Ask a Dermatologist: How to Treat Acne

(photography: istockphoto)

September means a fresh start for many, prompting the Acne and Rosacea Society of Canada to declare September 14–20 the country’s first Acne Awareness Week. With more than 5 million Canadians affected by the skin condition, the new non-profit organization, led by dermatologists, hopes to raise awareness and provide trustworthy information.

We spoke with Dr. Benjamin Barankin, spokesperson for the Acne and Rosacea Society of Canada and head dermatologist at the Toronto Dermatology Clinic, for an update on the best acne treatments.

What new technologies are available to treat acne, and how do they differ from previous methods?

By prescription, we have new topical therapies better than what we’ve ever had before. Ingredients like antibiotics, Retin-A and benzoyl peroxide, which used to be individual products, are now being combined. They’re more effective and come with more moisturizers [in the formula], so they’re less irritating. For oral therapies, we have many antibiotics, as those haven’t changed much in some time, but there are new hormonal therapies—new types of birth control pills, for example. And there’s a newer form of Accutane, or isotretinoin, available. We also have options that we can use to treat acne, but also to start treating the marks and scars, and those are certainly different. We have new photodynamic therapies and lasers that work quite well for acne and acne scarring—so we can treat acne, prevent acne and get rid of acne scars better than ever before.

Do treatment methods vary for teens versus adults?

Adult acne tends to be deep under the skin, more painful and oftentimes hormonally triggered. It’s typically cystic rather than blackheads and whiteheads, which affect teens more. Adult acne is much more common in women as it often flares up with periods, whereas teenage acne appears fairly equally between men and women. We’re more likely to use hormonal therapy in adult females, but in general we use similar topical prescription gels and antibiotic pills in both groups. We’ll use hormonal therapy in both groups, but more commonly in adults. We also use isotretinoin, or Accutane, in both groups, although it’s more likely you’d receive it as an adult, because adults do particularly well with it.

Ingredients such as benzoyl peroxide and salicylic acid can sometimes dry out or irritate skin. How can people counteract this effect?

When you get started on these agents, your skin has to get used to them. There are two ways to do this. Number one: start using it every other day. For example, three times a week you use benzoyl peroxide or salicylic acid, and if that’s going well after, say, two weeks, then switch to everyday use.

If you have really sensitive skin, another strategy is called short-contact therapy: you would apply benzoyl peroxide, but instead of leaving it on overnight, wash it off after five to 10 minutes. You can do this for a couple of weeks, and if your skin is tolerating it, start to increase your time to one hour, then four hours, then leave it on overnight as your skin gets used to it. If you do have irritation or you’re getting a bit uncomfortable, then it’s important not to keep fighting through. Take a breather—one or two days off—and just moisturize, then restart once things have calmed down.

Those with acne are often reluctant to moisturize for fear of clogging pores and causing more breakouts. Should they avoid moisturizer?

If you have acne, especially red pimples and pustules with a lot of inflammation, the skin can actually be dehydrated. There are a lot of people who, even though they’re breaking out, have dry skin tendencies, but it might be for genetic reasons as well. On top of that, generally speaking, medicated acne products—whether prescription or over the counter—are drying, so you need to counteract that with a mild moisturizer, labeled “non-comedogenic.” There are a lot of great over-the-counter options, like Spectro, Cetaphil or CeraVe.

What can be done to prevent scarring?

Avoid picking, squeezing and scratching; there’s no benefit [to that]. The main way to prevent scarring is to treat acne aggressively. Don’t let it linger. If pimples and pustules—particularly nodules and cysts—are hanging around more than a couple of months, you’re starting to scar. So if you have a deeper type of acne, if it’s sore, if you’re starting to see divots, get on top of it quickly. You can certainly do things to help with scars if they develop, but truly your skin will never be quite the same, and you’re much better off treating acne quickly and aggressively.

At what point should someone see a dermatologist?

If the acne is extensive, meaning it’s not just on the face but also the chest, back or shoulders; if there’s scarring, like divots in the skin; if you have a family history of severe, chronic acne—you should see a dermatologist. Also, if you’ve tried over-the-counter products or something from your family doctor, and it’s not improving things significantly after three months, see a dermatologist. I would also seek treatment from a dermatologist if your acne has a significant psychosocial impact. Whether it’s mild, moderate or severe, the severity doesn’t determine how much people are impacted by it.