Although we know our inner beauty can shine no matter what our skin looks like, having acne or acne scars can be a heavy emotional burden. Dr. Michael Shapiro, a board-certified New York Dermatologist, explains how medical treatments can improve acne.
Epoch Times: There are different kinds of acne, are there significant differences people should know about?
Dr. Michael Shapiro: There are two major types of acne: pimples (red), and clogged pores, comedones, (the proverbial “white heads” and “black heads”).
The red pimples are inflammatory and/or infectious in origin and are treated with topical or oral antibiotics, while the clogged pores are best treated with retinoids (ie. Retin A, tazorac, etc). The latter medications normalize the extrusion [out flow] of oil out of the oil gland and along the hair follicle onto the skin.
Epoch Times: What causes acne? Is it genetic only or also diet/environment related?
Dr. Shapiro: Acne is a complex disease that is due to many factors. These include propionobacterium acnes (P. acnes) and the abnormal extrusion of oil from the sebaceous (oil glands) through the hair follicle onto the skin. Hormones such as those that spike during teenage years affect oil production and thus worsen acne. The connection between food and acne is controversial. We have all heard that chocolate or other foods make acne worse. There are some studies to suggest the fact that high glycemic-load diets make acne worse.
Another factor in acne that is undeniable is stress. Stressful life events (i.e. finals time for teenagers and college-age individuals) makes acne worse.
Epoch Times: Are there on misconceptions about treating acne?
Dr. Shapiro: One of the most common is that acne is due to dirt. I am often asked what soaps to use. I always answer by reminding the parent and patient that acne is not due to underwashing, but rather due to the factors above.
Soft, non-harsh, soaps such as Dove unscented, Purpose, Oil of Olay, and others, are best to use because they are not as drying on the skin. Another misconception is the value of scrubs. This also ties into the idea that acne is due to “dirt”. Acne actually gets worse with any kind of friction, including dermabrasion, scrubbing, constant contact with hands/cell phones/baseball hats, etc. So all of this should be avoided.
Epoch Times: Besides creams, are there other forms of treatment?
Dr. Shapiro: Alpha-hydroxy acid washes are helpful. Oral medications are also used. These include spironolactone, oral antibiotics, oral Accutane (a synthetic vitamin A derivative), and birth control pills. Some vitamin supplements are also recommended by some.
Epoch Times: How do birth control pills help acne? Is there risk of side-effects?
Dr. Shapiro: Birth control pills alter the estrogen and progesterone levels in the body. These hormones certainly impact many components of the acne disease spectrum, such as oil production, keratinization [formation of the outer layer of skin], etc.
Clearly there are women who flare with acne during menstruation, and for these women, birth control pills are a good option. Another option for women is spironolactone, which is an old-time blood pressure medication, which, if taken at low doses, improves and stabilizes acne.
Again, this is best for women with hormonally driven acne. Birth control pills may be associated with blood clots, and other issues, and are best prescribed under the guidance of a gynecologist.
Spironolactone has been used for decades for treatment of hormonally-driven acne. It may cause sexual malformations in male fetuses, and there are theoretical concerns about its association with breast cancer (and thus it is not recommended for older women or those who have a family history of breast cancer).
Epoch Times: How do acne creams work?
Dr. Shapiro: The topical antibiotics work by killing the bacteria that causes P. acnes.
The retinoids normalize oil extrusion through the hair follicule. This solves the problem of clogged pores, and also reduces the conditions that allow the P. acnes to survive in the skin.
Epoch Times: Oftentimes, medical acne creams can be harsh on the skin causing redness and sun sensitivity, what are some milder alternatives to these creams?
Dr. Shapiro: Differin or azeleic acid creams are milder versions of the retinoid creams. However, even the stronger forms, such as Retin A and tazorac, should be tolerated if used in small amounts. Other strategies include short contact, where the patient doesn’t put on the creams overnight but rather for just a few hours each night.
Also increasing the frequency and amount of moisturizing helps alleviate the drying/irritating nature of these products. Sun sensitivity is a real but modest factor in the use of these creams, and can be managed by diligent use of sunscreens.
Epoch Times: What can be done about acne scars?
Dr. Shapiro: These are treated surgically (with a procedure called subcision), by dermabrasion (i.e. sanding), chemical peels, and a variety of lasers.
Epoch Times: Do you find different people’s skin responds differently to acne treatments?
Dr. Shapiro: Absolutely. Some people have a lasting and permanent improvement from antibiotics, while in others the acne comes right back. The same can be said for any medication used for acne, though the frequency of recurrence of disease is much smaller after Accutane.
Epoch Times: Acne creams are sometimes not recommended for women who are pregnant or planning to become pregnant. Why is this?
Dr. Shapiro: Accutane causes severe birth defects when taken by pregnant women because it disrupts normal embryonic cell migration. Topical retinoids may also theoretically cause similar problems if they are absorbed in significant concentrations.
Epoch Times: More than just a skin disorder, acne can indicate other underlying health conditions. What should people know about this?
Dr. Shapiro: Some forms of acne are associated with hormonal disruptions. A good example is the association of acne with PCOD (polycystic ovarian disease). Here the severe acne is seen in association with a heavy body … and excessive hair growth. Other hormonal defects such as abnormal elevations in growth hormones can cause acne-like eruptions in association with other health problems.
Epoch Times: What diet changes can help improve acne?
Dr. Shapiro: I am not a big believer in restricting the diet of my acne patients. Having said that, eating a diet with less carbohydrates and simple sugars, and an overall lower glycemic index, may lessen the burden of disease in some patients.
Epoch Times: What suggestions do you have for skin cleansing routines to improve acne?
Less is more in terms of scrubbing and washing. Gentle is the name of the game, as any mechanical/frictional activities will make acne flare. The type of acne that flares with friction (i.e. scrubbing, etc.) is the comedonal [clogged pore] type, which takes the longest to resolve.
Epoch Times: Anything else readers should know?
Dr. Shapiro: It is important and best to treat acne aggressively and early, to prevent scarring, as this affects self-esteem, self-image, and mood in significant ways.
In people of color, another consideration to mention is that inflammatory acne, when it resolves, leads to unsightly post-inflammatory pigmentation (i.e. dark marks). These are not scars but are equally troubling cosmetically and emotionally. Again, early treatment is the key to avoid this from happening.
Dr. Michael Shapiro, M.D., FAAD, ACMS, is a board-certified New York Dermatologist the medical director of Vanguard Dermatology with office locations in SoHo, Greenpoint, Sheepshead Bay, Forest Hills, and Staten Island.