acne often becomes an issue during a sensitive time in a teen’s life. The adolescent years are, in particular, a key phase, when a person’s appearance and social standing among peers is very important. Depression is a very real issue with teens, and according to many studies, can be heightened with acne. Scars may result, and inflammatory blisters and cysts are a painful distraction. Assessing the quality of life among teens suffering from acne is an important action for sensitive providers to include in their visits.
One very effective treatment for either persistent or cystic acne is isotretinoin, previously known as Accutane. Except for Botox, since 1982, it is one of the most studied medications in American history and when the basic rules are followed, for many patients it is very nearly a cure. Consisting of a purified form of vitamin A, isotretinoin is the oral cousin of the well-known Retin-A, the topical cream used for acne, melasma and wrinkling.
One question that often comes up in patient meetings is whether diet plays a role. At this point, the research community offers a cautious “most likely”. Remember when we told you that hormones are a driving force in oil production, which is the foundation of acne development? Human beings are the only mammal in the history of the world that continue to use breast milk – which is full of hormones — as part of their daily diet throughout their lives, and in particular during the teen years. Where does this breast milk come from, you ask? Dairy cows, of course. Remember, the dairy cow lactates and produces milk heavily which through yogurt, cheese, ice cream and milk we enjoy and can drive hormonal activity.
Schedule a consultation with a skin health provider at a location near you to have a thoughtful discussion of your acne concerns.