But the reality is that acne vulgaris is the most common form, affecting up to 90% of adolescents, more frequently boys, and in most cases disappearing after the age of 20. In women, it is more common for it to persist beyond adolescence.

Acne is more common in boys and tends to disappear after the age of 20.

In any case, even though it tends to disappear, it usually causes some (in some cases significant) discomfort in the person who suffers from it, and therefore treatment is necessary. Even though it is the most effective treatment, not all people with acne require isotretinoin (acutane®), either because their acne is not mild, because they do not want to take pills, or because it is summer and they will be exposed to the sun. What treatment options are available in these cases?

1-General measures

1. Before using any treatment, it is advisable to wash your face with a mild soap specifically designed for acne-prone skin.
2. If you use cosmetics and/or makeup, it is important that they are oil-free or labeled as oil-free/non-comedogenic.
3. Reducing your intake of foods with a high glycemic load could help you control your acne. You can find more information in the post on the “Influence of diet on acne.”
4. If your doctor prescribes any topical treatment (cream or gel), it is very important that you use it consistently. If you don’t follow the treatment, it definitely won’t work ;)

2-If you have blackheads and small pimples…

When acne consists of small pimples, in the form of comedones (blackheads) and blackheads, the most commonly used creams are topical retinoids (tretinoin, adapalene), which I discussed in a previous post, as they are also anti-wrinkle treatments. These treatments regulate the production of keratin, which is the substance that usually “clogs” the pores, promoting the formation of pimples. Some cosmetic treatments such as facials or peels can complement the treatment.

Retinoids can cause skin irritation and some people do not tolerate them very well. In these cases, other creams containing salicylic acid or azelaic acid can be used. However, if they are well tolerated, they can be used for a long time and can help us control pimples and blackheads easily.

3-If you also have RED PIMPLES…

Some people, in addition to pimples and blackheads, have redder spots, which sometimes have a white head. Some of these spots can even be painful.

If this is the case, in addition to retinoids, it is advisable to use a treatment that destroys the bacteria involved in acne, Propionibacterium acnes. It may be useful to use benzoyl peroxide, if not already used, or antibiotics (usually clindamycin or erythromycin). There are creams that contain both products together (retinoid + antibiotic -Treclinac®- and retinoid + benzoyl peroxide -epiduo®/tactuoben®-) for ease of use.

4-Sif you have MANY RED PIMPLES or acne is also located on your CHEST and BACK…

When pimples are more noticeable or if there are pimples on the back or chest, antibiotic tablets are usually used, as it is difficult to treat all these areas with creams or other topical products alone. The most commonly used oral antibiotic is doxycycline, which is both antibacterial and anti-inflammatory. It should be used for a maximum of 3 months. A recent study found that there was no difference in improvement between using it for 3 months or 6 months, so there is no justification for prolonging treatment as this can lead to bacterial resistance.

Oral antibiotics are useful when acne appears on the chest and back.

In recent years, there has been an increase in bacterial resistance to antibiotics. To prevent this, it is recommended not to use antibiotics as the sole treatment for acne, either in cream or oral form. In general, it should be recommended in conjunction with a benzoyl peroxide cream, as this has been shown to reduce the number of resistant strains.

5-If you have many red, inflamed, PAINFUL pimples and/or SCARS…

In these cases, dermatologists usually prescribe isotretinoin (Roaccutane®), since, apart from the discomfort caused by the pimples, the risk of lifelong scarring makes us seek the most effective treatment.

In conclusion…

There are currently various treatments available for acne. Cosmetic products alone are not usually sufficient to cure it, but they can be a good complement in some cases. It is best to have a dermatologist examine your type of acne and recommend the most appropriate treatment for your case.

Do you have doubts about your acne?

Consult with me ONLINE and I will advise you on the best option for you.

The post 5 basic guidelines for treating acne first appeared on Dra. LOREA BAGAZGOITIA.

1. Moisturize your skin thoroughly.

Dry indoor air and the use of heating contribute to our skin feeling tight, rougher, dry, itchy, and sometimes even cracked. To prevent this, there is nothing simpler than applying moisturizer to the entire body every day. Although it seems obvious, many of us forget to do so. It is not necessary to use the most sophisticated and expensive products, but simply to be consistent in applying them. Dry lips are also common, as they crack in the cold. Remember to moisturize them too (lip balm, petroleum jelly, etc.).

In some cases, the degree of dryness is such that dry/xerotic eczema may appear, i.e., a rough, reddish area with cracked skin that itches a lot. This is common in older people who do not usually use moisturizing creams. In these cases, treatment with a topical corticosteroid cream is necessary. If you have any areas of “rough” skin that do not improve with moisturizing creams, it is a good idea to consult a dermatologist.

2. Use sun protection

We usually pay attention to sun protection in summer, because that’s when the sun shines on our whole body. But we shouldn’t underestimate the effect of UV rays on the skin of our face during winter. The gradual accumulation of sun exposure throughout our lives not only increases the risk of skin cancer but also causes the skin to look older (less lustrous, dry, with wrinkles and spots). From both an aesthetic and cancer prevention point of view, it is advisable to get into the habit of using sun protection in winter too.

