Acne: Don't Suffer Through It

We've popped it, put a bandage over it, washed it with cleansers that are too irritating and too often--all the things we know better than to do. When it comes to acne though, often one of the worst things that we can do is ignore it.

The most common problem that patients see their dermatologists for, is acne. Acne is a very common skin condition--in fact, almost everyone, at least in the developed world1 has had acne at least once. It's unfortunate that many people I see in public or hear complaints about in their conversations, are people that have moderate acne that aren't being treated. In almost all cases, treatment would be effective, and immensely improve the patient's quality of life. Acne is common, and sadly, it's commonly ignored.

Why do you think patients “ignore” their acne?

Like most issues, there isn't one factor or cause. Everyone is different, and there are a combination of factors that are likely involved.

  1. Quality of life is subjective and everyone reacts to acne differently. While some people with moderate acne may not be bothered much, another person may abhor the thought of even the mildest forms of acne.
  2. Often the public's perception of acne is that it's something that will go away with time, or that it's a trivial cosmetic issue. This can set the norm for how one ought to deal with acne--by just getting through it or ignoring it.
  3. Norms are often passed down generationally. Many parents and grandparents tell their kids and grandkids that acne can't be treated, and that you have to wait it out.
  4. For many patients, acne is within their tolerability range; unlike a broken rib, the pain and frustration of acne is just mild enough that many patients don't bother to seek treatment. This doesn't mean that their quality of life isn't affected however.
  5. Many patients mistakenly believe that their acne can't be treated or that acne treatments as a class aren't effective. This might be from personal experience or from anecdotal experiences coming from those they know.
  6. Many patients feel that a specialist like a dermatologist isn't available to them.

You mentioned that public perception of acne is both trivial, and yet untreatable. Why do you think this almost paradoxical view has become so pervasive?

It's important to remember that it's only in recent decades that acne treatment has really improved to a level where we're truly confident that there is an effective treatment for everyone. In the old days, a doctor might simply prescribe an ineffective product (by today's standards) and tell the patient to stop eating pizza, and unsurprisingly the success rate of treatments were inconsistent.

When you can't solve the problem, the only other option is to learn to live with it--to cope, and I think many parents or grandparents are passing on how to deal with acne in the way that they know--that is, to change how you think about it, to accept what you can't change. Ignoring or trivializing isn't ill-intentioned, but it's a good way to deal with problems that you have no power to change. Acne is a condition that is at least, partly genetic, so it's likely that a parent or grandparent who had more severe acne in their teens (the cases that were harder to treat) are advising children and grandchildren who are more likely to be suffering from the more severe types of acne in precisely the wrong way. The difference is that today, there are much better options for treating acne, even severe cases, than in the past. Acne treatment has come a long way--treatments are safer, and far more effective today, so now that solving the problem is viable, there's no reason to live with the problem.

What about patients who themselves have tried treatments in the past, and have given up?

That's the challenge with acne treatments, even today: They are effective, but they take effect slowly. Successful acne treatment demands patience. If you have eczema and apply a corticosteroid, the rash will go away quickly, usually within a day. Patients are immediately rewarded, motivated, and compliance is high. If you have a typical skin infection, and you take an oral antibiotic, you can see marked improvement within two days, and it's usually gone within a week. Not so with acne. Even the most reliable effective medications can take weeks or months before the patient even begins to notice improvements. This can be frustrating, especially if there are unwanted side-effects like irritated skin at the start of treatment, which can be common. Patients often have unrealistic expectations of treatment, and give up effective treatments before it had a chance to work. Sometimes, different approaches or a combination of approaches are required, and sometimes patients give up on treatment altogether before finding something that works. This is unfortunate because the treatments are effective if the patient and doctor work together and stick to the plan.

Do you recommend seeing a doctor on every occasion that you see acne?

No, that's not practical. Patients should evaluate the pros and the cons carefully. If you have very mild acne (a few blackheads or whiteheads from time to time), and aren't bothered by it, just focusing on gentle cleansing and lifestyle and general skin care improvements is indeed a viable option.

Suffering with acne is not a good idea, however. If acne is negatively affecting you, there are treatments--safe and effective ones, so there's no reason not to seek it. The other important factor is acne scarring. If you have inflammatory acne (pimples, pustules, cysts), there is significant risk of scarring, which is incredibly hard to correct once formed. Treating the acne swiftly and effectively is by far, the best way to prevent scarring altogether.

You seem confident that acne in most cases should be treated. What changed the game in acne treatment?

It's not that there is a single event that made acne treatment suddenly effective, although there are watershed events like the discovery of isotretinoin for treating severe acne. As with all medicine, improvements and discoveries are gradual and incremental. If you compare options 30 years ago and now, however, patients that have acne today are far more likely to be able to find satisfactory treatment. Treatments are more specific to the type of acne, age group, and severity, and there are also many more effective products that are available over the counter as well. In recent news, Differin, a staple retinoid drug that was prescription only for a very long time, now has FDA approval for over the counter inclusion.

When should patients see a dermatologist?

If a patient has multiple pimples, nodules, or cysts, they should certainly see a dermatologist. These types of acne carry a risk of scarring, which can be difficult to correct. The other time to see a dermatologist is when acne is affecting you negatively. Quality of life is important, and if acne is affecting how you feel, it's time to treat the acne. People can “get used to” feeling bad which can be a helpful coping mechanism for things that we truly have no control over. Patients with cleared acne often cite not realizing how bad they felt about their acne until after the acne was gone. When they delight in clear skin, they recognize how much acne was in fact, affecting their emotions though they didn't recognize it. Being tolerable doesn't mean that you need to or should tolerate it.

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