Arlington Center for Dermatology

What cause acne?

The two main causes of acne are blockage of the pores and bacterial growth. Oil and cells get trapped below the surface of the skin, creating a growth medium for the bacteria. White cells migrate to the site to fight the bacteria, in turn releasing chemicals that lead to swelling, redness and further attraction of white cells (inflammation). The result is a dilated pore, filled with white cells, inflammatory and anti-inflammatory chemicals and bacteria. This is the content of the acne pimple. It is hormones and genetics that determine how much acne you will have. A typical teenager has some “normal” acne, that is, most teenagers have at least a few pimples now and then, due to the increase in hormones at puberty which stimulate the sebaceous glands. There may be genetic factors that determine who much acne bacteria remains on the skin, as well as those individuals that suffer from moderate to severe acne. Many women in their 30’s, 40’s, and 50’s suffer from “hormonal” acne, that is, it appears to be caused by an increase in the sebaceous gland’s response to circulating (normal) hormones with age. Why this occurs is poorly understood. There is also a subset of women with “true” hormonal acne who have abnormal levels of androgenic (male-type) hormones. These women often have accompanying excess facial hair (also hormonally regulated) and irregular menstrual cycles, although women who have normal hormone levels may also have excess hair. Flare Factors: Stress, menses, puberty (new onset hormones).

Topical therapy Topical agents for acne may be categorized as either antibacterial or comedolytic (one that can open up obstructed pores).

It is an important cornerstone of any acne therapy program to combine them, thus addressing the two most important causes of acne.

What cause aging skin?

Sun damage is the most profound factor in development of aging of the skin. The most important other cause in facial aging besides sun damage is cigarette smoking. Another possible contributing factor in women is loss of estrogen. Finally, genetics, nutrition and other environmental factors probably play important roles which are yet to be elucidated. The best approach for prevention of skin aging are the practice of good sun protection and avoidance of cigarette smoking. A recent study of identical twins revealed that factors such as sun exposure, cigarette smoking, stress and alcohol ingestion had a dramatic negative effect on aging changes that were independent of heredity. Certain topical preparations have been shown to reverse some signs of photo-aging. It has been assumed that these anti-aging preparations also can prevent skin aging, although no real studies have been performed which establish a regimen for this purpose. It is possible that antioxidant supplementation and/or nutritional factors could decrease skin aging. The last 10 years have seen an explosion of new treatments for prevention and reversal of skin aging.

Vitamin A Derivatives (retinoids)- tretinoin (Retin-A, Renova),tazarotene (Tazorac,Avage), and adapalene (Differin) and various types of retinols.

Of all the topical agents, the prescription retinoid creams have the most scientific evidence demonstrating they can reverse aging changes. Tretinoin has been shown to reduce fine lines, mottled hyperpigmentation (age and liver spots), and sun damage. The main problem with tretinoin and the other retinoids is that many people cannot tolerate the side effects of dryness and irritation that often accompany their use. There is sometimes a period of “retinization” that can last as long as two weeks that causes skin redness, peeling and discomfort. This is one of the reasons retinol creams have become popular – they are not as drying as Retin-A. Although the effects of retinol creams on human skin have been studied far less than that of the Rx retinoids, they hold great promise. A recent study shows that retinol does increase collagen in human skin. Vitamin A derivatives retinoids or retinols) are the cornerstone of any topical antiaging regimen, although people with rosacea and/or sensitive skin would be advised to avoid them as they tend to aggravate the condition by stimulating blood vessel growth. Reference the retinol products: Afirm, Dermal Repair.

What is melasma?

Melasma is a skin condition that occurs on the face in the form of brown patches. A change in hormonal status (higher levels of estrogen) is thought to trigger and be the cause of the condition (i.e. birth control pills, pregnancy), although many women without these risk factors also develop melasma.