Fortunately, there are now lots of sunscreen creams (SPF 30+) with excellent cosmetic properties (they come in liquid form, as sprays, for oily skin, for dry skin, with more color, in makeup format, etc.). Just pop into your local pharmacy and ask :)

Protecting yourself from the sun also prevents wrinkles.

What about those of you who are skiers and mountaineers? The reflection of UV rays on snow considerably increases their harmful effect, which can cause first- and second-degree sunburn. So don’t forget to use extreme protection on your face and lips, reapplying it throughout the day while skiing.

3. Do you have spots on your face? Winter can be a good time to treat them.

The relationship between facial spots and the sun is clear. Spots become more noticeable in the summer, and it is at this time of year that we tend to worry about them most. However, most treatments for spots cannot be done in summer (either because of the medication used or because of the risk that the spots will darken even more due to the sun) and it is better to do them in winter.

There are different types of spots on the skin (solar lentigines, seborrheic keratoses, melasma, etc.), each with a different treatment.

It is advisable to have them assessed by a dermatologist to determine the appropriate treatment in each case (cryotherapy, laser, depigmentation creams, peels, etc.). It is advisable to have them assessed by a dermatologist to determine the appropriate treatment in each case (cryotherapy, laser, depigmentation creams, peels, etc.). In any case, to prevent any of them, it is essential to protect yourself from the sun with SPF 50+ daily, even in winter.

4. Do you have acne? Winter is the best time to treat it.

If you have acne, you may have noticed that it usually improves in the summer. The sun tends to “dry out” pimples, so when winter returns, you generally feel like it’s worse. Winter is a good time to start treating your acne because some of the treatments used (isotretinoin, doxycycline) can make your skin more sensitive to the sun, and therefore their use in summer (although possible) becomes much more uncomfortable.

The post 4 basic tips for taking care of your skin in winter first appeared on Dra. LOREA BAGAZGOITIA.

What is hormonal acne?

In fact, this is not the term we usually use in medical language; we more precisely refer to it as “adult female acne.” This diagnosis applies to women who develop acne or continue to have it beyond the age of 25. However, this age limit is somewhat arbitrary, as the approach for a 23- or 24-year-old woman would likely be the same.

Although breakouts can appear anywhere on the face, hormonal acne typically affects the chin and jawline. The spots may be small (like blackheads or whiteheads), more inflammatory with a white tip (pustules), or even deep and painful (nodules).

In some cases, breakouts are related to the menstrual cycle and worsen a few days before the period. In others, there’s no clear connection.

Pictures of adult women acne

Why does hormonal acne appear?

Hormonal acne can appear in women who never had it before or persist from adolescence. In either case, it tends to become less frequent over time. It is estimated that half of women in their 20s have acne, a quarter of women in their 30s, and more than 10% of women over 40 also experience it.

The main causes of adult female acne are the same as in teenage acne:

• Hyperkeratinization of the hair follicle
• Excess sebum production
• Presence of the bacteria Cutibacterium acnes in the pore
• Inflammation

What makes this condition “hormonal” is that it tends to worsen in situations where androgen levels (male hormones) increase — whether due to medications (such as certain birth control pills) or medical conditions (such as polycystic ovary syndrome). Androgens, which are also naturally present in women (produced by the ovaries or adrenal glands), stimulate sebum production, which can trigger breakouts.

However, interestingly, most women over the age of 25 with acne have normal hormone levels. In fact, we usually don’t order blood tests. This has led to the hypothesis that in many cases, the sebaceous glands are simply more sensitive to normal androgen levels, producing more sebum and leading to acne.

Other contributing factors may include stress, pollution, the menstrual cycle, smoking, and the use of greasy or comedogenic cosmetics.

Does diet affect hormonal acne?

Until a few years ago, dermatologists generally denied that diet had any influence on acne. However, we now know that diets with a high glycemic load and those rich in dairy products can worsen acne.

Does this mean eating well will cure your acne? Probably not — in most cases, medical treatment is needed. However, a healthy diet rich in fruits, vegetables, legumes, and fish can reduce the inflammatory nature of acne and prevent flare-ups. For that reason, a healthy diet is an excellent complement to treatment.

How to treat hormonal acne

When acne is hormonal in origin, the first step is to establish a proper skincare routine, including thorough cleansing and the use of exfoliating agents as a complement. You can use physical or chemical exfoliants (like salicylic acid or alpha-hydroxy acids).

Depending on the severity and extent of the inflammation, medical treatment will vary. In cases where the acne is mild and non-inflammatory, topical treatment may be sufficient, combining retinoids, benzoyl peroxide, and a good skincare routine. Topical antibiotics should be used only for short periods (no longer than 3 months).

However, when lesions are more inflamed or affect a large area of the face or neck, we may recommend oral treatments, such as hormonal contraceptives, spironolactone, isotretinoin, or antibiotics.

