One of the things that is frustrating for me is when a patient with moderate acne and scarring, or their parents hesitate about whether they should treat it or not. Sometimes, individuals fail to understand that treatment is a very time-sensitive issue.
If you leave acne going on and on untreated, it causes scarring. Although there are many treatments for scars, I believe that it's better to stop it earlier on. It's better to stop it earlier because for many individuals, acne and scarring can reduce their social performance, emotional development, and their overall interaction with others. We get embarrassed by the fact that we have acne on our face.
While it's always important to use the minimum amount of medication that is required to control the problem, it's also important to recognize that problems like acne should be treated, and they should be treated early. I think that for youngsters who are 9, 10, or 11 and are starting to develop acne-I think that it's very sensible to start early with topical therapy-Benzoyl peroxide wash or a salicylic acid cleanser. A number of these products over the counter do have benefit. Benzoyl peroxide especially is a powerful anti-bacterial that can break up whiteheads and blackheads to a certain degree. It's well researched and a good treatment.
It does cause bleaching, and that's something that needs to be explained to the patient. If towels are used to wipe skin that's just been treated with Benzoyl peroxide, it will bleach the towel too. Beds and pillowcases can also become white. Early intervention using a drug like Benzoyl peroxide when acne is just starting can help inhibit its progression.
Neglecting Lifestyle Factors
One of the topics that will often come up when I have a conversation with a patient is, "are there certain foods that I should avoid to help clear up my acne?"
I don't definitively know whether there is such a thing. We do know that individuals with moderate or severe acne need to try and keep their BMI down. For this type of acne, the symptoms become worse if they are overweight.
I think we have to accept that if somebody comes along says that every time they eat French fries, my acne becomes worse, I think that's fine. Avoid foods that make your acne worse. There's no reason to get into a fight over whether the evidence is anecdotal or lab tested. If a patient believes that chocolates make acne worse, then clearly it's common sense to avoid them.
The idea that there is a magic laser therapy that cures acne is quite common. At this time at least, I don't think that we have a single laser or light treatment that is capable of turning off acne in the long-term.
We know that acne goes on for a long time. If left untreated, 25% of individuals who had acne at 18 will still have acne at age 25. We need to treat this condition, and we also need to appropriately select the treatment.
Scars are a very common problem that is associated with acne, and sometimes the patient's or their parent's inability to recognize the risk can be frustrating. Scars sometimes combine elements of post-inflammatory Hyperpigmentation, leaving a brown stain that will remain fixed for a long time. These markings are not permanent however.
Scarred skin is thinner. There is a dent in the skin. At other times, the skin becomes bumpy. Intervention to prevent scarring is important.
Not Allowing Enough Time for Treatment
The main frustration with acne treatment from the patient's point of view, is that they are painfully slow. You can be treating the acne away, and then there is an unexpected flare-up. It's easy to think that the treatment isn't working.
The treatments do work over time, however, and I believe that it's the job of the physician to try and engage the patient and let them understand proper expectations. Continuation of the treatment is essential.
Not Just a Teen Problem
We often think of acne as a teen disease, but as dermatologists close to a third of the patients that we see for acne are adult women. I sometimes see women in their twenties or thirties who have developed acne recently without any previous acne as teens.
These are probably another sub-type of acne, often along the jaw-line. This type of acne is more hormonally driven. As their skin is much more sensitive it's much more difficult for these adult women to tolerate potentially irritating treatments like Benzoyl peroxide, and thus, require a different approach.
Not Treating the Whole Area
A common problem that occurs in patients treating acne, is that they fail to properly apply the treatment to the whole area, and not just the spot that existing acne covers. The acne treatment needs to cover the area of the face, and not just the spot.
If you have a date on the weekend and have a few spots using some Benzoyl peroxide to dry out a lesion is very reasonable, but as a long term therapy, you need to treat the area, not the spot.