Acne typically begins in the pre-pubertal years, extending into adolescence and early adulthood. Increased levels of androgens cause increased sebum production, abnormal follicular keratinization, colonization of the bacterium P. acnes, and inflammation. This results in clogged pores such as open comedones (blackheads), closed comedones (whiteheads), papules, pustules, and in more severe cases, nodules. Acne is frequently found on the face, neck, chest, and back. Some women experience hormonal acne in their 20’s, 30’s and even 40’s, which usually flares on the chin, jawline, and neck.
Individuals with moderate-to-severe acne may develop scarring. This can negatively affect one’s self esteem or body satisfaction. It is best to wait at least 8 months after treatment is finished to determine the extent of severity. Scarring can be treated with topical retinoids, microneedling, and chemical peels.
Post-inflammatory hyperpigmentation is also referred to as “pseudo scarring.” This occurs when there is discoloration to the skin after the acne has healed. This may fade in time and is treated similarly to acne scarring if it does not fully resolve on its own.
At home treatments include choosing a facial cleanser and moisturizer to use daily that are noncomedogenic. It is also important to avoid picking at breakouts to prevent scarring.
Prescription treatments depend on the nature and severity of one’s acne. Topical treatments include retinoids, antibiotics, benzoyl peroxide, sulfur, sodium sulfacetamide, salicylic acid, and azelaic acid. Oral treatments include antibiotics, spironolactone, and isotretinoin. Some larger cystic lesions can even be treated with intralesional steroidal injections.
With the constant wearing of face masks, there has been an increase in patients reporting acne on their nose, cheeks, and chin. Cotton masks may be less irritating than disposable masks. However, they can harbor oil and bacteria, so only use cotton masks if you are able to wash them after each daily use. Keep a simple skin care routine rather than adding in spot treatments that can potentially irritate skin more and limit use of makeup.
Written by Ansley McKenna, APRN