Acne can be a terrible affliction or a very minor problem. It can occur from the teenage years, and also as an adult. Acne can cause problems that will be present for life, leaving cosmetic issues that may be very hard to deal with. I want to discuss today the process of the problem and how to handle it.
First of all, what is the process behind the problem??? Acne usually starts in adolesence. It is a familial problem that manifests during hormonal changes. It can occur in all skin types and with different degrees of severity. 
Acne can lead to social problems that may last a lifetime. Hormonal increases in adolecense lead to changes in the output of oil in our skin, making it thicker. This leads to the pores becoming closed, and with bacteria in the skin using this "food" source, they multiply. The result is the inflamed cystic "comedones" that we call acne. In most instances, the blemishes are limited, resolve in a short period of time, are not severe, and, with the exception of slight embarassment, do no long term harm. In a minority of cases, the problem is severe, unremitting, and can lead to permanent skin changes. The changes that can occur are scarring, changes in skin pigmentation, and the resulting self confidence issues that remain.
What can be done about all of this then? Most manage by keeping the skin clean and using over the counter products that we see on television. For minor cases, this is enough. For more severe cases, these products are no match and the blemishes continue. At this point, hopefully, parents recognize the severity of the problem and will seek other help. That is where we can help.
The first step usually recommend is a change in basic skin care. We like cleansers that contain salicylic acid. The salicylic acid in the cleanser helps to liquify and remove the oil that is the root of the problem. We also recommend benzoyl peroxide solutions that will help reduce the bacterial load. The third thing I like for patients to do is start a retinol topical cream. Retinol also helps reduce oil, dry the skin, and compact the stratum corneum, the dead layer of skin cells. If need be, I will also start an oral antibiotic to decrease the bacteria and decrease the inflammatory response that the bacteria cause. Antibiotics are generally continued at a low dose as the inflammatory response is less while on them.
For most, these routines are effective in managing the acne. In others, these steps may not be enough. The next step I usually add is laser therapy. We use the Cutera system on a setting that will heat up the skin and kill the actively reproducing bacteria. There is no recovery time and these treatments can be repeated at 4-6 week intervals with no pain.
After this step, if no response is noticed, we have a decision to make. In some women we will add some other medications as hormone modulators such as birth control pills or spironolactone. If these do not give us results, we then must consider more powerful oral medications. The one that is the most effective is Accutane. Accutane is a medication that works very well. It is also capable of causing problems for some patients. Everyone has heard of a horror story related to Accutane but few hear of the great number of successes. The biggest problem a patient can encounter is conception while on the medication. I-pledge is a program that was instituted to educate patients taking the drug about how to avoid pregnancy and the birth defects that can occur. Secondly, headaches, brain swelling, depression to name a few are the other side effects than may be encountered while on Accutane. The biggest complaints I see are that of dry skin and cracked lips and these are very tolerable. In most instances the results far exceed expectations and over shadow the risks. The usual patient takes the medication for 6 months.
My personal philosopy is that the risks of Accutane, when given correctly, are very much worth it. I am often asked to try to treat patients with scarring and pigment changes resulting from severe cystic acne....this is VERY hard work and is usually only marginally successful. For that reason, I start off with the less problematic treatments and give them a fairly short trial...6-8 weeks. If there is no measurable result and the acne is severe, I usually will then suggest Accutane if the patient is a reliable person and can understand the risks.
Come see us today at Total Body Surgical Cosmetic Surgery if you need help....918-786-7780.