Acne vulgaris (commonly called acne) is a common skin condition, caused by changes in the pilosebaceous units. These units are structures of the skin that consist of a hair follicle and an oil gland. The changes occur as a result of increased sebum production through testosterone stimulation. Both men and women have varying amounts of testosterone. Acne is most common during adolescence, affects more than 85% of adolescents, and often continues into adulthood. This type of acne affects the areas of skin with the highest number of sebaceous follicles. These areas include the face, upper chest, and back. Whenever acne becomes inflammatory, it can damage the skin by destroying collagen. For most people, acne subsides over time and tends to disappear, or at least decrease, after one reaches their twenties. However, there is no way to predict how long it will take to completely disappear, and some people may continue to suffer well into their thirties, forties, and beyond.
Patients may be surprised to learn that the development of acne vulgaris in recent years is actually quite rare. True acne vulgaris in an adult woman can be a feature of an underlying condition such as pregnancy and disorders such as polycystic ovary syndrome or the rare Cushing’s syndrome. Menopausal acne is also known to occur when the production of the natural ovarian anti-acne hormone estradiol fails at menopause. Lack of estradiol also causes hair thinning, hot flashes, thin skin, wrinkles, vaginal dryness, and predisposes to osteopenia and osteoporosis, as well as triggering acne (known as climacteric acne). So what is adult acne and why does it occur in adulthood? Why does it also seem to mainly affect women and occur around the area of the mouth where there are fewer pilosebaceous units? In fact, why it lasts for years and does not respond to the usual treatments such as products with benzoyl peroxide or 2% salicylic acid (Acnesal). I would also ask why it is so common and annoying for so many people.
Is adult acne really acne?
I think these effects occur because what we call adult acne is probably a totally different disease. Several factors are known to be linked to acne, including the tendency of the condition to run in families and exposure to certain chemical compounds such as dioxins. Remember that the 1930s are the decades of rosacea and what we often see is a different disease called perioral dermatitis disguised as adult acne. Many doctors also call this acne and treat it the wrong way. Stress, through increased production of hormones by the adrenal glands (stress), causes the outbreak of the condition. While the connection between acne and stress has long been debated, scientific research indicates that “increased perioral dermatitis” is “significantly associated with increased stress levels.”
So what exactly is perioral dermatitis?
Perioral dermatitis is a condition closely related to acne vulgaris that affects young women between the ages of twenty and forty-five. Occasionally, men or boys are affected. Perioral refers to the area around the mouth and dermatitis indicates redness of the skin. In addition to the redness, there are usually small red bumps or pus bumps and slight peeling. Sometimes the bumps are the most obvious feature and the condition can look a lot like acne. The most affected areas are within the edges of the lines from the nose to the sides of the lips and chin. A small strip of skin bordering the lips is often spared. Skin lesions can affect the area around the eyes. It is not uncommon and has a tendency to reappear in people who have had it once. This condition is often stress-related and becomes common in the summer as it acts like rosacea, getting worse with exposure to sunlight. Sometimes there is mild itching or burning.
How long does it last?
If left untreated, perioral dermatitis can last for months or years. Even if treated, the condition can recur several times, but the disorder usually does not recur after successful treatment.
What Causes Perioral Dermatitis?
The cause of perioral dermatitis is unknown. We know that it is a neurodermatis and, therefore, it is related to stress. Some dermatologists believe that it is actually a form of rosacea or seborrheic dermatitis made worse by sunlight. We know that strong corticosteroid creams applied to the face can cause perioral dermatitis. Once perioral dermatitis develops, corticosteroid creams seem to help, but the disorder returns when treatment is stopped. In fact, perioral dermatitis often recurs even worse than it was before the use of steroid creams. Some types of makeup, moisturizers, and dental products may be partially responsible. There is also a suspicion that fluoridated toothpastes are linked to an outbreak of this condition.
Can it be prevented?
There is no guaranteed way to prevent perioral dermatitis. Don’t use strong prescription corticosteroid creams on your face. Your dermatologist may have suggestions for using moisturizers, cosmetics, and sunscreens, and may advise against using fluoride toothpaste, tartar control ingredients, or cinnamon flavorings.
Are laboratory tests needed to diagnose the problem?
