Dr. Crutchfield asks that we rerun this column from our March 21 issue as his favorite of the year.Watch for continuing “Advice” columns on these pages and on the MSR website in 2014.
Question: Dr. Crutchfield, my daughter has acne. Won’t she just outgrow it, or should we treat it?
Why should anyone care about treating acne?
Acne is a very common skin condition that affects over 90 percent of people in their lives. At a time when adolescents are developing a strong sense of self, self-worth, value and identity, acne not only contributes to low self-esteem, but can also cause long-term and permanent scars on the skin. If it bothers the patient, it should be treated.
Acne patients before (l) and after treatment
Photos courtesy of Dr. Crutchfield
Acne is a disorder of the pores and oil glands in our skin located most notably on our face, chest and upper back. All of the pores have a small oil gland attached to them at their bottom. When pores become plugged, the natural skin oil has nowhere to go and thus forms a bump in the skin.
We also have normal, natural bacteria that live on our skin that are attracted to the oil as a food source. These types of bacteria can also cause inflammation in the skin. Acne is a condition that manifests as red, tainted papules and pustules in the skin, especially on the face, chest and back.
Acne is genetically determined. It can run in families. The oil glands in the skin become activated by hormones. Concurrently, this is around the same time hormones start changing during adolescence, and this is when we first start to see acne.
Unfortunately, acne doesn’t disappear when we leave our teens. I treat many patients into their 20s, 30s and beyond with acne.
How is acne treated?
Acne can be treated by unplugging the pores, reducing inflammation, reducing bacteria, or decreasing oil production. Topical preparations like chemical peels or salicylic acid will unplug follicles. Other topical antibiotic solutions will decrease bacteria, and certain acne creams can reduce inflammation. Other medications and lasers can decrease oil production.
One of the best-kept secrets when it comes to treating acne is that the vast majority of acne treatments are designed to improve acne, but very few treatments are designed to clear acne up completely. This is one of the biggest concerns my patients express to me: They are using medicine to treat acne, and while they say their condition is better, they still have acne.
Unfortunately, that is what the medicines are designed to do. Medications make the condition better compared to not using any type of treatment; however, medication alone will not necessarily make acne 100 percent clear.
Three basic treatment
Traditional suppressive approach: These are medicines that have been used for decades and are very good at suppressing acne. As I mentioned previously, these medicines will make the condition improve compared to not taking any medication; however, it will not necessarily make acne 100 percent clear.
Unfortunately, some of these medications will stop working after a few months and we have to use a different group of medications to suppress the acne. The goal of the traditional suppressive approach is to make the condition better until one outgrows it. Thus, with the traditional suppressive approach, we use medications to improve things until one outgrows acne.
The second approach is to use a treatment program that will clear up acne for a while. It puts acne into remission and can be a series of laser treatments, phototherapy treatments, or chemical peels.
The third approach is to use an oral vitamin A derivative that is strong and most effective, but has considerable side effects and should be considered with a dermatologist.
for people of color
When acne resolves in treating patients of color, patients can have dark spots in the skin. It is important to discuss with your doctor that you want to treat both acne as well as the dark spots that it causes. There are several types of lightening agents to fade away dark spots; however, the treatment of dark spots can be very challenging.
Treat acne as soon as you notice it. There are many topical over-the-counter preparations that your pharmacist can recommend. Use a very gentle, non-abrasive, non-harsh cleanser and moisturizer.
If you still encounter problems after using over-the-counter preparations recommended by your pharmacist, then it is time to see a board-certified dermatologist. Treating acne appropriately and early can prevent low self-esteem, discomfort and lifetime scarring.
Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine and one of the top 21 African-American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.