Life can be unfair. How else to describe the feeling of looking in the mirror and seeing a brand new, bright red pimple nestled in the crevasse of an equally new wrinkle? Adult acne affects a large portion of the population. Studies have pegged the percentage of women sufferers at somewhere between 25 and 50 percent (the number of men with adult acne is about half of that of women), but there are several treatment options for battling this scourge. Dr. Mary P. Lupo, a dermatologist and clinical professor of dermatology at Tulane University School of Medicine, discusses what acne is, how to treat it and how you can get rid of those annoying blemishes.
Q: What is acne?
A: It's a multi-focal condition; it's not just one thing that causes it. The physiologic problem is that the pore is clogged. The oil and dirt in the clogged pore can't get out, causing bacteria to flourish. The bacteria digest the oil, which is the food for the bacteria. This releases inflammation in the pores and causes redness and tenderness etc. ... so it's a combination of a mechanical problem combined with a bacterial problem combined with an inflammatory problem.
Q: Is there a difference between the acne that adults suffer from and the acne that teenagers get?
A: From a physical point, there are some differences. Generally, teenage acne tends to be in the T-Zone (forehead, nose and chin) whereas the acne of adult women tends to be on the jaw line and more on the cheeks, and that's pretty indicative of it being a hormonal/stress type of acne. Adult men's acne is often a result of problems with hair and it's more of a folliculitis (an infection of the hair follicles), but there's an overlap between folliculitis and acne: Is the problem in a pore without a hair, or is it a problem in a pore with a hair?
Q: What causes acne?
A: Hormones have a tremendous effect on acne. It's not poor hygiene, although if you're going to sleep with oil or dirt or makeup on your face, you're certainly not allowing the pore to extrude its contents. If acne could be cured by cleansing, nobody would ever need to see a dermatologist. People tend to over-cleanse in their frustration to treat their acne. The biggest cause is hereditary. The No. 1 reason people have acne is because their mother or father had acne. It probably has to do with a hereditary problem with the pores themselves. The cells that line the pore don't behave properly and they don't extrude (dead skin cells, which then blocks the oil) like they should, and they get plugged up in that pore. The hormones stimulate the sebaceous gland, causing them to produce too much oil, and the pore can't handle it and it gets backed up.
Q: People are often tempted to pop pimples. Good idea?
A: Bad idea. The No. 1 reason for the scar that you get from acne is from the rupture of that pore. When you squeeze it, you rupture it, causing its contents to spill into the surrounding skin, which sets up an inflammatory response with white blood cells, which destroys some of the collagen. And you get scar tissue in there, and that's a permanent scar.
Q: What are some over-the-counter treatments available?
A: If you've got acne, for about three months assuming it's not the real painful nodule underneath the skin it's perfectly reasonable to use over-the-counter salicylic acid products, combining them with over-the-counter benzyl peroxide products. Those two things address the two problems. The salicylic acid helps with the clog in the pore, and the benzyl peroxide helps to kill the bacteria. You can use these things in any area. I usually tell patients that this is almost like a volcano smoldering underneath your skin, and it bubbles up to the surface. You don't wake up one day with acne. It's a process that takes several weeks to smolder up to the surface. So, in order to be fair to any protocol, whether it be an over-the-counter protocol or a dermatologist's protocol, you must give it three months. If in three months you're not better, give up that program and try another.
Q: What about prescription products?
A: For most acne, mild and moderate, it's a combination of retinoids, topical antibiotics and, in moderate to severe cases, the addition of oral antibiotics or laser and light therapies. For retinoids, I'm talking about Retin-A, Tazorac and Differin. First, they help the acne clear; second, they help with the discoloration, the little brown spots and red spots; third, they prevent the acne from coming back; and fourth, all of these prescription products improve the appearance of skin from the aging standpoint. You go from treating your acne to treating your wrinkles, seamlessly. For severe acne that's not responding, then we consider the Accutane option (an oral retinoid).
Q: What about laser treatments?
A: For about eight years, I've been using the cool-touch laser, an infrared laser that heats the sebaceous gland, shrinks it and stimulates collagen production, so we use it for active acne and acne scars. This new Isolaz (laser) is different. It is for acute acne, and it addresses both aspects of acne: the pneumatic component of it it literally sucks that junk out of your pores: the oil, the dirt and the dead skin cells and the light is an energy of light in the blue range and actually kills the acne, the bacteria. So it hits both things that you need to address when you're treating acne. You're removing the clog and then you're killing the bacteria. People get anywhere from three to five treatments in a series. We usually use this for people who are going to need oral medication. A lot of people don't want to take medicine. They're afraid of bacterial resistance. They're afraid of side effects. You would not use these treatments for mild acne; I would say it's not necessary. It's not detrimental, but I just don't think it's cost-effective.