Why is Acne So Difficult to Treat?

We see and talk about acne a lot--it's by far the most common reason that patients visit a dermatologist. At the same time we know that acne is more than a temporary annoyance--we know that acne has serious psycho-social effects and require attention. Many people ask, "If it's so common and so problematic though, why does it still continue to frustrate teens as well as adults in 2016?"

We don’t need to go back too far in history when death and disease was far more common. As medicine has advanced in leaps and bounds in the last century, we are now accustomed to asking, "why hasn’t X been cured?" At the same time, there are still many medical challenges like cancer and AIDS that have yet to be solved. There are also many more mundane, but nonetheless frustrating, illnesses like the common cold that also have no easy cure. Acne also largely falls into this category of concerns that resist a clean solution.

A common misconception:

It's easy to assume that medical research is "losing the battle" when we constantly hear about how much is poured into research funds, and yet we continue to witness friends and family affected by illness. Most people know of a family or friend who has lost to cancer, and most of us get sick from the common cold from time to time. More than 95% of us will experience acne at some point in our lives. These personal experiences leave plenty of anecdotal evidence to suggest that medicine is falling short, and therein lies the pessimism that we sometimes feel towards medicine.

Part of the problem is in the analogy. When we talk about "winning the war on cancer" at the level of medical research, the analogy invokes a battle in which a cure is the victory, and the lack of it, a loss. The same thing can be said of acne and the common cold. Unfortunately, most illnesses do not have a simple cure, and we are quite far away from it. This doesn't mean, however, that medicine isn't making the patients' lives better, helping them cope with the condition, or improving their quality of life. While medicine still faces many challenges, there is plenty of evidence that medicine is advancing at the fastest rate we've ever seen, and are showing consistent results.

  • Most conditions do not have a simple cure. While antibiotics have revolutionized the treatment of bacterial infections, viral infections (including the common cold) and autoimmune conditions rarely have a cure.
  • Many conditions that do not have a cure can still be managed effectively by controlling its symptoms and helping the patient maintain a high quality of life.

Advances in Acne Treatment: What it means

Specific to dermatology, acne treatment has advanced in leaps and bounds over the last few decades. The idea that "dermatology is losing the battle against acne" is a myth that ends up hurting many patients who don't seek treatment when their acne problems can be effectively treated. In truth, acne treatment has advanced a ton in the last several decades. While it's true that patients still continue to get acne, and there will continue to be new cases every year, it doesn't follow that it's not worth seeing a dermatologist. With acne, there is a pervasive double-myth that many of the older generation still believe in.

  • Acne isn't a big deal; you get over it with age
  • Acne can't really be treated

This advice may have had some truth to it decades ago when treatment for acne was much less sophisticated. If a problem is very hard to deal with but can't really be controlled, often a reasonable solution is to ignore what you can't control. This serenity prayer like wisdom is no longer helpful, because acne can be treated, and we now know that the consequences of acne are more serious than we previously understood it to be. Acne can cause permanent scarring, and it can have devastating psycho-social effects on the patient.

Practical Advice:

The first advice is to trust your dermatologist's ability to provide appropriate treatments to acne. The biggest challenge that patients and doctors face when treating acne today is treatment adherence. Acne treatments are far more effective today for all types and severities of acne. Unfortunately, acne treatments are not fast acting like antibiotics when treating a bacterial infection. When patients have an unrealistic expectation of how fast they expect to see results, they too often give up the treatment or don't adhere strictly to their regimen. It's very important for patients to talk to their dermatologists about what the expected outcomes are, and when they can expect to see improvement, and to continue to communicate with their dermatologist if they feel that the treatment isn't working.

Dr. Richard Thomas explains the frustration and challenges that comes with treating acne. A must watch video for those struggling to treat acne.