Hammerling: Got acne? This might be why

Acne is a common skin disease that affects the oil glands of the skin, especially in teens.

Approximately 50 million people in the United States have acne, including 85 percent of teenagers. In adult women, its prevalent in about 10 percent of the population.

However, significant physical and psychological issues can result from acne that wasn’t treated early or aggressively enough, such as permanent scarring, poor self-image, depression and anxiety.

In general, patients can have:

• Noninflammatory acne, characterized by the presence of whiteheads or blackheads.

• Inflammatory acne, characterized by red bumps, aka pimples.

In the majority of cases, individuals exhibit both types of acne. Acne typically occurs in the facial area, chest and back, where the oil glands are the most prominent.

Some factors that may contribute or worsen acne include: Oil-based cosmetic use; stress; humidity or exposure to dirt; premenstrual changes or hormonal changes; irritation from occlusive clothing, headbands, hats, helmets, etc.; medications, such as phenytoin, isoniazid, phenobarbital, lithium, quinine, rifampin and steroids.

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Hormone work up

The role of hormones with the cause of acne is well known, but endocrine evaluation is warranted in some cases, because most patients will have normal hormone levels.

Indications for hormone work up in acne patients include patients with persistent acne unresponsive to conventional treatment, body odor, axillary or pubic hair, accelerated growth, advanced bone age and genital maturation.

In adult females, signs such as infrequent menses, hair loss or excess hair growth, infertility, polycystic ovaries, and obesity warrant further hormonal testing.

Recalcitrant acne caused by androgen excess can be present in both males and females with congenital adrenal hyperplasia. The most common cause of acne in women with elevated hormones from the ovary origin is polycystic ovarian syndrome.

Hormonal testing can be complex with ordering labs such as : Free and total testosterone, (DHEA-S), LH, FSH, Growth hormone, insulin-like growth factor, lipid levels, insulin, prolactin, estrogen, and progesterone. Some of these levels may be abnormal in those with severe acne.

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Acne treatment

In general, the purpose of treatment is to prevent or minimize breakouts and to prevent scarring.

The treatment selected by the provider is dependent upon the type and severity of acne.

Some over-the-counter treatments include products that include Benzoyl peroxide, Salicylic acid or sulfur.

In some cases, your doctor may suggest a combination of treatments including oral antibiotics, birth control pills, Accutane or Spirinolactone.

Since some medications should not be used during pregnancy, it’s important to inform your doctor if you’re pregnant, breast-feeding or planning to become pregnant.

For those patients who have old acne scars, there are a variety of treatment options to minimize the appearance of acne scars such as chemical peels, micro needling or Fraxel laser.

Microneedling is a minimally invasive treatment that can help improve the appearance of skin that has been scarred. It works by stimulating collagen production which can improve the appearance of skin texture and firmness.

Microneedling helps the appearance of acne scarring, stretch marks, enlarged pores, hyper pigmentation or even wrinkling. Usually the patient can see improvement in two to three sessions spaced a month apart.

Fraxel Laser treatment is a more aggressive treatment to improve acne scars by promoting tissue contraction and skin tightening. Patients can continue to have improvement for up to six months after the treatments.

Susan R. Hammerling, PA, MPAS, DFAAPA, works at Florida Dermatology Associates of Suntree.