July 11, 2018

Acne Vulgaris: Should I be treated?

By Dr. Benjamin Carter

In my practice I often see adolescent patients with acne. Most patients have mild to moderate acne and have little to no risk of scarring. Rarely, I will see scarring, even with mild to moderate acne. Frequently I will have a patient come in for acne treatment who has severe inflammatory acne with deep cysts and nodules (nodulocystic acne). These patients can develop scarring very quickly and unfortunately due to circumstances or to the rapidness of onset these patients end up with substantial acne scarring. The scarring can occur on any of the acne affected areas including the face, neck, chest, back and arms. The scarring can be mild textural change or more significant “pock” or “ice pick” scarring. The more severe the scarring the more difficult it is to correct in the future. There is no doubt that early intervention for acne can minimize the risk of scarring for most patients.

Each year Americans spend upwards of 3 billion dollars to treat acne. Acne vulgaris (common acne) affects up to 50 million people in the US each year. The majority (85%) of individuals affected are between the ages of 12-24 years old. For this reason most people perceive acne to be an affliction of the young but surveys reveal acne can persist well into adulthood with as many as 35% of women and 20% of men complaining of acne in their 30’s. Interestingly, Caucasian boys and men are more likely to develop nodulocystic acne which is more severe and is more likely to scar.

Acne is the result of multiple processes in the skin which influence the pilosebaceous (hair follicle and oil gland) unit. During adolescence as hormone levels rise there is increased oil production within the skin which in turn creates increased stickiness of skin cells. These skin cells build up creating hyperkeratosis (increased dead skin cell thickness) which overlies the hair follicle opening . This in turn leads to additional build up of oil and skin within the hair follicle. At this point there can be proliferation of Propionibacterium acnes (P. acnes) which can be found on the skin normally but in acne can produce an inflammatory response within the follicle. If the follicle ruptures that inflammatory response can become even more intense and more significant and deep acne cysts and nodules can form in response to the rupture leading to intense redness, pain and scarring.

Treatments for acne are tailored to those three principle factors: oil production, sticky skin cells and inflammation. For most patients with mild to moderate acne, topical therapy will be sufficient. Salicylic acid, benzoyl peroxide (BPO), glycolic acid can all be helpful for sticky skin cells and BPO functions as an astringent reducing the amount of oil on the skin and killing bacteria. Topical retinoids such as tretninoin serve to increase skin cell turnover and reduce oil production. Topical antibiotics such as erythromycin and clindamycin can be used to reduce the numbers of P. acnes bacteria on the skin in turn reducing inflammation. Oral antibiotics can also be helpful for moderate to severe acne by reducing global inflammation in acne affected skin. For moderate or severe scarring acne or nodulocystic acne oral isotretinoin can be administered.

These treatments can help reduce the social, emotional and psychological effects of acne in addition to reducing the potential for scarring. If you or someone you know suffers with acne call Dr. Benjamin Carter at Riverside Medical Arts for an appointment at (435) 628-6466.

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