Acne

New Patient Appointment or 214-645-8300

UT Southwestern Medical Center offers one of the leading dermatology and cosmetic and plastic surgery centers in the country for research and patient care. Our experienced skin care specialists provide the most advanced care to treat acne and prevent or minimize the appearance of scars.

Specialized Treatment for Acne

Acne, the most common skin condition in the United States, typically develops when hair follicles (tiny sacs from which hair grows, also called pores) become blocked by oil and dead skin cells. Acne causes pimples, whiteheads, blackheads, or cysts, usually on the face, chest, upper back, or shoulders. Although acne is most common among teenagers, it can affect people at any age.

Our board-certified cosmetic surgeons, plastic surgeons, and dermatologists have all had extensive training in their specialties, studying for additional years after medical school. Our faculty members have published thousands of articles and books on plastic and cosmetic procedures, chaired hundreds of national and international symposia on all aspects of plastic and cosmetic surgery and dermatology, and delivered many scientific presentations.

Causes and Risk Factors of Acne

Acne has four main causes:

  • Bacteria
  • Excess production of skin oil, known as sebum
  • Excess activity of hormones called androgens
  • Hair follicles clogged by oil and dead skin cells

Normally, dead skin cells rise to the surface of follicles (pores) and are shed by the body. If the skin produces excess sebum, dead skin cells begin to stick together and are trapped inside pores.

Certain factors can trigger acne, such as:

  • Hormonal changes: Changes in the levels of certain hormones can make the skin produce excess oil. These changes can happen during puberty, menstrual periods, or pregnancy; or they can result from taking birth control pills or experiencing stress.
  • Medications: Certain medications such as corticosteroids, testosterone, or lithium can trigger acne.
  • Humidity and excessive sweating: Both can clog follicles.
  • Diet: Eating foods high in refined sugars, carbohydrates, or dairy can cause acne in some people, but this connection is controversial.

Factors that do not cause acne include:

  • Greasy foods: Research does not show that chocolate, nuts, or greasy foods cause acne.
  • Cosmetics: Oil-free cosmetics typically do not cause or worsen acne, nor do they affect the effectiveness of acne medications.
  • Hygiene: Removing makeup regularly is important, but dirty skin does not cause acne. In fact, excessive cleansing or scrubbing with harsh soaps or chemicals irritates the skin and can increase sebum production, which can worsen acne.

Symptoms of Acne

Depending on the severity of acne, its signs and symptoms vary from mild to severe. Skin changes include:

  • Comedone or plug: Skin bumps caused by pores blocked by oil and skin cells
  • Crusting of skin bumps
  • Redness around skin eruptions
  • Whiteheads: Closed pores with comedones that are white
  • Blackheads: Open pores with comedones that darken as bacteria is exposed to air
  • Papules: Small, red bumps
  • Pustules (pimples): Papules containing white or yellow pus, caused by bacteria and inflammation
  • Nodules: Large, solid, painful lumps beneath the skin’s surface caused by blockage and inflammation deep in follicles, also called nodulocystic acne
  • Cysts: Large, painful, pus-filled lumps beneath the skin’s surface
  • Scars: Darkened areas of skin that remain after acne eruptions heal, especially after cysts or nodules

Diagnosing Acne

Our experienced dermatologists can diagnose acne by examining the skin, so patients do not typically need further testing. We might perform a bacterial culture with certain patterns of acne or for large pus bumps that don’t clear up, to rule out infection.

We also determine the type and grade of acne, from grade 1 (mild) to grade 4 (severe). This assessment helps us decide on an effective treatment plan specific to each patient.

Treatment for Acne

At UT Southwestern, we can treat every case of acne using a variety of effective treatments. We begin acne treatment by discussing what types of over-the-counter treatments patients have already used and how long they have used them. This information helps us understand what has or has not worked to determine next steps.

If over-the-counter products have not helped after several weeks of use, our dermatologists prescribe stronger medicines and discuss other options with patients. Our goals are to help:

  • Control acne
  • Prevent scars or other skin damage
  • Make scars less noticeable

Acne medications

Remedies for acne include oral (pills taken by mouth) and topical (applied to the skin) medications. Oral medications for acne include:

  • Antibiotics, such as tetracycline, doxycycline, or minocycline, to reduce bacteria and redness
  • Oral contraceptives that combine estrogen and progestin, for women who have acne and also wish to use contraception
  • Anti-androgen drugs, such as spironolactone, which blocks the effect of androgens on oil glands in the skin
  • Isotretinoin (Accutane) for people with severe acne that does not respond to other medications

Topical medications, such as creams or gels, include:

  • Antibiotics such as clindamycin or erythromycin, to reduce bacteria and redness
  • Retinoids (derivatives of vitamin A) such as tretinoin, adapalene, or tazarotene to prevent follicles from becoming clogged
  • Prescription formulas of benzoyl peroxide or salicylic acid to prevent clogged follicles
  • Azelaic acid to reduce bacteria

Procedures to treat acne and acne scars

For people with severe acne or scarring, our dermatologists work with our cosmetic and plastic surgeons who have specialized expertise in procedures to reduce scarring. Together, we provide comprehensive care to treat acne and help patients look their best.

Depending on each patient’s needs, we might use these procedures with or without medications:

  • Chemical peels: Repeated applications of solutions using salicylic, glycolic, or retinoic acid to remove the top layer of skin
  • Injections: Steroids to treat severe acne involving nodules or cysts, fillers such as collagen or fat to fill out indented acne scars, or Botox to relax skin around scars
  • Light therapy: Treatment involving a chemical activated by a special blue light to fight skin bacteria
  • Dermabrasion: Skin resurfacing using a small, rotating device to improve the appearance of scars by removing the top layer of skin
  • Laser therapy: Skin resurfacing using erbium-YAG laser technology to rejuvenate the skin and improve the appearance of scars
  • Surgery: Minor procedures to remove individual acne scars and repair with stitches or a skin graft

Self-Care for Acne

Patients can take certain steps to help improve their skin:

  • Wash once or twice a day, including after exercising or sweating. Use a mild, nondrying, nonabrasive cleanser and lukewarm water.
  • Remove all dirt or makeup, but be gentle – avoid scrubbing or repeated skin washing.
  • Shampoo regularly, or daily, if the hair is oily.
  • Look for water-based, oil-free, or noncomedogenic formulas for cosmetics and skin creams.

 Things to avoid include:

  • Touching the face.
  • Squeezing, scratching, picking, or rubbing pimples or other acne eruptions to minimize the risk of skin infections, slower healing, and scarring.
  • Using greasy or oil-based cosmetics or creams.
  • Leaving makeup on overnight.
  • Wearing tight headbands, caps, or hats.

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