Acne: Act Now
Adolescence – the reason I don’t need to be young again.
I’ve gladly grown out of many obsessions and predicaments: Having to read books that “inspire me”; home perms; Jimmy W., only the third most popular boy at Spackenkill High School; wanting to be the president; finding the perfect husband; being the perfect wife.
But I, along with many adults, never did outgrow the one bully that taunted our adolescence: acne.
F. Scott Fitzgerald said youth is “a form of chemical madness.” And acne is driven partially by an androgen-induced increase in oil production. Because both men and women make androgens, acne can pop out anytime with hormonal fluctuations caused by puberty, periods, menopause, medications and stress.
The American Academy of Dermatology (AAD) has the following recommendations for managing acne in adolescents and adults.
Treatments focus on reducing the bacterial count and oil production.
Benzoyl peroxide is our first BFF. It’s available over the counter and is relatively cheap. When combined with prescription antibiotics, it enhances their effectiveness by preventing the development of drug-resistant bacteria. For mild acne, it can be used alone or in combination with a retinoid.
Retinoids, our second BFF, are a vitamin A derivative. There are three topical forms (tretinoin, adapalene and tazarotene) and one pill form (isotretinoin). Retinoids are the “core” of acne treatment because they attack acne at all stages of development. Retinoids decrease oil production, and reduce new lesion formation and scarring. There are two common concerns with this treatment: skin dryness and cost.
The dryness can scald and cause skin to scale, peel and flake like a blanched tomato. Instead of using it daily, applying it every two to three days would help. Also, avoid sun – retinoid and many other acne medications sensitize skin to sun.
Cost can also be a downside to retinoid treatment. A 40-gram tube of tretinoin costs $70-$205 in the U.S., $29-$52 in Canada. Tazarotene is the most expensive. There are “slight differences” in tolerability and efficacy among the three. Isotretinoin (brand name Accutane) is reserved for severe acne. Because it causes fetal malformation, it can only be used under a doctor’s careful supervision.
Another effective option for women are oral contraceptive pills (OC) that contain estrogen. They reduce acne by reducing the level of androgen. The FDA has approved four OC formulations for the treatment of acne, but all estrogen-containing OC works.
Other than medications, what else can we do?
While the AAD doesn’t recommend any specific dietary changes, “emerging data” suggests reducing the consumption of starchy food (white bread, mashed potatoes, pretzels) may help acne.
Another important thing to remember: Don’t squeeze zits. A "hands off" approach can minimize much of the self-inflicted secondary swelling, infection and scarring.
Instead, ice the painful or swollen lesions. Immediately apply topical medication. Wash your face with gentle soap regularly. Treat the skin like a delicate silk surface not a hard-scrubbed surgical site.
Acne isn’t trivial: it can be downright devastating. By controlling acne, we’re halfway to finding a cure for adolescence.