While most common in teens, the onset of acne can be troubling at any age. Depending on its severity, acne can cause emotional distress and scar the skin. The earlier you start treatment, the lower your risk of such problems. Learn about the causes of acne and effective treatment options for adolescents and adults.

1. Understanding Acne
Mital Patel-Cohen, MD
Dermatology

2. Who Gets Acne?
• Acne is one the most common skin conditions
• Acne affects up to 90% of adolescents
 Women can have initial acne present in 20-40s
• Males = Females
• All races
• Family history

3. How Does Acne Form?
 Step 1: Hair follicles become clogged with shedding skin cells
and oil (sebum)
• Oil glands enlarge during puberty increasing oil production
 Step 2: Increase in sebum allows for bacteria to overgrow
(P. acnes)
 Step 3: Inflammation occurs due to extra bacteria (and
possibly other factors)
Photos: gskpro.com

4. Acne Triggers:
• Hormonal changes/shifts
• External factors: cosmetics, hair products,
sweat, head gear/sporting equipment
• Stress
• Medications
• Diet: ??? (dairy, sugars, trans-fats)

5. Types of Acne:
Comedonal Papular/pustular Nodulocystic
Photos: DermNet NZ

6. Acne Skin Care:
• Skin Hygiene: Wash face 1-2x per day
with gentle cleansers and warm water
• Avoid harsh scrubs
• Avoid picking/popping pimples
• Moisturizer/Make-up: oil free or “non-comedogenic”
• Sun protection

7. Treatments:
Options, Options, Options!!
• Topical: salicylic acid, glycolic acid, benzoyl
peroxide, azelaic acid, topical antibiotics,
retinoids, dapsone gel, sulfacetamide
• Oral: antibiotics, spironolactone, oral
contraceptives, isotretinoin
• Alternative supplements: zinc gluconate,
Vitamin D, Green tea, Vitamin B complex,
Fish oils

8. Mild Acne Management:
• Follow an acne skin care regimen
• Topical treatments are most often used for mild disease
• Topicals can take up to 12 weeks before improvement is seen
• Topicals can be irritating and can cause dry skin therefore consider
beginning on alternate days and using moisturizer
Most common agents:
Benzoyl peroxide: Antibacterial and comedolytic properties
Common adverse effects include skin irritation and bleaching of hair and
colored fabric
Topical antibiotics (clindamycin, erythromycin): Reduce number of
P. acnes and reduce inflammation
Topical retinoids (tretinoin, adapalene): Decreases oil production and
clogged pores
Common adverse effects include dryness, redness, itch, sun sensitivity

9. Moderate Acne Management:
• Topical treatments +/- oral antibiotics +/- oral
contraception
Most common agents:
Oral antibiotics: doxycycline, minocycline
-Improvement is seen in 2-3 months
-Contraindicated in pregnancy and in children < 8 years old
- Take with food and full glass of water
-May cause GI upset and photosensitivity
Oral contraceptive pills or spironolactone: used for women with
hormonally induced acne (most often acne along the jaw line)

10. Severe Acne Management:
• All before mentioned options to be tried, if no improvement
consider isotretinoin
Oral isotretinoin:
- Used for severe or refractory cases of acne
- Can cause birth defect therefore female patients must use two
forms of contraception
- Bloodwork before and during the treatment will be needed to
follow cholesterol and liver tests
- Mainstay side effects: dry skin and dry lips
- Rarely causes depression, severe headaches, vision changes,
inflammatory bowel disease

11. Treatment Take Home Points:
• There is no single best treatment for acne
• Most often combination treatments are
needed
• Dermatologists create treatment protocols
based on the patient’s skin type, acne lesion
type, and severity
• Acne treatments take 8-12 weeks

12. Hyperpigmentation: Brown Discoloration
• Time
• Sun protection/SPF
• Lightening creams:
hydroquinone, retinoids azelaic
acid, kojic acid, vitamin C
• Chemical peels
• Microneedling
Photos: DermNet NZ

13. Post-inflammatory Erythema: Redness
• Time
• Sun protection/SPF
• Laser therapy to
remove redness:
pulse dye laser,
KTP laser, IPL
Photos: DermNet NZ

14. Acne Scarring: Texture Change
• Time
• Retinoids
• Chemical peels
• Microneedling
• Laser Resurfacing

15. Hypertrophic Scarring: Raised Scars
• Topical steroid
creams
• Intralesional
injection of steroid
Photos: DermNet NZ

16. Take Home Points
• Acne is a VERY common inflammatory skin
condition
• Acne is caused by multiple factors
• Acne comes in several different forms
• We have many treatment options
• Each patient is unique and needs their own
treatment plan

17. This Photo by Unknown Author is licensed under CC BY-SA

18. Thank You!
Dr. Patel-Cohen
Please feel to reach out to our office for any
dermatologic concerns. We see patients of all ages!
150 Park Avenue, Florham Park 973-775-5156
34 Mountain Blvd, Bldg. B, Warren 908-769-2510
1 Diamond Hill Road, Berkeley Heights 908-277-8668