Although acne is one of the most common disorders that a dermatologist will diagnose1 it remains challenging to treat. Not only is successful treatment difficult to achieve, but compounding the difficulty is the need to address and overcome patient misconceptions about acne.
Practice insights regarding treatments that now range from traditional to high tech were given to us by Savina Aneja, MD, a board-certified dermatologist and fellow of the American Academy of Dermatology. She specializes in general and cosmetic dermatology and treats patients of all ages. Dr Aneja’s clinical interests include cosmetic dermatology, skin cancer/cutaneous oncology, and acne.
Please describe your typical acne patients.
Dr Aneja: The 2 most common types of acne patients I see are:
- Teenagers, who have a combination of comedonal, papular-pustular, or cystic acne on the face, chest, or back. Most of these patients have tried a few OTC products but haven’t had much success
- Adult women, with hormonally driven breakouts. These breakouts tend to be more cyclical and most commonly affect the chin, lateral cheeks, and upper neck.
What are your first-line treatments?
Dr Aneja: Acne needs to be treated based on the subtype of acne–it’s not a one-size fits all type of pathology. Patients with hormonal acne often benefit from oral contraceptive pills, spironolactone, and newer topicals like [clascoterone]. Patients who have comedonal acne have more improvement with topical retinoids. Patients with papular-pustular presentations may need a combination of topical retinoids and topical or oral antibiotics. Patients with chronic, scarring, or moderate to severe acne may be candidates for systemic therapy with isotretinoin.
Are you using any novel treatments for acne, such as laser therapy? Why or why not?
Dr Aneja: Lasers and similar energy based therapies can be used safely to treat acne–photodynamic therapy has been promising for some of our patients.
Are there any interesting/successful/dangerous home remedies that you hear of patients using?
Dr Aneja: A lot of home remedies are quickly gaining traction due to spread of information on social media–patients try to treat acne or pimples with apple cider vinegar, coconut oil, and recently oral aloe Vera juice–unfortunately none of these really help!
What do you feel the role of diet is in acne, and how do you counsel your patients about diet?
Dr Aneja: Diet can definitely influence acne–a lot of my patients see improvement with limiting or decreasing dairy in their diets.
What are the most common misconceptions about acne that you need to dispel in your patients?
Dr Aneja: A lot of misconceptions:
- Some erroneously believe acne is caused by allergies or diet, but the truth is acne is multifactorial and influenced by many factors such as hormonal fluctuations and bacterial colonization of the skin.
- Some erroneously believe only patients with severe acne should see a dermatologist, but it is much easier and faster to clear acne when it first presents, before there is widespread involvement or scarring.
- There are many misconceptions about the safety of isotretinoin, however this medication can be very safely used when prescribed by a dermatologist who carefully monitors the patient.
- A lot of people feel that acne can only be troubling for teenagers, but in my practice I see many adults who develop acne and require treatment.
- Very few patients realize that acne scarring and active acne are different because of these differences patients may see improvement in active acne well before their scarring improves.
Any other insights to share?
Dr Aneja: There have been a lot of new therapeutics developed to treat acne. In just the last year we now have access to new topical and oral medications that can safely treat our patients.
1. American Academy of Dermatology Association website. Skin Conditions By The Numbers. Accessed June 2, 2022. https://www.aad.org/media/stats-numbers.