Most of the time, no testing is necessary. A dermatologist can usually make an accurate diagnosis just by examining the skin. Sometimes a skin scraping or biopsy is done. Occasionally, blood tests are ordered to rule out other conditions that may appear similar.
How is this condition treated?
Dermatologists tend to use oral antibiotics, similar to the ones we use in rosacea to treat the condition. This means that a patient would need to take doxycycline or tetracycline for a minimum of 3 months to prevent recurrence. For milder cases or pregnant women, topical antibiotic creams can be used. Occasionally, your dermatologist may recommend a specific corticosteroid cream, just for a short time to help your appearance while the antibiotics are working.
Is this similar to acne treatment?
Yes and no. I guess systemic antibiotics are a mainstay in treating common acne vulgaris. Some of these antibiotics, such as doxycycline (ByMycin) and minocycline (Minocin) have anti-inflammatory properties and are generally more effective than tetracycline. However, resistance is becoming more common, and other antibiotics, including trimethoprim (Septrim), are more helpful in acne than in perioral dermatitis. Roaccutane (isotretinoin) is a very effective systemic retinoid in the treatment of severe acne vulgaris. It does this by reducing sebum excretion by 70%, is anti-inflammatory and even reduces the presence of acne bacteria. I do not usually use it with perioral dermatitis as the basis of the condition is not related to sebum. Roaccutane is a teratogenic and pregnancy should be avoided. A negative pregnancy test result is required before starting therapy. A doctor will also check your cholesterol and liver tests on a monthly basis.
Are lasers of any value?
Lasers using Photopneumatic ™ technology such as PPx and Isolaz are of little use in treating this condition as the underlying problem is not related to increased sebum. However, IPL (as used in rosacea) appears to be of some benefit in managing the condition.
What can be expected with the treatment?
Most patients improve within two months with oral antibiotics. If corticosteroid creams were used for treatment, there may be a flare when the creams are discontinued. However, if antibiotic treatment is stopped too soon, the problem may come back.
Are there other treatments?
There are many over-the-counter products available for treating acne, many of which have no scientifically proven effects. Generally speaking, successful treatments show little improvement within the first two weeks, instead taking a period of about three months to improve and begin to stabilize. Many treatments that promise big improvements in two weeks are likely to be largely disappointing. However, short bursts of cortisone can give common acne very quick results, but are not recommended for this condition. .
Topical Bactericides
Topical bactericidal products containing benzoyl peroxide can be used on mild to moderate acne. The gel or cream containing benzoyl peroxide is rubbed twice a day into the pores of the affected region. You can also use bar soaps or washes and their concentration varies from 2 to 10%.
I do not normally recommend the use of benzoyl peroxide in this condition, as it is a keratolytic (a chemical that dissolves the keratin that clogs the pores) and the main problem is not due to blocked pores. Other antibacterials with less keratolytic effects include triclosan or chlorhexidine gluconate.
Topical antibiotics
These include ointments such as erythromycin, clindamycin, or tetracycline. They work by killing the bacteria that are harbored in the follicles. While topical use of antibiotics is just as effective on common acne as oral use, I don’t find them as effective on this condition. However, I sometimes use Rozex and Metrogel (metronidazole) in the same way that I would treat a rosacea patient.
Hormonal treatments
In women, common acne can be improved with hormonal treatments. The common estrogen / progestogen combination pill does have some effect, but the antiandrogen cyproterone in combination with an estrogen (Dianette) is particularly effective in lowering androgen hormone levels. Most adult acne patients are too old to use this drug, so it is generally not used.
Topical retinoids
This group of drugs is used to normalize the life cycle of follicle cells. They include brand names such as tretinoin (brand name Retin-A), adapalene (brand name Differin), and tazarotene (brand name Tazorac). Like isotretinoin, they are related to vitamin A, but are administered topically and generally have much milder side effects. However, they can cause significant skin irritation and I never use them in this condition.
Phototherapy
It has long been known that short-term improvements can be achieved with blue and red light. Recently, visible light has been used successfully to treat acne (phototherapy); In particular, the intense violet light (405-420 nm) generated by specially designed fluorescent lighting, LEDs or lasers used twice a week has been shown to reduce the number of acne lesions. by two thirds. It is even more effective when applied daily. The mechanism appears to be that a porphyrin produced within P. acnes generates free radicals when irradiated at 420 nm and shorter wavelengths of light. These free radicals ultimately kill the bacteria.