Tuesday, July 25 2017 4:09

Acne: It’s Not Just For Teens

Written by Dr. Noushin Heidary, Bryn Mawr Skin & Cancer Institute

About 60 million Americans have active acne, including 85 percent of those between 12 and 24

Acne (or acne vulgaris, the even more unattractive medical term) is such a common skin disease that it’s often considered a natural part of life. At some point in their lives, most people have dealt with occasional blemishes, while others have suffered with severe acne that results in deep-seated cysts or even scars. Though hard to quantify, it’s easy to see the impact on the quality of life and the psychological distress that acne can cause, especially, though not limited to, teens.

First Line Treatments

Fortunately, there’s an ever-growing arsenal of treatments to combat this inflammatory skin disease and its consequences.

A good place to start for treating mild acne is over the counter products—such as cleansers or pads containing benzoyl peroxide or salicylic acids. If OTC medications don’t help, then a visit to your dermatologist may be next. Your dermatologist may prescribe topical antibiotics—such as clindamycin combined with benzoyl peroxide—which may help reduce the severity of acne.

Another important treatment is vitamin A-derived products called retinoids, which unclog pores and exfoliate skin cells. Although most retinoid creams are by prescription, differin gel (adapalene 0.1% gel) was approved by the FDA for over the counter treatment of acne.

If topical treatments don’t help, then systemic treatments—oral antibiotics such as doxycycline and minocycline—are the next step. Cysts and pimples can be dramatically reduced with oral antibiotics, but long-term use can cause complications including antibiotic resistance and changes in gut flora.

For the most severe acne cases, isotretinoin (Accutane) is an excellent option, but with some significant potential complications, including depression and severe birth defects if taken while a woman is pregnant.

Some teens and women suffer from hormonal acne, or acne that typically gets worse around menses and typically affects the jawline and chin. These patients have increased sensitivity to circulating hormones, like testosterone, that cause oil glands to go into hyper-drive.

While oral contraceptives can be helpful for hormonal acne, another option that’s gaining popularity is the high blood pressure medication spironolactone. Spironolactone blocks the effects of circulating hormones on oil glands and has been a game-changer for many women who haven’t responded to other treatments.

Alternative Treatments, Diet and Self Help

Conventional acne treatments don’t work for everyone. And because alternative treatments don’t need to be tested before being sold in the U.S., be sure to discuss them with your doctor before trying any.

One alternative treatment that’s recently gained attention is tea tree oil. This pleasant-smelling essential oil comes from the leaves of a tree native to Australia and has been shown to have antibacterial and cosmetic properties. The ingredient that’s largely responsible for acne benefits is terpinen 4-op, a potent antioxidant. Tea tree oil can be a short-term solution for mild acne and has similar efficacy to benzoyl peroxide.

For years, dermatologists dismissed the idea that diet is linked to acne. But several studies suggest that foods high in glycemic index—carbohydrate-rich foods like white bread, chips, white potatoes—can actually trigger acne. Dairy has also been weakly associated with acne, with the strongest association being skim milk. Because high glycemic carbs, along with dairy, saturated fats and trans fats are common in Western diets, a change to low glycemic carbs, high antioxidants, limited dairy, and omega-3 supplements may help improve acne.

And finally, it’s best to avoid scrubbing the face and exfoliating frequently. This can lead to excessive dryness and increased oil production. Instead, wash your face twice a day with a gentle cleanser and lightly exfoliate once or twice a week. And always choose moisturizers and make-up that are non-comedogenic (won’t clog pores).

In-office Procedures

Similar to the range of medications, procedures available from your dermatologist continue to evolve. From special acne facials to lasers, new treatments offer help.

A variety of chemical peels can treat acne and acne scarring, including the most common options—alpha-hydroxy acids (glycolic acid), beta-hydroxy acids (salicylic acid) and retinoid (tretinonin). Chemical peels work by reducing inflammation, exfoliating the skin, and reducing bacteria on the skin and do so with very little downtime.

Microdermabrasion is a non-chemical, non-invasive procedure that removes the outermost, dead layer of skin. It typically helps with mild acne resulting from clogged pores.

Photodynamic Therapy (PDT) is an especially effective in-office, “power-level” treatment. PDT controls resistant, hard-to-treat active acne by combining light and a special light-activated solution that targets and destroys acne. PDT, which also diminishes older acne scars and leaves your skin smoother, is thought to work by shrinking the skin’s oil glands and killing bacteria that cause breakouts. These treatments show great promise in treating acne, especially pimples and cysts.

The newest drugstore solution to acne uses light-based therapy. Neutrogena Light Therapy Acne Mask emits a fluoro pink glow—a combination of red light (to reduce inflammation) and blue light (to reduce bacteria on the skin’s surface) for a two-pronged attack on acne. Although not as strong as the lights used in dermatologist offices, it allows patients to use light-based therapy at home to help with mild and moderate acne.

Isolaz is a breakthrough technology that safely treats and prevents acne by extracting pores, killing bacteria, and purifying the skin from the inside out. First, a vacuum device is used to loosen and extract dirt, blackheads, dead cells and excess oil from deep within pores. Next, a broadband laser, or intense pulsed light, kills acne-causing bacteria from within and heals the surface layer of the skin. Isolaz laser is ideal for women in their 40s and older with acne who are also looking for a wrinkle-reducing and skin-smoothing treatment.

Treating Acne Scars

A primary goal of acne treatment is to prevent scarring. Unfortunately, acne scars can be stubborn, and no single treatment is best for everyone. The good news is that several methods may help improve your complexion and minimize the scars’ appearance.

One of the best ways to treat acne scars is with the fractionated CO2 laser and the fraxel laser. These resurfacing lasers stimulate the body’s own collagen to reduce signs of acne scars.

A new and promising treatment for acne scars uses a technology called MFR or micro needling fractional radiofrequency. This technique uses tiny gold-plated microneedles to deliver radiofrequency energy and heat to targeted layers within the skin and break down the scars deep under the skin. Once the layers of the skin have been heated, collagen stimulation and tightening begins. After a series of treatments, the skin should look smoother, tighter and more youthful.


Dermatologists have a wide array of treatment options available. Just as acne is not one-size-fits-all, acne treatment is not either. A dermatologist can tell you about different treatment options and devise a customized plan to get rid of acne and help with acne scars.

Here’s to better skin!

Noushin Heidary, M.D., specializes in medical dermatology, dermatologic surgery and cosmetic procedures. She’s a graduate of Harriton High School, Princeton University and New York University School of Medicine. A fellow of the American Academy of Dermatology, Dr. Heidary is known for her compassion and warm bedside manner and was named a “Top Doc in NJ” and won a Patients’ Choice Award.