Stephanie Gardner, MD
The first signs of mild acne could be the appearance of a few red bumps around your mouth or chin. Perhaps you're going through a stressful period at work or have other demands knocking at your door. This can't be acne, you think. Acne is what teenagers get.
There's a lingering myth that acne only affects the teenage crowd. In fact, acne is the most common skin condition in the country, affecting an estimated 40 to 50 million Americans, and can cause anxiety and stress regardless of severity.
Understanding acne and comparing acne treatment options can help you tackle the problem head-on and find a workable solution. While acne, commonly called acne vulgaris or acne rosacea, is not curable, it is treatable. Mild acne can be properly managed with the help of your dermatologist or doctor.
"A lot of patients are surprised to discover they have adult acne," says John E. Wolf Jr., MD, professor and chairman of the department of dermatology at Baylor College of Medicine in Houston. "The big myth is that acne is a childhood and teenage disease. Acne can be seen literally cradle to grave."
What does acne look like? The symptoms of adult acne can look vastly different than teenage acne. Take location, for instance. Instead of tiny bumps in the T-Zone, acne may be more likely to appear in the lower part of the face, especially around the mouth, jaw and neck.
Acne spots often appear in areas with the highest concentration of sebaceous glands, for example, the face, neck, upper back, and chest. Basically, pores become blocked, causing pimples, called papules and pustules, to form. Whiteheads (completely blocked pores) and blackheads (partially blocked pores) can trap a combination of oil, bacteria, and dead skin cells.
There may be itching, pigmentation, or dry skin associated with adult acne, says Patricia Farris, MD, a dermatologist in private practice in Metairie, La., and clinical associate professor in the department of dermatology at Tulane University School of Medicine in New Orleans.
There are a number of factors contributing to acne. For women, hormonal changes such as pregnancy and menopause can lead to breakouts. Stress may be a contributing factor, and acne can be triggered or aggravated by external factors, such as clothing or medications.
If you've noticed any symptoms of acne, the first step is to set up an appointment with your doctor or dermatologist. There are a variety of treatments available today so you don't have to rely on expensive cover-ups.
Typically, mild acne is treated with topical medications such as benzoyl peroxide, salicyclic acid, or azelaic acid. Topical antibiotics such as erythromycin, metronidazole, or clindamycin may be used to treat mild inflammatory acne. Your dermatologist may prescribe retinoids, such as Retin-A, Differin, or Tazorac, which are derived from vitamin A, that help unplug follicles and have anti-inflammatory properties.
Some research shows that for mild acne, combining a topical retinoid with an antimicrobial agent is more effective than using either agent alone.
Topical medications come in different forms, including gels, lotions, and creams. Talk to your dermatologist to determine which type will be the best fit for your skin. Individuals with dry or sensitive skin may be better served by creams and lotions, while those with oil-prone complexions may benefit from gels.
Most adult acne sufferers have dry skin, as opposed to oily-skinned teens, explains Farris, so creams and lotions can be less irritating than gels.
It's critical to the success of your treatment that you follow the prescribed instructions carefully. For example, you may only need to apply a pea-sized amount of your topical medication to your face. You should apply the topical treatment to the entire affected area, not only the lesions. Certain medications should only be applied at night.
Common procedures to improve the appearance of mild scars include microdermabrasion and chemical peels, which physically remold scars. As a byproduct, these can stimulate collagen secretion which can also improve scars. These procedures take away the surface dead skin cell layers, allowing your topical medications to penetrate more deeply and be more effective in treating acne.
You should set a realistic expectation for the time it takes to see improvements. Know that it takes approximately eight weeks for acne to develop, so therapy must be continued for at least this long for it to be effective.
"We don't have an easy cure for acne," says Wolf. "We can't give you a shot to make this go away in a couple of weeks. It's going to take time and cooperation."
It's important to discuss the time frame and management strategy with your doctor so that you can set realistic expectations as to when your acne should be under better control. Individuals respond differently to treatment, and it can take at least six weeks to see improvements. With retinoids, you usually see visible improvement after eight to 12 weeks of treatment.
The good news for individuals with mild acne is you don't have to live with it. Just keep in mind the following skin hygiene tips.
SOURCES:John E. Wolf Jr., MD, professor and chairman, department of dermatology, Baylor College of Medicine, Houston.Patricia Farris, MD, clinical associate professor, department of dermatology, Tulane University School of Medicine, New Orleans.Feldman, S. American Family Physician, 2004; vol 69: pp 2123-2130.Purdy, S. British Medical Journal, 2006; vol 333: pp 949-953.Katsambas, A. Clinics in Dermatology, 2004; vol 22: pp 439-444.
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