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Peds Derm Corner- Acne- April

Each month, Dr Swanson posts information about a common pediatric dermatology issue to educate patients and parents. This month, the topic is acne.

What causes acne?
It is not just one thing that causes acne and every person is different.  But in general, hormones tend to play a key role.  Hormones change the consistency of the oil secreted by the skin so it becomes thicker and clogs the pores.  Because the pores are clogged, a bit of a traffic jam develops and the area gets inflamed and can get infected and that is what causes your pimple.  There is also a significant genetic component to acne and if your parents dealt with bad acne as a teen, it increases the chance that you will have to deal with acne.
Does food contribute to acne?
Studies tend to say no, however we are all individuals and I believe that certain foods can cause acne in certain individuals.  The common culprits are chocolate, sugar and excessive amounts of 2% or whole milk.  We also see that some people that work in fast food, where grease and oil are in abundance, can have more trouble with acne.
How should I treat my acne?
To determine the best treatment, it is important to identify what kind of acne you have.  There are 2 main types of acne: red bump acne (inflammatory) and blackhead/little bump (comedonal) acne.  Over the counter acne medicines typically contain either salicylic acid or benzoyl peroxide.  Salicylic acid tends to work best for blackhead/little bump acne and benzoyl peroxide tends to work better for red bump acne.  If your acne is mild, trying over the counter medications can be worthwhile and could take care of the issue.
But if your acne is more than a mild nuisance, then it’s time to see a dermatologist to discuss prescription treatments.  There are lots of options including prescription topical medications, oral medicines like antibiotics or birth control pills, and even Accutane (isotretinoin).  The treatment we choose depends on the location of the acne, severity of the acne, and type of the acne.
What is Accutane?
Accutane (isotretinoin) is an oral medication for acne that is a derivative of Vitamin A.  It is indicated for people with acne that is severe, nodulocystic, or scarring.  It is also indicated for people that have tried numerous other treatments and haven’t seen enough improvement.  The medication is taken for 5-6 months and clears up all of the acne.  For most people who take Accutane, the results are permanent and their acne never returns.
Accutane is an amazing, life changing medication, but it has certain potential side effects.  Patients who take it notice that their skin gets very dry and their lips get chapped.  Sometimes patients get mild muscle or joint aches.  When you are taking Accutane, blood work is necessary to monitor liver function tests and triglycerides (a form of cholesterol).  That blood work is done monthly.  Girls who take Accutane have more hoops to jump through because the medication can cause severe birth defects if a woman gets pregnant on it.  Monthly urine pregnancy tests are required while on Accutane and pregnancy prevention is mandatory.  The medication can cause depression, but that typically affects patients with a history of depression.  There are some concerns about an association with inflammatory bowel disease (ulcerative colitis or crohn’s disease), but no association has been proven.  Patients on Accutane must be seen in the office every month to be monitored for improvement and side effects.  Although all of these potential side effects are important to consider, Accutane is a very effective medication and the only side effect that most patients experience is dry skin and chapped lips.

If you have any other questions regarding acne and how it is affecting your child, please schedule an appointment with Dr Swanson, our pediatric dermatologist.

What is a pediatric dermatologist?
A pediatric dermatologist is someone that has undergone extensive training to deal with the specific skin conditions and issues that affect children. Pediatric dermatologists have typically completed medical school, a general dermatology residency, and a pediatric dermatology fellowship. While all dermatologists receive some experience dealing with children with skin problems, a pediatric
dermatologist has chosen to subspecialize and receive more extensive education and training with the pediatric population.