DEAR DOCTOR K: I'm a woman in my mid-50s plagued with acne for the first time in my life. Please help!
DEAR READER: Most people get acne in childhood - about 80 percent of teenagers suffer from it. However, it's not that unusual for someone to first get it later in life.
Acne occurs when the lining of hair follicles becomes blocked.
Hair follicles are little pores in the skin through which hairs grow. Tiny glands in the skin squirt body oils into the follicles. The oils can thicken and block the opening of the hair pores and the glands. Skin bacteria feed on the oils, and in doing so produce inflammatory substances.
If the blockage of the glands and pores prevents the inflammatory substances from getting out, the result is acne.
Fortunately, there are several effective treatments for acne.
If you have mild acne that's not inflamed, try a non-prescription cream or lotion containing benzoyl peroxide. This will help keep pores open and discourage the growth of bacteria.
Non-prescription creams or gels containing salicylic acid and sulfur can help existing acne to dry and peel. However, they won't prevent new eruptions.
Topical antibiotics such as erythromycin are available with a prescription. Prescription antibiotic pills are even more effective. Both kill bacteria involved in the development of acne.
Retinoids are a common and useful acne treatment. They are derived from vitamin A and are available by prescription.
Retinoids are especially effective when used with antimicrobial drugs. These include antibiotics and benzoyl peroxide.
Tretinoin (Retin-A) is the retinoid most commonly used for treating acne, but it can irritate your skin. A microencapsulated form of the drug is less irritating.
The most powerful retinoid is isotretinoin. You take it by mouth rather than applying it to your skin. Isotretinoin is very effective for severe acne, but it can have severe side effects and can cause birth defects if taken during pregnancy. So women should be absolutely sure they are not in the earliest stage of pregnancy (meaning they've had a period very recently) before taking the drug.
Oral contraceptives are often effective to treat acne, although they also can bring on acne in some people. If they don't work, a drug called spironolactone may be added or used alone.
Light and laser treatments may help treat acne or acne scars. However, their effectiveness is still up for debate.
After treatment has been successful, how do you keep acne from coming back? Wash your face with soap and warm water twice a day and use oil-free creams on your face. Some of my patients tell me they've heard that acne in adulthood is caused by having too much sex. The good news is, it's not true.
We have a lot more information on acne in our Special Health Report, "Skin Care and Repair." You can find out more about it at my website.
I recommend finding a good dermatologist to sort out the pros and cons of the many treatment options that exist and figure out what's best for you.
• Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: www.AskDoctorK.com.
