Acne control is Possible, Doctor Says

Teenagers have always been plagued with acne and, unfortunately, there doesn‘t seem to be an end to it yet. There are, however, pretty good ways at keeping those pimples under control.

“We can usually get things under fairly good control where the patients are pretty happy,” said Provena Saint Joseph Medical Center dermatologist Dr. Anil Singal.

“Acne is actually just a case of pimples”, Singal explained.  “When teenagers approach puberty,” he said, “they get a surge of hormones. It’s the androgens, like testosterone, that produce more oil in the skin.”

All that extra oil can sometimes become trapped inside the hair follicle, along with some skin cells that don’t slough off properly. That combination, along with bacteria normally found on skin, can cause the hair follicles to become plugged and inflamed.

That, Singal said, is what a pimple is.

Inevitable irritants

The amount of oil production and tendency for skin cells to hang around when they should have been sloughed off has a genetic component, he said. Keeping a clean face helps keep the pimples down, but Singal stressed that neither acne nor blackheads are caused by dirt or by poor hygiene. If you’re going to get it, he said, you’re going to get it whether you scrub your face all day or only wash it once a day.

In fact, scrubbing may actually make it worse, he said. it can be counterproductive by irritating the skin. Singal has many weapons against acne in his dermatological arsenal. Most of his patients have already tried over-the-counter products that didn’t work for them.

According to consumerreportshealth.org, over-the-counter products include creams and gels with benzoyl peroxide that work by killing bacteria, unblocking pores, and making skin less oily. it can be useful for several different types of acne, including blackheads, whiteheads, and red, inflamed pimples.

Creams and gels that contain retinoid also work by unblocking pores. Singal said the treatments he prescribes usually begin with a topical antibiotic cream or gel, which works by both killing bacteria and reducing inflammation. He might combine that with a topical retinoid for the best overall response.

“If we need a more aggressive treatment and need to shut it down right away,” he said, “I might add oral antibiotics.”

No two patients respond the same to the various treatments, Singal said, and more than one method might be tried. Patients should give each treatment 4 to 6 weeks, though, before making a decision about whether or not it’s working.

There are other treatments for acne, such as Accutane, or isotretinoin, but side effects can be extreme, and physicians usually consider it as a last resort. They might even make their patients sign a waiver that they will use two different types of birth control while they are on this medication because of the risk of serious birth defects should pregnancy occur during treatment.

There is another treatment for acne that’s relatively new, too. Singal said Dapsone gel is a prescription cream that shuts down the inflammation response in the skin. It’s a little more expensive, though, he said, since it’s new on the market.

Singal said those with acne should use a gentle cleanser to clean the face twice a day. Don’t use alcohol pads or toners or scrub the face, he said, as that can irritate the skin and dry it out.

And do not, he said, pick or squeeze pimples or blackheads. That pressure can cause them to break underneath the skin, become more inflamed, and even make a permanent scar.

The following are both over-the-cover and prescription methods for treating acne. Most take about eight weeks to work.

Benzoyl peroxide: a gel, cream, or face wash that helps kill bacteria, unblock pores, and make skin less oily. Side effects are dry, red, peeling skin, burning or tingling feeling in skin.

Retinoid creams or gels: Work by unblocking pores. Side effects are skin may look sunburned.

Antibiotic creams and gels: Kill bacteria that make pimples red and inflamed. does not help with white heads and blackheads.

Antibiotic pills: Reduce the number of red and inflamed pimples. Side effects are diarrhea, upset stomach, nausea, vomiting, permanent skin discoloration, liver damage.

Isotretinoin (Accutane) pills: Stops skin from producing as much oil. Can reduce the number of pimples or cure acne completely, but the side effects may be worse than benefits. Side effects are birth defects, very dry skin, nosebleeds, headaches, muscle or joint aches, blood in urine, anemia, hair loss, diarrhea, affects liver and cholesterol level, depression, aggressive behavior, suicide thoughts.

Hormone treatments: Birth control pills can help with acne, but they are not the first course of treatment most doctors recommend. Side effects are blood clots in deep veins.

Dapsone gel: this new medication works by shutting down the inflammation response in the skin. Side effects are hemolytic anemia.

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