Acne in Washington, DC
What Causes Acne?
Treatment for acne is generally tailored to the type of acne and the severity of the disease. Keeping in mind that both excessive oil and a type of bacteria are the cause of acne, most treatments aim to either lower the production of oil, reduce the amount of P. Acnes bacteria on the skin surface, and prevent the blockage of hair follicles that leads to comedones (whiteheads). A common first line therapy is a benzoyl peroxide wash. Benzoyl peroxide is an antibacterial wash with mild comedolytic ability (ability to break up the plugs that begin the process of comedone formation). Another first line, and the most effective topical acne agent, are retinoids. Topical retinoids such as Tretinoin (Retin-A) act to thin the top layer of skin, reducing comedone formation, and have a secondary effect of reducing oil gland activity. For patients with inflammatory acne (pustules and cysts), a short (~3 month) course of oral antibiotics such as Doxycycline or Minocyline may be prescribed. This allows the body to reduce acne burden from the inside out, after which topical agents like those described above are normally sufficient to keep acne under control.
Accutane has been used for over t thirty years and is a remarkably effective treatment for cases of severe nodulocystic acne resistant to normal treatments. This is a Vitamin A-like drug which has several effects, the most prominent of which is a nearly complete shutdown of oil production in the sebaceous glands, resulting in shrinking of the sebaceous glands during the treatment period which is somewhat permanent, effectively ‘resetting’ the acne producing potential of skin. A 5-6 month course of Accutane usually results in dramatic and long lasting clearing of acne. While there have been many articles warning of potential dangers of accutane, in our experience accutane is an incredibly safe and effective drug for severe acne, and when required is an excellent treatment to reduce the risk of scarring from severe nodulocystic acne in both adolescents and adults.
While acne is most common in the adolescent population, over 50% of people will suffer from acne at some period during adulthood. While adult acne is generally milder than adolescent acne, it can be distressing and embarrassing. Male adult acne is treated similarly to adolescent acne, and normally topical agents are sufficient to control male adult acne. In women, adult acne is often cyclical and related to hormone surges around menstruation. Women with adult cyclical acne can benefit from both oral contraceptive pills, which regulate hormone production, as well as the prescription drug spironolactone, a mild diuretic pill which also has the effect of binding excess sex hormones, smoothing out the peaks and valleys of hormone production related to a woman’s menstrual cycle.