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Vital Signs

Fall 2006

Acne Best Cleared Using Individualized Treatments

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Acne is a problem most often associated with adolescence, but many adults in their 30s, 40s and even 50s wind up going to a dermatologist, frustrated that they have not been able to do anything to make the condition go away.
Many potential culprits for acne exist, explains Miguel Gutierrez, M.D., UCLA dermatologist. In some cases, genetics can be involved.

Hormonal changes during adolescence or, for women, during menstrual cycles or when starting or stopping birth-control pills, can play a role, as can stress. Certain fatty foods can stimulate more active oil-gland production, promoting acne. Some have postulated that dairy products may also influence oil-gland secretion. Medications, as well as skin-care products and cosmetics that clog the oil ducts, can cause outbreaks. Dr. Gutierrez notes that many women who never had acne problems as teens experience outbreaks resulting from polycystic ovarian syndrome, an inflammatory skin disorder involving interactions among hormones, oil-secreting glands and bacteria.

Two major processes fuel acne: overproduction of the oil glands and inflammation involving the bacteria that live on the skin. "Often, people will use a product that addresses only one part of the problem, and it won't clear up their acne," says Dr. Gutierrez. For those with mild acne, over-the-counter products can be enough. However, for people with more severe acne, over-the-counter treatments are often ineffective and can even worsen the problem.

While many home remedies have been touted-from cleansers to toothpaste-there has been no research to show whether they are beneficial. Trying to manipulate the skin by squeezing a pimple or extracting blackheads can exacerbate matters, says Christina Kim, M.D., UCLA dermatologist. For patients who need prescription strength medications, dermatologists often prescribe one or more therapies. Topical retinoids can shut down oilgland production, unplug the pores and improve the turnover of the skin. For inflammation, oral antibiotics, benzoyl peroxide and sulfur-based products or acids may be used. Cosmetic treatments include laser and light therapies that target the oil glands and facial bacteria, as well as chemical peels that remove the upper layer of the skin, opening the pores and evening out the pigment. "Every patient is different, and so a lot of acne therapy is trial and error," says Dr. Gutierrez. "In most cases, results will be seen in four to six months." 

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