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Our experienced medical journalist Jeanie Lerche Davis took your questions about adult acne to specialists. Here's what she found out.
Nothing works
Question: I have suffered from acne for more than 20 years. I have tried everything from prescription topical gels and creams to antibiotics to birth control and three rounds or Accutane. Nothing has helped me and I continue to struggle with it daily. Any ideas that may help would be greatly appreciated.
Answer: Adult acne is very common condition and for many patients there is no real "cure" for the condition. Even some patients who have taken Accutane need to continue to use topical acne treatments and oral antibiotics to keep the condition under control. In addition to these conventional acne treatments, some patients are able to achieve better results with adjunctive therapies such as chemical peels. However, it is important to recognize that adult acne can be a chronic condition that often requires some type of treatment indefinitely. -- Dr. Heather Woolery-Lloyd, voluntary faculty, dermatology, University of Miami School of Medicine.
Getting a second opinion sometimes helps. Even the best doctors can be fooled by conditions that mimic acne! Here are a few examples:
Perioral dermatitis is an acne-like condition that involves dry, scaly patches around the mouth area. Acneform eruption is an itchy rash that gets worse when acne medications like retinoid and benzoyl peroxide are applied. Acne rosacea involves central facial redness and flushing; some people have lesions.
Even with hard-to-treat cases, there are things we can do:
Monthly salicylic acid peels can improve the appearance of the skin. These peels are 10 to 15 percent stronger than over-the-counter products. Smoothbeam laser therapy is FDA-approved for treatment of acne and acne scars. The laser penetrates beyond the skin surface to shrink the sweat glands, which dries the skin and can decrease cystic acne without medications. Typically, four to six monthly treatments are required. Mineral therapy like sea-salt baths help. People who swim improve their acne, probably due to minerals in the chlorine. The mineral zinc -- taken as a supplement -- offers mild help for acne problems. Spironolactone (an oral medication) acts as a hormone blocker and in low doses may help women whose acne problems are due to excess androgen hormones. However, women should not use it if there is a chance they may get pregnant. Reducing stress in your life can also help reduce acne problems.
Birth control pills, including those marketed for women with acne problems, have a very weak effect and only on a small number of women. Most of our female patients are on oral contraceptives and they still have a lot of acne. -- Dr. Robert Polisky, dermatologist in Elk Grove, Illinois.
Question: I am a 27-year-old female who still suffers from the occasional acne breakout, especially preceding my menstrual cycle. I have been told again and again that there is nothing that can be done. I am very health-conscious, with a clean diet. I drink a gallon of water each day and wash my face following exercise. This problem is very embarrassing. Is everyone right? Can nothing be done?
Answer: Acne associated with menstrual periods is quite common. This type of acne is due to hormonal changes and is treated just like acne that is not hormonally influenced. Typically daily use of a topical retinoid such as Tazorac, Retin A, Avita, or Differin can help to modify the skin so that it is less prone to breakouts. Daily use of a topical antibiotic and/or benzoyl peroxide is also useful. Frequently oral antibiotics can be used the week before periods to further circumvent this type of breakout. Additionally, certain birth control pills such as OrthoTricyclen can be helpful to control this type of acne. -- Dr. Heather Woolery-Lloyd, voluntary faculty, dermatology, University of Miami School of Medicine.