Acne affects all ages and can be treated

The following is an MSR interview with Dr. Charles Crutchfield (CC) on acne, a topic of interest to many of our readers.

MSR: Are teens the only ones who deal with acne?

CC: Absolutely not. I see patients in their teens, 20s, 30s, even 40s and 50s who have to deal with acne. The majority of acne occurs in the teenage years, and that’s why it’s thought of as a teen disease; however, patients of all ages can deal with acne.

MSR: So adults can have it too? If so, does it differ from teen acne?

CC: Yes and no. Adults certainly can have acne, and the term for teenage acne is “acne vulgaris.” Once again, as I mentioned, acne vulgaris can be in the teens, 20s, 30s, 40s, even 50s.

However, the majority of adults can also get a second form of an acne-like eruption called acne rosacea, also known as adult-onset acne. It’s slightly different from teenage acne, because it deals with inflammation and bumps in the skin and is modulated by hormones, but the exact nature is poorly understood.

Fortunately, both teenage acne and adult-onset acne are treated in similar manners with good results.

MSR: What is the cause of acne?

CC: Acne is a disorder of the oil glands and pores in the skin. Oil glands become active under the influence of hormones, and most hormones start changing in the teenage years — that’s why acne is considered a teenage disorder or comes on with adolescence.

The oil glands become active and produce excess oil. Often the pores become plugged and the oil is trapped in the skin. Then, when the oil is retained in the skin, bacteria come in and eat the oil, and when bacteria are present, they cause extreme inflammation.

This description is the whole process of acne. Hormones influence oil glands, and they produce too much oil; bacteria come, and inflammation ensues. With inflammation, some of the cells that are trying to kill the bacteria die, and when these types of immune cells die, they become pus. That’s why acne has pustules.

MSR: How should teens and adults treat it? Is it treated the same for both?

CC: It’s treated slightly differently; however, all treatments for acne tend to be effective in both teenage and adult-onset acne. One of the fundamental treatments for teenage acne is an over-the-counter medicine called benzoyl peroxide, which is also the active ingredient in the common medicine called Proactiv.

Additionally, medicines that are even more effective are available, such as prescription-strength benzoyl peroxide and topical vitamin A derivatives called retinols. Retinols are the mainstay of prescription treatments for acne.

Medicines such as topical antibiotics and other topical anti-inflammatories can also be used. Finally, oral medications such as oral antibiotics, which are used to treat inflammation and not necessarily kill bacteria, and oral vitamin A products such as isotretinoin, known as Accutane, can be used to treat acne.

In adults, oral antibiotics are used with topical anti-inflammatories such as metronidazole creams, which tend to be very effective.

MSR: What are some tips for preventing acne?

CC: Acne is a genetic disorder driven by hormones. As long as you’re not going to go through adolescence, you shouldn’t have acne. Unfortunately, it’s difficult for all of us to do that, so the most important tip is that, if you do have acne, treat it.

There are good treatments available, and it’s best to start using those early so the acne doesn’t get out of control. Use over-the-counter preparations first, and if that works, terrific. If it doesn’t, see a board-certified dermatologist for additional prescription-strength anti-acne treatments both for teenage acne and adult acne. There are excellent treatments for both forms.

MSR: Is it true that acne is forever? Must you find ways to deal with and treat it?

CC: This is an interesting question. The severity of acne is very relative. I have some patients who will have one blemish and call me at three o’clock in the morning panicking. I have other patients that might have 30 or 40 blemishes who come into my office, and they are not concerned about acne at all, but they want me to check a mole on their leg.

So the key with acne is, it’s not necessarily forever. Most people will outgrow it, but how long that may take is unpredictable. The majority do outgrow it in their teens and 20s; however, it can last into the 30s and 40s and sometimes is lifelong.

The key is, if it bothers you, you certainly can treat it, and there are great treatments available.

MSR: As one ages, is there a time when acne completely disappears?

CC: For the most part, yes. However, I still have patients in their 50s and 60s (or even later) who are dealing with adult-onset acne. But in general, as time goes on it becomes less severe. Unfortunately, people don’t want to wait 10 or 20 or 30 years for acne to disappear — they want it gone yesterday.

MSR: Anything else you would like to add?

CC: Certainly the take-home point here is that in this day and age there are many excellent treatments for acne. Both over-the-counter products, acne chemical peels, laser acne treatments and prescription-strength products can do a fantastic job.

The key is, if you have acne and it bothers you, you don’t have to live with it. See a board-certified dermatologist to design a customized program to effective treat your acne.

For additional pictures and information on acne treatments, visit www.crutchfielddermatology.com.

Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.