Acne

  • Acne is the most common skin condition in the United States, affecting up to 50 million Americans annually.1
  • Acne often causes significant physical and psychological problems such as permanent scarring, poor self-image, depression and anxiety.2
  • See your dermatologist for the successful diagnosis and treatment of acne. Early treatment is the best way to prevent scars.

 Acne facts

  • Acne, a chronic inflammatory skin condition, is characterized by blackheads, whiteheads, pimples and deeper lumps (cysts or nodules) that occur on the face, neck, chest, back, shoulders and upper arms.
  • Acne usually begins in puberty and affects many adolescents and young adults, but it can occur at any stage of life.
  • Approximately 85 percent of people between the ages of 12 and 24 experience at least minor acne.3
  • The costs associated with the treatment of acne exceed $3 billion.3

Causes of acne

  • Acne is caused by many factors.
  • Overactive oil glands can produce too much oil and combine with skin cells to plug pores. When the pores in the skin become plugged, bacteria on the skin multiply, causing skin lesions.4-5
  • The following can bring on acne or make it worse:
  • Heredity/genetics.
  • Hormones.
  • Menstruation.
  • Emotional stress.
  •  Medications.
  • Foods with a high glycemic load such as white grains (bread, rice, pasta) and sweets have been linked to acne.6 For overall good health, people should eat a healthy, balanced diet.

 Acne care

  • Gently wash affected areas once or twice a day and after sweating with mild, nondrying cleanser. Vigorous washing and scrubbing can irritate your skin and make acne worse.
  • Shampoo hair often — daily if it is oily.
  • Use “noncomedogenic,” “nonacnegenic” and oil-free cosmetics, toiletries and sunscreens.
  • Avoid astringents, toners and exfoliants, which may unnecessarily dry the skin.
  • To prevent scars, do not pop, squeeze or pick at acne.
  • To reduce the risk of scarring, seek treatment early for severe acne that does not respond to over-the-counter medications.

Acne treatment

  • There are many effective acne treatments available. Your dermatologist can determine which treatments are best for you.
  • Use the medications and products prescribed for your acne as directed, and allow enough time for them to take effect, which could be four to eight weeks.
  • Resolution of acne takes time. There are no “overnight” or “immediate” cures. When the skin clears, treatment should continue in order to prevent new breakouts. Your dermatologist can tell you when to stop treatment.
  • Topical therapy is a standard of care for mild acne. Some common topical medications include benzoyl peroxide, antibiotics, retinoids and salicylic acid.2, 5
  • Oral antibiotics are a standard of care in the management of moderate and severe acne, as well as acne that is resistant to topical therapy or covers a large body surface area.2, 5
  • Due to increasing bacterial resistance, it is best not to treat less severe forms of acne with oral antibiotics. If possible, the duration of antibiotic therapy should be limited.2
  • Some antibiotic therapies for acne include tetracycline, doxycycline, minocycline, erythromycin, trimethoprim-sulfamethoxazole, trimethoprim and azithromycin.2, 4-5
  • Combination therapies using oral antibiotics and topical retinoids have been found to be effective in managing acne.2, 7
  • Some women find that oral contraceptives containing estrogen may help clear their acne if other treatments do not work. Other medications, such as spironolactone, that modify the skin’s response to male hormones also may be helpful.
  • Oral isotretinoin is the only medication approved for severe cystic acne, the most serious form of this skin disease.
  • Isotretinoin has been used as a course of treatment for acne for more than 25 years.2, 8 Acne will improve in about 85 percent of patients after one course of treatment (four to six months).
  • Mood disorders, depression, suicidal ideation and suicides have been reported in patients taking oral isotretinoin, but a causal relationship has not been established.2, 9-11 Many studies have indicated that treatment of acne with isotretinoin was accompanied by improvement of both depressive and anxiety symptoms, as well as improved quality of life in patients with acne.12-14
  • Isotretinion cannot be prescribed to a pregnant female patient, and women who can become pregnant must follow strict rules to prevent pregnancy. The risk of a baby developing severe birth defects is high, even in patients taking the medicine for a short time.
  • The Academy is committed to the safe and responsible use of isotretinoin and supports continuing education for physicians and patients to prevent fetal exposure and other potential hazards connected to the use of this medication.
  • For the Academy’s position statement on isotretinoin, visit the Academy website at www.aad.org/Forms/Policies/Uploads/PS/PS-Isotretinoin.pdf.
  • Prescribers, patients, pharmacies, drug wholesalers and manufacturers of isotretinoin in the U.S. are required to register with the Ipledge program. This program requires mandatory registration of all patients receiving this drug. Detailed information can be found on the iPLEDGE website at ipledgeprogram.com.
  • Current evidence is insufficient to prove either an association or a causal relationship between isotretinoin use and inflammatory bowel disease in the general population.12, 15-16 While some recent studies have suggested such a relationship,12, 17-18 further studies are required to conclusively determine if the association or causal relationship exists and/or whether IBD risk may be linked to the presence of severe acne itself.
  • Laser and light-based therapies continue to be researched for their effects on mild to moderate acne.19-20
  • Laser resurfacing, dermabrasion, chemical peels and skin fillers provide safe and effective treatments for acne scarring. Since acne scars are unique in their appearance and often have complex characteristics, patients should consult their dermatologist to determine an individualized treatment plan for the most successful result.

