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Adult Acne

Management and treatment options for acne and acne scars

6321603_lAcne is a common dermatological problem that is easily correctable. Some only suffer for a short period while others have it for a much longer period. It usually starts during adolescence because of rising male sex hormone and results in 70% to 80% of teenagers having acne. But acne is not confined to teenagers! Adults in their 20s and 30s can also be afflicted with “adult acne”. As many as 7% of women and 1% of men over 40 years old have also been found to suffer from acne! Acne is trivial to some people but annoying to others. In published literature, acne has been shown to have significant psychological effect especially during adolescence. The psychological impacts, often underestimated by doctors, include low self-esteem, difficult interpersonal relationship in courtship or workplace, anxiety and depression. Therefore, it is important to treat acne well in order to prevent physical as well as psychological scarring.

Every year, large sums of money are spent on creams and lotions for acne treatment without the guidance of doctors. This lack of guidance in treatment is thought to contribute to the cost and severity of the condition.

Acne and its Causes

Acne is primarily a problem of blocked sebaceous (oil) gland. Dermatologists classify acne lesions into two broad groups – non-inflammatory lesions and inflammatory lesions. Non-inflammatory lesions include whiteheads and blackheads, while inflammatory lesions comprise pimples, nodules and cysts.

During the pubertal period, male hormones surge in both males and females, stimulating the sebaceous glands to become bigger and more active. Their greasy secretion and the accumulation of skin cells near the gland opening leads to blockage of the sebaceous glands. These sebaceous glands are found mainly on acne prone area, e.g. face, chest and upper back. Once blocked, bacteria grow easily in these blocked sebaceous glands, which then lead to inflammation, redness, swelling and pus – and a pimple is formed!

The severity of acne depends on several reasons – the number, type and extent of acne lesions; its response to current or previous treatment; and the presence and formation of scars. All these factors will influence the dermatologist’s decision to treat it with either topical or oral medication. The basic principles of treatment are to exfoliate and unblock the sebaceous glands, to counteract the bacteria and inflammation, and to rein in on the overactive sebaceous glands and hormones. Nowadays, dermatologists have very effective medications to control acne outbreaks.

Treatment Options to Counter Acne Outbreaks

There are many over-the-counter preparations that might help the milder acne. The more severe ones will need prescription-only medication from doctors. Topical benzoyl peroxide, salicylate acid and tretinoin are the most commonly used topical agents in the management of common white and blackheads. Topical clindamicin or erythromycin is frequently prescribed for inflammatory papulopustular acne, and they are often combined with benzoyl peroxide for better results.

The more severe acne patients will often need oral medication to achieve better control, either alone or in combination with topical agents. Oral tetracycline, doxycycline, minocycline, erythromycin, clindamicin or bactrim are the many options that dermatologist can choose from. Women patients have the additional options of taking birth control pills or anti-androgens to reduce their acne. When all else fails, the dermatologist still has an ultimate weapon in oral isotretinoin. Isotretinoin is a very powerful drug for acne, and it has transformed the life of many acne patients. It almost always works, but it has some serious adverse reaction and needs to be used with care. In the United Kingdom, only dermatologists can prescribe isotretinoin because of concern of its side effects.

The Truth about Acne5394811_xl

A lot of people still consider acne outbreak a hygiene issue. Despite stepping up their cleansing routine and frequent change of cleanser, their acne still persists! Excessive and too vigorous washing can sometimes make acne worse! In a straightforward case, washing one’s face with a gentle cleanser and water two to three times a day will suffice. The main use of facial cleansing is to remove dirt, sweat, grimes, cosmetic and dead skin cells, and it has very little impact on the control of acne.

Many of acne patients like to pick and squeeze their acne because a successful pop is always very satisfying! Not that squeezing or extracting acne is absolutely bad, but one should only limit it to blackheads. The hands should always be clean, and the squeeze clinical and precise! Inappropriately squeezing the inflammatory lesions is likely to cause worsening inflammation, expansion of the lesion, and worse, scarring!

Many patients were also talked into believing that acne is due to accumulation of toxins and that they need detoxification treatment. Amazingly, some even believe that it is good when their acne gets worse while on detox treatment as it shows the treatment is effectively purging out the toxin from their face!

Scarring and Possible Treatments

Scarring occurs to a varying degree in high percentage of acne patients, and there are various sorts of scarring, e.g. atrophy scar, saucer-shape scar, punch out scar, ice-pick scars, hypertrophic scars and keloid scars. There will also be acne marks like post-inflammatory erythema (red) and hyperpigmentation (brown). Almost all acne marks will improve with time or treatment, but some scars remain permanent. Therein lies the importance of treating acne well because there is no perfect way of removing scars. Studies have shown that the degree of scarring correlates with the initial severity of acne and delay in starting treatment.

When a patient is distressed psychologically by scarring, several treatments are available to ameliorate the situation. These include medium depth chemical peels, dermabrasion, scar subcision, punch grafting, ND-YAG laser, laser resurfacing, botulinum toxin injection (for specific area), fillers injection and surgical excision of isolated scars. For keloid scars, a combination of topical steroids, intralesional steroid injection, cryotherapy or excision with radiation treatment may help. In many cases, many different types of scars all appear together, requiring the combination of different treatments to achieve the optimal results.

In recent years, the successful development of super-pulsed, high-energy fractional laser has allowed dermatologists to achieve good results, rapid wound healing and much less post-laser adverse reactions.

In summary, acne should be treated early to minimise scarring, and it is important for patients to understand their problem and be aware of the array of available dermatological treatments. It is also important for doctors to clarify the many myths about acne and acne treatment and emphasise the importance of compliance with treatments in order to have satisfactory treatment outcome.


Dr Wong Soon Tee is a Consultant Dermatologist at Assurance Skin, Laser & Aesthetics.
Posted by ezyhealth on Jan 8 2014. Filed under Aesthetics. You can follow any responses to this entry through the RSS 2.0. Both comments and pings are currently closed.

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