The treatment strategy should be long-term, as adult female acne is often chronic. Short-term treatments usually bring initial improvement, but acne tends to return afterward.

Taking a long-term approach and having strategies in place to control flare-ups and maintain clear skin has proven, in my experience, to be very effective. In any case, treatment should always be personalized, taking into account each woman’s needs, preferences, and individual response.

The post Hormonal Acne: What It Is and How to Treat It first appeared on Dra. LOREA BAGAZGOITIA.

In this article, I discuss the most common side effects of isotretinoin, as well as when they occur and what precautions to take in each case. Remember, however, that if you have any concerns, it is best to discuss them with your doctor (whether a dermatologist in person or an online dermatologist) before starting treatment.

 DRY LIPS DUE TO ISOTRETINOIN

This is undoubtedly the most common side effect, as it occurs in all people taking isotretinoin. It has been observed to begin as early as the first two weeks of treatment. It is important to be aware of this and to use petroleum jelly or lip balm from the beginning of treatment.

DRY SKIN DUE TO ISOTRETINOIN

Isotretinoin, which is used to treat acne, reduces the production of sebum in the skin. It is therefore normal to feel that your skin is drier than usual, and you may even develop eczema. This is much more noticeable in people with atopic dermatitis. In any case, with or without dermatitis, it is essential to use moisturizers daily to avoid itching or the appearance of eczema patches that can result from treatment. A recent study has shown that it is common to notice skin dryness on the face around the third week of treatment and on the body around the fourth week.

After the 3rd week of treatment, the skin begins to feel dry.

Just as the skin dries out, so do the mucous membranes, which can occasionally lead to nosebleeds (epistaxis). This is one of the most common adverse effects; as long as it is not excessively frequent or bothersome, it is not usually necessary to stop treatment for this reason. If you get nosebleeds very frequently, I advise you to discuss this with your dermatologist as a dose reduction could help to improve this discomfort.

Isotretinoin speeds up the rate at which the skin regenerates; this causes the skin to be thinner and more delicate during treatment. This sensitivity makes sunburn more likely than normal. Therefore, it is necessary to use sunscreen daily, even on cloudy days.

To avoid sunburn, sunscreen should be used on a daily basis.

The fragility of the skin is also evident when using wax, so this method of hair removal is not recommended. You can use a razor, laser, or cream.

It is estimated that this increased skin sensitivity begins to be noticeable before the fourth week of treatment.

DRY EYE DUE TO ISOTRETINOIN

Isotretinoin also affects certain glands that lubricate the eye, so dry eyes may be experienced in the first few weeks. For this reason, the use of contact lenses is not recommended, especially at high doses. Artificial tears may help prevent dry eye discomfort.

Isotretinoin may cause dry eyes. This may be relieved with artificial tears or by reducing the dose.

Treatment may cause difficulty seeing at night. This is called nyctalopia and is reversible, i.e. it will go away when the treatment is finished. Most people do not notice this, but it is important to be aware of it in professions such as pilots or drivers, as it can make it difficult to do your job at night.

MUSCLE DISCOMFORT FROM ISOTRETINOIN

It is normal to feel discomfort in the lower back, ribs, or muscle fatigue, which may occur during the fourth or fifth week of treatment. In cases where the discomfort is severe, your dermatologist may reduce the dose of isotretinoin or prescribe an anti-inflammatory treatment to control it until your acne is completely treated.

It is normal to experience some muscle or joint discomfort during treatment with isotretinoin.

CHANGES IN ANALYTICAL RESULTS DUE TO ISOTRETINOIN

We order this analysis to look for changes in transaminases (which indicate how the liver is working), cholesterol, and triglycerides. However, it is rare to find changes in these values, and unless there is a very large change in the results, we usually do not stop the treatment, knowing that the values normalize in all cases at the end of the treatment.

DEPRESSION AND ISOTRETINOIN

Although it appears on the label and is always talked about, it is still unclear whether there is a causal relationship between taking isotretinoin and depression. No study has shown that isotretinoin causes depression. In fact, there are studies that indicate that isotretinoin improves personal satisfaction in those who take it.

Isotretinoin has not been shown to cause depression. However, it is prudent to monitor for any noticeable changes in mood during treatment.

In any case, although it has not been proven whether or not there is a direct relationship, and knowing that it is unlikely to occur, it seems prudent to be aware of whether there is a clear change in mood in someone being treated with isotretinoin and, if so, to discuss it with the dermatologist.

Here is a specific post about isotretinoin and depression (in Spanish).

IN CONCLUSION…

Isotretinoin is the most effective treatment for acne. It is a safe drug, but it is not without risks and side effects. Most of them are controllable and in all cases reversible at the end of treatment. It is important to be aware of them in order to make the treatment as tolerable as possible.

Do you have side effects related to your isotretinoin treatment?

The post Most common side effects of isotretinoin (“accutane”) for the treatment of acne first appeared on Dra. LOREA BAGAZGOITIA.