References 

1. Bickers DR, Lim HW, Margolis D, Weinstock MA, Goodman C, Faulkner E et al. The burden of skin diseases: 2004 a joint project of the American Academy of Dermatology Association and the Society for Investigative Dermatology.Journal of the American Academy of Dermatology 2006;55:490-500.

2. Strauss JS, Krowchuk DP, Leyden JJ, Lucky AW, Shalita AR, Siegfried EC et al. Guidelines of care for acne vulgaris management. Journal of the American Academy of Dermatology 2007;56:651-63.

3. Bhate K, Williams HC. Epidemiology of acne vulgaris. The British journal of dermatology 2013;168:474-85.

4. Katsambas A, Papakonstantinou A. Acne: systemic treatment. Clinics in dermatology 2004;22:412-8.

5. Bhate K, Williams HC. What’s new in acne? An analysis of systematic reviews published in 2011-2012. Clinical and experimental dermatology 2014;39:273-7; quiz 7-8.

6. Bowe WP, Joshi SS, Shalita AR. Diet and acne. Journal of the American Academy of Dermatology 2010;63:124-41.

7. Simonart T. Newer approaches to the treatment of acne vulgaris. American journal of clinical dermatology 2012;13:357-64.

8. Peck GL, Olsen TG, Butkus D, Pandya M, Arnaud-Battandier J, Gross EG et al. Isotretinoin versus placebo in the treatment of cystic acne. A randomized double-blind study. Journal of the American Academy of Dermatology1982;6:735-45.

9. Kaymak Y, Taner E, Taner Y. Comparison of depression, anxiety and life quality in acne vulgaris patients who were treated with either isotretinoin or topical agents. International journal of dermatology 2009;48:41-6.

10. Hahm BJ, Min SU, Yoon MY, Shin YW, Kim JS, Jung JY et al. Changes of psychiatric parameters and their relationships by oral isotretinoin in acne patients. The Journal of dermatology 2009;36:255-61.

11. Magin P, Pond D, Smith W. Isotretinoin, depression and suicide: a review of the evidence. The British journal of general practice: the journal of the Royal College of General Practitioners 2005;55:134-8.

12. Wolverton SE, Harper JC. Important controversies associated with isotretinoin therapy for acne. American journal of clinical dermatology 2013;14:71-6.

13. Yesilova Y, Bez Y, Ari M, Kaya MC, Alpak G. Effects of isotretinoin on obsessive compulsive symptoms, depression, and anxiety in patients with acne vulgaris. The Journal of dermatological treatment 2012;23:268-71.

14. Marron SE, Tomas-Aragones L, Boira S. Anxiety, depression, quality of life and patient satisfaction in acne patients treated with oral isotretinoin. Acta dermato-venereologica 2013;93:701-6.

15. Bernstein CN, Nugent Z, Longobardi T, Blanchard JF. Isotretinoin is not associated with inflammatory bowel disease: a population-based case-control study. The American journal of gastroenterology 2009;104:2774-8.

16. Crockett SD, Gulati A, Sandler RS, Kappelman MD. A causal association between isotretinoin and inflammatory bowel disease has yet to be established. The American journal of gastroenterology 2009;104:2387-93.

17. Crockett SD, Porter CQ, Martin CF, Sandler RS, Kappelman MD. Isotretinoin use and the risk of inflammatory bowel disease: a case-control study. The American journal of gastroenterology 2010;105:1986-93.

18. Reddy D, Siegel CA, Sands BE, Kane S. Possible association between isotretinoin and inflammatory bowel disease. The American journal of gastroenterology 2006;101:1569-73.

19. Hamilton FL, Car J, Lyons C, Car M, Layton A, Majeed A. Laser and other light therapies for the treatment of acne vulgaris: systematic review. The British journal of dermatology 2009;160:1273-85.

20. Momen S, Firas AN. Acne vulgaris and light-based therapies. J Cosmet Laser Ther 2015;17:122-28.