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