What is Acne?
Acne is a common condition that can cause significant social, psychological, and physical consequences. It can cause depression, anxiety, low self-esteem, pigmentation changes, and physical scarring.
Acne is a skin condition characterized by blockage and inflammation of the hair follicle and oil producing glands. It primarily affects the face but can also be found on the chest and back. It can present as comedones (white heads, black heads) or inflammatory lesions (papules, pustules, or cysts). Most people have a combination of comedones and inflammatory lesions. Inflammatory lesions can become large and painful and lead to tissue destruction and scarring.
Acne is a condition that can affects over 80% of people under 20 years old and the prevalence decreases with age. It is commonly seen in adults, especially women, and can be related to pregnancy, menopause, or other hormonal imbalances.
Acne is caused by multiple factors including hormones, increased sebum (oil) production, the presence of Cubacterium acnes, inflammation, and abnormal shedding of skin cells. Diet and genetic factors are also important.
Acne can affect the face, chest or back. Symptoms can vary depending on severity of the acne. Comedones (white heads, black heads), papules (red bumps), pus filled lesions, and cysts (deep painful lesions) can be seen, and more than one type may be present at once. Other symptoms that may be present are scarring, skin discoloration and oily skin.
Acne can be a condition that lasts for many years. For many people it improves after adolescence, but for some it persists. Oral isotretinoin is the only medication that can potentially cure acne.
Certain foods, such as dairy products and high glycemic index foods can worsen acne severity. Excessive cleansing of the skin and topical vitamin E can worsen acne and should be avoided.
The goal of acne treatment is to reduce acne development and to prevent it worsening. Acne can be treated with topical and oral prescription medication or light-based devices such as intense pulse light (IPL) and Celluma LED blue light therapy. When acne is left untreated it can lead to scarring as well as pigmentary disorders which can further reduce quality of life. Acne treatments can improve the appearance and quality of the skin and combined treatments can often lead to better outcomes. Acne is generally a slow to respond disease and may take several months so improve. Maintenance treatments are often recommended to help prevent acne from coming back.
Topical medications include retinoids, benzoyl peroxide, azelaic acid, antibiotics, or a combination of these products. Oral medications include antibiotics, oral contraceptives, spironolactone, and isotretinoin. The choice of medication depends on the type and severity of the acne, area of involvement, age of the patient, side effects and cost.
Intense pulse light (IPL) uses light of multiple wavelengths to reduce inflammation, eliminate Cutibacterium acnes from pores, reduce oiliness of the skin as well as treat redness and pigmentation in the skin. The Lumenis M22 has a special notch filter designed to address acne and can be beneficial for those patients who do not want, or are intolerant to, medical treatments. Dr. Fisher recommends 4-6 treatment sessions 2 weeks apart for best results.
Celluma LED blue light therapy is a safe treatment to reduce oiliness of the skin and to improve inflammatory acne. Blue light works to eradicate Cu#bacterium acnes and reduce inflamma,on, pimples, and redness within a few weeks. Dr. Fisher recommends having 2 treatments per week for 4 weeks for best results.
Skin care is an important part of acne prevention and treatment as skin barrier function is often damaged in acne patients. It is also helpful to reduce side effects and improve the success of treatments. Using gentle cleansers and avoiding over cleansing the skin is important to maintain a healthy skin barrier and prevent worsening of acne. Moisturizers that are oil free, non-comedogenic and contain active ingredients such as ceramides, anti-inflammatories and salicylic acid can be beneficial. Sunscreen should be worn daily to reduce pigmentary changes and protect the skin from UV damage.
