Acne is not just a teenage problem and may present in the late 20s through to the early 40s. This form of acne is more common in women and may be related to hormonal changes. Adult acne usually presents along the jawline and chin area. In severe cases acne lesions can be seen on the shoulders and trunk. Acne can range from a few pimples through to cysts & scars. Stress can be a contributing factor.
Acne treatment options:
Topical (cream based)
Creams include vitamin A/retinoids as well as topical antibiotics.
Pros: Little side effects limited to skin only.
Cons: Takes 8-10 weeks to work. Success in 60-70% of cases. Won’t solve hormonal or cystic acne.
Pros: Mostly side effect free. No screening test required. Can be combined with all other forms of acne medication for faster & more effective results, eg. lasers, peels & topical prescriptions.
Cons: Success in 70% of cases. Limited efficacy in hormonal acne. Acne may recur. Treatment course may be 4-16 months.
Anti-hormone medications (applies to females)
Pros: Relatively side effect free. No concerns with pregnancy (unlike Accutane). Very effective in hormonal acne cases. Can be combined with creams & anti-inflammatory meds for better and faster results.
Cons: Takes 2-3 months to kick in. Failure rate of 10-15%. Acne may recur after stopping.
Vitamin A/ isotretinoin
Pros: The most effective treatment for acne. It is by far the most cost effective way of addressing acne of all types, including hormonal, cystic, blackhead & picking acne. Accutane has the highest cure rate of over 65%.
Cons: Purging common. Side effects are common, but under your control. Monitoring (blood tests) with follow ups are mandatory whilst on this medication. Major side effects are rare. 30-40% of patients require a second course of this drug.
Lasers & LED/phototherapy
Pros: Treats acne, addresses scars. Little if no side effects. Fast way to clear red marks & post acne pigmentation.
Cons: Success in 70% of cases. Limited efficacy in hormonal acne. Will require 2-6 sessions over several weeks. Best as adjunctive therapy; namely combined with Accutane, topical medications & anti-hormonal tablets.
Pros: The fastest way to treat blackheads & mild to moderate acne. Little if no side effects.
Cons: Limited efficacy in hormonal acne. Best as adjunctive therapy; namely combined with Accutane, topical medications & anti-hormonal tablets.
Skin care & acne
Pros: Mostly side effect free with a small probability it will be effective for moderate to severe acne. Worth a try if you have very mild to mild non-scarring acne.
Cons: Most fluffy over the counter skin care products will not work. If you are inclined to try, you can start with a BHA wash & azelaic acid. You don’t need to see a dermatologist for this.
Diet can help reduce all forms of acne, including hormonal acne, cystic acne & other subtypes. It’s simple. Don’t eat processed foods, no sugar, no dairy products. You can not have cheat days. Ever. Unlike a caloric restricted diet, you can not make up for cheat days. I encourage all patients to be on a diet for better control & accelerated acne clearance.
If you are into supplements, take zinc sulfate. You can buy this in most pharmacies. Dosage as per directions. Zinc can be marginally helpful for some, but given how harmless it is, you can start on zinc supplements if you are inclined to lean towards natural supplements.
Simple, cheap, effective for picking acne. If you pick, I will suggest these patches. They cost approximately 20 to 30 cents each & can be purchased in most pharmacies. Do not get expensive ones, simple hydrocolloid patches will be fine. If your picking is significant, I will also refer you to a psychologist who will provide you with strategies to reduce picking. My counselling skills are limited.