Adult Acne
Causes
Acne begins with skin oil and dead skin cells that plug the skin pore.
Bacteria can become trapped in the plug.
The body’s immune system can react to the entrapped bacteria, resulting in an inflamed pimple.
Symptoms
Acne lesion appears in areas of skin with the most oil glands (face, forehead, chest, upper back and shoulders).
One or more types of active lesions can be present:
Whiteheads are non-inflamed whitish plugs
Blackheads are non-inflamed plugs that turn dark when exposed to air
Papulopustular acne are inflamed raised areas of skin that may contain pus
Nodular acne are inflamed, often painful, deep lesions
Sometimes, there may be temporary or permanent changes to the skin, after the acne disappears:
Hyperpigmentation, or skin darkening of the affected area, typically goes away on its own but a darkened patch may persist for several months or longer without treatment.
Scarring can occur with inflammatory acne.
Diagnosis
In addition to a skin exam, your doctor may ask questions to help identify triggers or conditions associated with acne flares such as:
Medication history
Menstrual history (if applicable)
Medical history
Family history
Skin care regiment
Current and prior treatments and response
Management
Home Skin Care:
Apply gentle cleanser with fingers, and rinse with warm (not hot) water twice daily.
Be gentle. Aggressive skin scrubbing can make inflammatory acne worse and promote new pimple development.
Use water-based or non-comedogenic lotions, cosmetics, and hair products.
Fight the urge: Popping and picking pimples can make scarring worse.
Over the Counter Medications:
Benzoyl peroxide- has antibacterial properties and helps prevent plug formation. Skin irritation can occur with higher concentrations.
Salicylic acid- helps dissolve dead skin cells and has mild anti-inflammatory properties. Can also cause skin irritation with increased frequency of use.
Sulfur- uncertain mechanism of action but has been used for acne treatment for years, often in combination with benzoyl peroxide or salicylic acid.
Tea tree oil- has antibacterial and anti-inflammatory properties but a slower onset of action compared to benzoyl peroxide
Prescription Only
Azelaic acid- has antibacterial, and mild anti-inflammatory properties. May also prevent plug formation.
Retinoids- helps break up blackheads and whiteheads and prevent plug formation. Can cause skin irritation and increase skin’s sun sensitivity.
Dapsone- topical gel has antibacterial properties and can be used for inflamed acne
Antibiotics- limited, short term use of antibiotics such as tetracycline typically reserved for moderate to severe inflammatory acne that is resistant to topical treatment. Antibiotic resistance is increasing in patients with acne. The antibiotics are often combined with benzoyl peroxide to reduce the likelihood of developing antibiotic resistance.
Birth control pills- may be considered for use in acne made worse or caused by hormonal changes during the menstrual cycle
References
https://www.uptodate.com/contents/treatment-of-acne-vulgaris
https://www.dynamed.com/condition/acne
Habif TP. Acne, rosacea, and related disorders. In: Habif TP, ed. Clinical Dermatology. 6th ed. St Louis, MO: Elsevier Saunders; 2016:chap 7.