Annoying, painful and sometimes permanent, acne is a natural part of life -- worse for some than others. The exact cause of acne is unknown although many speculate multiple factors are involved. First are hormones, more specifically androgens (male sex hormone.) During certain times of life, like puberty, pregnancy and menopause these hormones cause oil producing glands in the skin (sebaceous glands) to produce more sebum. In combination with the shedding of keratinocytes that line hair follicle wall, bacteria accumulate. Our body attacks the bacteria and acne develops.
Different types of acne respond to different therapies. Over the counter (OTC), prescription, and holistic treatments can be used in combination or alone to control acne. Acne treatments are categorized by severity of acne. For instance:
Treatment for blackheads, whiteheads, and mild inflammatory acne:
Topical preparations of:
- Benzoyl peroxide -- destroys acne causing bacteria, may reduce oil production.
- Resorcinol -- breaks down whiteheads/blackheads.
- Salicylic Acid -- decrease shedding of keratinocytes, and breaks down whiteheads/blackheads.
- Sulfur -- breaks down whiteheads/blackheads.
***These preparations come in gels, creams and lotions. May cause some local irritation at first, if it doesn't resolve see your doctor. These treatments are very effective but must be used regularly, may take up to 8 weeks to see best results.
Treatment for Moderate to Sever Inflammatory Acne:
Prescription Topical and Oral meds, alone or in combination:
- Oral/Topical Antibiotics -- reduce inflammation and stop or slow growth of bacteria. Examples include: tetracycline, minocycline and doxycycline; clindamycin and erythromycin. **MAY decrease efficacy of birth control pills.
- Vitamin A derivative (retinoids) -- topical -- allows other medicines such as antibiotics to enter the follicle by unplugging comedones (pimples). Examples of this drug include: Retin-A; Tazorac.
Treatment for Hormonally Influenced Acne in Women
Prescription oral medications:
- Birth control pills -- help suppress androgen produced by ovaries. Examples: Yasmin, ortho tri cyclen lo.
- Low dose corticosteroid drugs -- help suppress androgen production by adrenal glands. Examples: prednisone, dexamethasone.
- Antiandrogen drugs -- reduce excessive oil production. Example: spironolactone.
- Vitamin A 25000 IU - 2 caps twice a day -- decreases sebum production
**use of high dose vitamin A may be toxic if used for prolonged periods of time; NOT to be used if want to get pregnant or is pregnant
- Zinc Picolinate/copper picolinate (double strength) -- 1 cap 3 x a day (corrects a deficiency) / 1 cap daily (balances zinc)
- Chamomile astringent -- wipe clean face with cotton soaked pad -- natural antiseptic, kills bacteria
If simple OTC therapies are unsuccessful it is important to make an appointment for further discussion of a personal regimen that is right for you. If persistent acne is not treated properly it can lead to lifetime scarring. Please contact our office with any questions or if you would like help controlling your breakouts!
Polycystic Ovarian Syndrome
Polycystic Ovarian Syndrome (PCOS) is characterized by irregular menstrual cycles (typically infrequent cycles), excess hair growth, and obesity. A relatively common gynecologic condition, PCOS affects an estimated 5-10% of the female population. Most women with PCOS suffer the effects from it for years, but are only properly diagnosed when they present to their doctors with infertility problems.
Women with PCOS can have few or many symptoms of the disease, and those symptoms can vary in severity depending on the woman. PCOS is diagnosed when a woman’s symptoms fit two of the three following criteria:
- Irregular or absence of menstruation: adolescents can present with heavy periods; women usually present with infrequent to no periods.
- Excess androgen production: elevated androgens (male sex hormones) in the body can cause excess hair growth in male pattern areas (face, groin, thighs, chest, arms), acne, and male pattern hair loss (not as frequent).
- Enlarged ovaries or multiple cysts on the ovaries: demonstrated on pelvic ultrasound, cysts on the ovaries are actually the least common presentation in PCOS. In addition, some women with multiple cysts on the ovaries do not actually have PCOS.
The cause of PCOS is unknown, but the existence of high levels of insulin in the body seems to be the most accepted reason for PCOS development. Increased insulin, via many pathways in the body, leads to increased production of androgens. This increase in androgens disrupts the normal ovulation process, leading to infrequent or irregular menstruation. There is also some research that suggests that PCOS may be genetic.
In addition to a physical exam and history, PCOS is diagnosed by checking numerous hormone levels in the blood including, but not limited to: DHEA, LH, FSH, progesterone, prolactin, and TSH (thyroid level). Often a blood sugar test, an insulin level, and cholesterol/triglyceride levels are also checked. Occasionally, pelvic ultrasound is used to aid in the diagnosis.
Women with PCOS are statistically at higher risk for the development of type II diabetes, hypertension, elevated cholesterol levels, and cardiovascular disease. They are also at higher risk for uterine cancer if they go for longer periods of time without menstruating.
Although there is no cure for PCOS, it is a manageable condition. In women who are not seeking pregnancy, birth control pills or progesterone supplements are used to help regulate their periods. Metformin, a drug usually used in people with diabetes, can also be used to help increase ovulation frequency and decrease androgens. Spironolactone, a diuretic, is used to decrease excess hair growth and help manage acne. In women who are trying to conceive, Clomid is used to help stimulate ovulation; Metformin is sometimes used as an adjunct to Clomid. Women with PCOS can help their own condition through weight loss, increasing exercise, and following a low fat/low cholesterol diet.