February 18, 2015

Adult Acne and Acne Medication: Why Meds?

As an Online Esthetician working exclusively with Adult Acne for people 30+ for the last decade or so, many clients come to me after being disappointed by doctors.  From differing hormone levels, to greater dead skin cell buildup as we get older, to a plethora of anti-aging products, there are so many new issues that arise over the decades, it baffles me how often people seem to get treated medically the same, irrespective of age.  

In general, I feel that throughout much of the medical profession, adult acne is not really well understood for one very simple reason - pore clogging and irritating ingredients in anti-aging skincare are not taken into account.  It's no accident that so much of the time a client will start out telling me that she never had a single pimple in high school - a definite indication her acne problem is not genetic!  What this means is that oil and bacteria may not be a problem in a case like this.

So why prescribe medication ?

All prescription acne meds are designed to either cut oil production, exfoliate dead skin cells or kill bacteria - and here's where it gets complicated.  If bacteria, excess oil production and/or dead skin cell build-up were all that were involved in the formation of adult acne, a string of prescriptions would likely do the trick for most people, and I would still be working in a fancy spa on the south side of Chicago doing fluff facials.  

What is missing here?  Why are these medications so often not helping?  

Let's examine some of the typical 
medications prescribed for acne and why.

Hormone Therapy
Examples : Yaz, Ortho-tricyclen, Spironolactone

The male hormone Testosterone is is responsible for oil production in the skin.  There are two main places this gets produced in women - the ovaries, where it's released right before our period, and the adrenal glands, where any time you have an adrenaline rush you get an accompanying testosterone rush.  In balance with the female hormone Estrogen, when female hormone goes down, male hormone goes up.  When male hormone goes down, female hormone goes up.  Excess oil production can sometimes be blamed on this balance being off kilter due to too much male hormone being produced.  Birth control pills are meant to balance the ratio of estrogen and testosterone.  Spironolactone prescribed alone, or included in the birth control Yaz, is a diuretic usually prescribed for high blood pressure that also happens to suppress testosterone. 

Examples : Clindamycin, Doxycycline, Minocycline, Aczone

When bacteria inside a pore (which exist inside every pore in every person) get out of control, they produce a chemical that makes it easier for them to feed on the oil produced by the skin (called sebum).  This chemical creates terrible inflammation which makes the pore swell up.  Now, since the bacteria in pores are "anaerobic", that is, they get killed by oxygen, if the pore swells shut and air can't get in, the bacteria thrive even more. Antibiotic is supposed to kill the bacteria so they stop producing so much of this chemical; that is, IF the antibiotic in question even gets to the bottom of the pore, which many actually don't.

Tretinoin - aka Retin-A
Examples : Retin-A Micro, Retin-A Cream, Tazorac, Adapaelene

For pore clogging, tretinoin and other vitamin A derivatives are often prescribed because of the way they flush out pores and loosen impactions - the start of every blemish without exception is a microscopic blackhead known as a microcomedone.  Retin-A helps to get rid of this by shutting down oil glands in such a way that dead skin cells having nothing holding them to the skin and far more of them fall off than normally would.  This happens from inside the pores as well as outside on the surface.
There are several prescription meds that combine some of these together, and a few that add Benzoyl Peroxide to the mix, which is available without prescription but is actually quite effective when combined with other drugs, such as tretinoin (EpiDuo) or Clyndamycin (Acanya).

Benzoyl Peroxide (BPO) is a versatile, effective and rather misunderstood drug.  First, it forces oxygen into pores, which kills the particular anaerobic bacteria involved in the vast majority of acne conditions, known as P. Acnes, that live inside almost every pore in every human being.  Next, it dries up excess oil. Finally, it exfoliates from inside the pore out.

When used properly, these medications can clear up acne before switching to a long term regimen of maintenance, involving gentle but thorough cleansing, toning, non-clogging moisturizers and serums, with clay mask once or twice a week.  

Next week, I'll go into a little more detail about the proper way to use some of these medications, and even more importantly, how good skincare can help you avoid dependence on these medications in the first place.

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