Acne Vulgaris or Common Acne is a multifactorial disease of the pilosebaceous unit. The pilosebaceous unit consists of the hair shaft, the hair follicle, and sebaceous gland, which makes sebum, and the erector pili muscle which causes the hair to stand up when it contracts. Androgens increase sebum production. Dihydrotestosterone (DHT) is the primary hormone. In acne patients, DHT can be 30 times more active. Bacteria and fungi are a normal part of the sebaceous gland. The major bacteria is Propionibacterium Acne (P.Acne), which are in large numbers in the acne patient compared to non-acne patients. Sebaceous glands also tend to be larger in the acne patient. All of these factors can be inherited.  

Other supporting causes of acne may include:

  1. Rising hormone levels during puberty.
  2. Hormone level changes during the menstrual cycle in women.
  3. Certain drugs such as corticosteroids, lithium, and barbiturates.
  4. Oil and grease from the scalp, mineral or cooking oil, and certain cosmetics.
  5. Friction or pressure from helmets, backpacks, or tight collars.
  6. Environmental conditions such as pollution or humid conditions.
  7. Acne can be aggravated by squeezing the pimples or by scrubbing the skin too hard.
  8. A high carbohydrate diet.

Acne affects all age groups, not just teenagers. 85% for people 12 -24 years of age experience it. 3% of men have acne until age 44. 12% of women have acne until age 44. 

Acne starts with a trapped follicle. Abnormal keratinization in the epidermis causes a blockage, microcomedone. There is Increased sebum production with cohesion in the proximal gland. Sebum flow is maintained but the quantity increases which develops a bottleneck. This oil stagnation sets up the possibility of infection in the form of an intrafollicular abscess.  

Inflammatory acne occurs when P. Acne converts sebum into free fatty acids which produces inflammatory mediators. Secondary inflammation can also occur via picking, use of harsh topical agents (Dial Soap), sports equipment irritation (helmets, uniforms), and other activities which spreads sebum through the dermis. 

There is no cure for acne, but control is possible. Treatments can go on indefinitely or over time. However, there is no time table as to when patients will see results. There is no ONE treatment for acne. Acne is multifactorial and the treatment should be as well. Therapy has to be individualized. The general plan must treat three things:

  1. Reduce sebum production.
  2. Reduce bacterial load/inflammation. This can be achieved with antibiotics, red/blue light therapy, and topical. By reducing bacterial load, inflammation will be reduced. Certain topical can also calm and reduce inflammation.
  3. Normalize skin exfoliation to open pours, thin the epidermal layer, and allow for drainage of sebum, and allow for topical medications to penetrate.

Control and maintenance requires a 4 step skin care regimen: cleanse, tone, exfoliate, and protect the skin. By using a gentle cleanser, there is less likelihood of blocking the pores of the skin without causing irritation. Using a toner, will restore proper pH balance to the skin's surface while removing superficial oils that may clog pores. Exfoliation, as mentioned previously, will open pours, thin the epidermal layer, and allow drainage of sebum. The skin should be protected by a hypoallergenic moisturizer with at least an SPF of 30. Most cosmeceutical companies carry a skin care line specific to acne and/or oily skin. Simple steps and a quality skin care line can give clearance to some degree to acne patients. 

Our clinic offers Medical Grade Chemical Peels to exfoliate and treat the pathology in the epidermis down to the very superficial dermis. A series of peels can penetrate deeper into the papillary dermis. Chemical peeling has the added benefit of reducing fine lines and creating softer, smoother skin by promoting collagen remodeling. These peels work very well with adult acne. They can also eliminate pigmented lesions. We carry two different Alpha-Hydroxy Acids (AHA), Glycolic and Lactic, and one Beta-Hydroxy Acid (BHA), Salicylic Acid. The selection and concentration of the chemical peel is based on skin type and acne presentation. The first chemical peel will be a milder concentration Subsequent peels will be at higher concentrations and based on the results from prior sessions.