from the Fall 2007 issue
Acne is one of the most common skin diseases we see on all sides of our practice – medical, cosmetic and research. Approximately 80 percent of people experience it, most commonly during adolescence or young adulthood. Acne affects self-esteem and, if left untreated, can leave permanent scars. There are now a wide variety of conventional and innovative treatments we offer acne sufferers. So here is a primer on the causes of acne and what solutions are available today to fight it.
Even though all of us are aware that acne usually starts during the teen years, sometimes we tend to forget why that is. Acne is a hormonal disease; no hormones, no acne. The hormones set in motion a cascade of events that triggers the blackheads, whiteheads, and red bumps that everyone hates. Androgen hormones cause oil glands to produce more oil, causing plugged pores. Bacteria called Propionbacterium acnes (or P. acnes) proliferate in the plugged pores and cause inflamed red bumps and pustules.
Many effective acne treatments work by unclogging the plugged pores and killing the bacteria. Pore unclogging treatments include drugs such as Retin-A, Differin, and Tazorac, and in-office treatments such as micro and vibra dermabrasion and chemical peels. Bacteria-killing treatments include topical and oral antibacterial agents, such as benzoyl peroxide, clindamycin, tetracycline, minocycline, and doxycycline. Another way to inhibit or kill the bacteria that cause acne is to use laser and light sources, such as the CoolTouch®, Aurora™, blue light and the new Omnilux LED therapy (see related article). You can make the light treatments even more effective against acne by applying a drug called Levulan® prior to the light treatment. This is called photodynamic therapy.
If the treatments listed above aren’t effective in controlling the acne, we bring out the “big gun” – isotretinoin (brand names are Accutane®, Claravis™ and Sotret®). A five-month regimen with isotretinoin can dramatically clear up acne. However, because severe birth defects can occur if a woman becomes pregnant while taking isotretinoin, she must be on two methods of birth control and comply with strict monitoring requirements (called iPLEDGE). Although rare, isotretinoin can trigger depression in some patients. Because of these potential side effects, some patients prefer other treatment options.
But let’s take a step back for a moment. All of the treatments mentioned so far deal with the consequences of the hormones acting on the oil glands. What can be done to affect the hormones that are the root cause of the acne?
The hormones that cause acne come from three sources: 1) dairy products that contain hormones, 2) the adrenals (“stress” glands), and 3) the ovaries or testicles. The acne-causing hormones from these three sources are additive. If, when added together, they exceed an individual’s “acne threshold,” acne will result.
What can be done to address these sources of acne-causing hormones? The first thing to do is stop all dairy products – no exceptions – for 6 to 12 months and see what happens. This is a no-cost, “natural” approach. Because the acne-producing hormones come from multiple sources, not all patients who stop all dairy consumption improve 100 percent. For help in implementing the “No Milk Acne Diet,” visit the website at www.acnemilk.com.
To help reduce the acne-causing hormones released by the adrenal glands when you are under stress, there are a variety of stress-reduction techniques available such as exercise, music, art and meditation. One good starting place is Herbert Benson, M.D.’s book, The Relaxation Response.
The third major source of acne-causing hormones is the gonads (ovaries for women, testicles for men). In men, the option of suppressing their androgens is not available. Women have several options for controlling acne-causing hormones released by the ovaries. One of the best options is the birth control pill, Yaz®, which contains the androgen-blocker drospirenone. Yaz is FDA-approved to treat acne in addition to being approved for premenstrual dysphoric disorder (what was once called “PMS”). For post-menopausal women who still suffer from acne, drospirenone is available in combination with estradiol in a hormone replacement therapy called Angeliq®. If the drospirenone-containing oral contraceptives alone are not enough, another drug that can be added for extra androgen suppression is spironolactone.
We now have a wide array of treatments at our disposal to help you achieve the clear, acne-free skin you desire. We can try to get at the underlying root cause by addressing the hormonal issues that are fueling the flames of acne. We can also use traditional topicals, antibiotics, isotretinoin and laser or light therapies to stamp out the fire.
Start by making an appointment with one of our dermatologists so we can help guide you on your path to clear, beautiful skin. Call 713.850.0240 for an appointment.
I would like to acknowledge William Danby, M.D., for many of the ideas on the hormonal causes and treatment of acne. He has written and lectured extensively on this subject.
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