Acne Is Not The Disease You Think It Is (Part 1)

Recent studies have shown that it can have devastating effects on the quality of life, even when the expression of the disease is mild or moderate. Many people who do not or have not experienced acne assume it is just a minor nuisance and primarily affects teens, not significant to one’s quality of life and that the adolescents affected by it will soon outgrow it. People who suffer with it, whether children or adults, know better.  Now science is substantiating what sufferers of acne know. 

Acne is associated with embarrassment, self-consciousness, anger, anxiety and depression psychologically. Socially, it is associated with problems dating, being gainfully employed and school attendance.  Additionally, it has been shown that the clinical presentation may not be indicative of the quality of life. (Zaenglein Al, et al, J. Of Am Acad Dermatolol. 2016;74:945-973)

Importantly, acne is not just a disease of teenagers. Fifty million people in the US have acne, including 85% of teens.  Acne persists with sufferers into the 20’s in 64% and into the 30’s in 43%. Acne in any form whether facial or truncal affects the quality of life.

What does all this mean for people with acne?  It is a powerful argument for early, aggressive treatment of acne to mitigate the stresses it creates, but also prophylactic, preventative treatment as well as long as the acne tendency is manifest.  

Beside the quality of life issues acne creates, disfigurement from scarring, mild or moderate to severe, is also a very important reason to treat early, aggressively and preventatively. Why?  No one really looked hard at how easily or why acne scars and how it may affect sufferers of acne that is even mild clinically.  Acne is an inflammatory disease with many factors that determine what type and degree of acne one gets, but even mild acne scars. 83% of scarring occurs from the post-inflammatory stages of the lesions when they are red or hyperpigmented. Only 17% of scarring occurs from the papule stage (red bumps.) 43% of people with acne experience scarring and 69% had only mild to moderate acne at the time they were evaluated. (Tan J. J Drugs Dermatol; 2017;16:97-102)  Patients with severe inflammatory acne are 3.4 to 6.8 times more likely to scar and patients who do not have early treatment are 1.6 to 2.8 time more likely to scar then they would have been with early therapeutic intervention. (Eichenfield LF, et al. Pediatrics 2013:131:S163-S186) Compelling reasons for early and aggressive treatments.  It is even more important in skin of color acne patients, who have even more inflammation and scarring potential than lighter skinned people.  Even their blackheads show intense inflammation unlike lighter skin types.  The concept of treating all acne prone areas instead of just currently affected areas has recently been shown to be important because acne prone areas have been shown to exhibit abnormal inflammation even without active lesions. That is why one does not just spot treat acne lesions.

The next blogs on acne will discuss medical treatment of acne, the device-based treatment of acne and acne scarring, including lasers, IPL, micro-needling, gold particle massage and Infra-red treatment, Photodynamic therapy and light devices, and a last blog on what’s new and coming for acne treatment.