When it comes to treating acne, much has advanced medical practice, but patients are still prescribed patience as part of any treatment regimen, according to a nationally recognized expert on the skin condition that affects millions of teenagers in the U.S. each year.
Seth J. Orlow, MD, PhD, serves as the Samuel Weinberg Professor of Pediatric Dermatology and Chairman of the Ronald O. Perelman Department of Dermatology at NYU Langone Medical Center, one of the largest academic programs of its kind in the country. He has been treating adolescent acne for over 25 years, and although more is known about the skin condition than when he first entered medical practice, and more medications are readily available or in development, “it is still an illness that takes time to treat in order to achieve maximal results,” Dr. Orlow says.
That is why patient compliance with treatment regimens remains one of the greatest challenges dermatologists face. Too often, Dr. Orlow notes, they become frustrated with slow progress and, as a result, lose interest in following recommendations. “If someone is seeing a dermatologist for acne, it is often a teenager or young adult with a moderate to severe case that can’t be managed with over-the-counter (OTC) medications, so they are going to be tougher cases to treat,” Dr. Orlow says. “Couple that with social stigma that these patients deal with, and you understand their frustrations when treatment doesn’t offer immediate results. But compliance remains the key to success.”
Another major challenge to dermatologists is debunking certain myths that are still prevalent among adolescent patients and their parents as to the cause of acne, particularly its relationship to cleanliness and diet.
“Adolescent acne is a skin condition of puberty, when the body is producing increased levels of hormones called androgens, which, in turn, cause increased production of increased oily sebum and increased blockage of the oil glands, facilitating the growth of acne bacteria,” Dr. Orlow explains. “When excess oil, sticky skin cells and bacteria become trapped, it creates acne inflammation. Some individuals are more susceptible to this problem, and that is why some have worse acne than others. But acne is not caused by a lack of cleanliness, or a lack of cleansing your face.
“You can’t heal acne by scrubbing it away,” he adds. “In fact, excessive face-washing can exacerbate acne.”
And what about diet? “Simply stated, there is no concrete research indisputably linking diet and acne,” Dr. Orlow says. He points out that some recent studies have shown a possible link between diet and the severity of acne outbreaks.
In treating acne, the focus — just as it was decades ago — is on three key factors: preventing dead skin cells from blocking the oil glands, reducing excessive oil production and reducing acne-causing bacteria. Most of the current OTC acne medications address skin cell shedding and the acne bacteria, but only a few oral prescription medicines attack the excessive oil production. “Some cases of acne can be managed very effectively with OTC products,” Dr. Orlow says. “But others require stronger levels of certain medications that only can be prescribed by a dermatologist.”
If you are going to take the initial step of treating an acne outbreak with an OTC product, Dr. Orlow suggests something that contains benzoyl peroxide, which helps prevent the formation of acne pimples and/or salicylic acid which helps open up clogged pores. In addition, physicians can prescribe topical retinoids that help normalize the shedding and stickiness of skin cells in the glands.
While the use of light-based devices remains a subject of debate, Dr. Orlow points out that some patients seem to benefit from certain types of blue or red light treatments. However, more moderate to severe cases of acne often benefit from the addition of certain oral antibiotics, which can only be prescribed by a physician. “Antibiotics are reserved for more difficult cases of inflamed acne,” Dr. Orlow warns. “They have proven effective in combating acne by reducing extremely high levels of acne-causing bacteria, and have other inflammation-dampening effects.”
For female patients, specific treatments that block the production or effects of androgens may be prescribed. And for some patients, particularly those with the most severe nodular and cystic acne, medications such as oral isotretinoin may be recommended — although the use of isotretinoin is tightly controlled by the U.S. Food and Drug Administration since it can cause birth defects if a woman becomes pregnant while taking the medication.
With the right treatment protocol, acne can be effectively managed in most patients, albeit a cure remains elusive for most. And while treatment is under way, Dr. Orlow offers another pointer. “I fervently encourage all of my acne patients not to pick at their lesions,” he said. “We want to avoid scarring, not foster it.”