Acne
Women and Acne
When it comes to acne issues, women sometimes have a larger burden to bear. Lament it as we might, they’re often judged more on looks than men. Their hormonal systems make them more prone to developing acne at certain times. Treatment options can be more expensive for them and costs harder to meet.
During the teen years, girls tend to develop acne sooner than boys. On average most girls will start to develop acne by about age 11, as contrasted with age 13 for boys. The reason isn’t hard to find. Girls mature sooner. They tend to enter puberty a few months to a couple of years before boys.
During those years the human hormone system sees rapid increases in levels of a number of well known hormones, such as estrogen or testosterone. But there’s a class of hormones that are less well known by name, but more relevant at this stage to acne onset: androgens.
As the name suggests, these hormones are shared by both males and females. But, as noted, the rise in females occurs sooner. Once they reach puberty, the androgen levels rise higher in males, so they tend to suffer more severe acne.
About 2/3 of all teens will develop acne, at least in mild form. But for females, the condition tends to last longer, at least cyclically. As a woman enters her 20s, her menstrual cycle tends to raise the likelihood of developing at least mild acne. Since that occurs approximately once per month, so does the acne. The week prior to the onset of flow is typically the worst for almost 62% of women.
The problem persists for women throughout the years of reproductive capacity. Over 50% of women (as opposed to only 42.5% of men) between ages 20-29 develop acne. The numbers dip radically for the years 30-39 to 35.2% and 20.1% respectively. By the time she’s reached her 40s, the number has lowered to 26.3% (12% for men). For those aged 50 and older the numbers are about 15% and 7% for women vs men.
The severity follows a similar pattern. Between the third and fourth weeks of the menstrual cycle, inflammations increase about 25%. Even blackheads and whiteheads rise about 20% during this time.
Pregnancy offers some relief, but it mostly shifts the pattern. It doesn’t eliminate acne entirely. During pregnancy, breakouts can occur at random. Skin changes, even for those who have never had acne, are a common occurrence when a woman is carrying.
Here again, significant hormonal changes are taking place. The largest number of cases tends to occur during the first trimester. That shouldn’t be surprising, since this is the interval during which hormone levels are changing most rapidly from their usual amount and distribution. Delivering the baby will often put an end to the outbreaks, but they tend to persist longer in women who breastfeed.
Though a woman has to always be more careful about what medications she takes, normal over the counter treatments are considered safe. Some studies have suggested, however, that isotretinoin (brand name: Accutane) and tetracycline (doxycycline), treatments for severe acne, should be avoided during pregnancy. They may cause birth defects or development problems in the fetus.
When in doubt, consult a dermatologist.
Acne Scars and Their Treatment
The unsightly appearance of acne lesions or pimples isn’t the only potential problem with the disease, unfortunately. In some cases, it’s possible for acne to leave permanent scars.
Some conditions may appear to be scars that are not. Macules and other bumps can occur even after acne is treated. Redness may persist for up to a year. But these aren’t true scars. They’re not permanent.
True scars are a permanent change to skin tissue produced by the healing process itself, chiefly creating fibrous tissue. As white blood cells attack bacteria they can produce changes in underlying skin cells in the surrounding area. This is one way scars become permanent.
They may also not be limited to areas under the surface.
So-called icepick scars are small pinholes that form in the surface of the skin. They look as if the skin has been poked with an icepick, hence the name. They’re typically too deep to be treated with simple dermabrasion or even laser resurfacing.
Boxcar scars are similar, except they tend to be flatter on the bottom, rather than narrowing to a point like icepick scars. Since they’re often shallower they can sometimes be treated with resurfacing techniques.
Keloid scars are firm and grow beyond the site of the injury. They’re characterized by an excess production of collagen. They often result in a shiny pink or red scar.
Prevention is the best option, of course. But when that’s not possible, there are a number of standard treatments.
Dermabrasion
Dermabrasion is used to treat a wide range of skin conditions, including mild to moderate acne scarring. A local anesthetic is given and the professional uses a high speed brush to remove layers of skin. The skin then naturally regenerates, minus the scar in many cases. When it’s not entirely removed, it’s often less obvious.
A variation on the technique is known as microdermabrasion. Instead of a high speed brush, aluminum oxide crystals are moved rapidly through a type of vacuum hose. They carry away skin cells on their way to being collected. It’s less invasive or traumatic to the skin, but the results may, therefore, be less.
Lasers
Laser treatment can be effective for some patients. Used well, they can change the contour and size of scars. CO2 lasers are often used to remove some tissue. Sometimes a single treatment is enough, but redness can persist for several weeks afterward. Lasers work in these types of treatment, essentially, by burning.
Surgery
A technique called ‘punching’ can be used to remove some icepick scars. The scar is excised down to subcutaneous fat and the resulting hole repaired. The repair may be done with sutures or a small skin graft.
Subcisions may be performed. These involve actually lifting the scar tissue away from unscarred skin. Results are mixed, but the technique can be effective.
Drugs
Keloids don’t respond well to these mechanical techniques, since altering the skin often just provokes the formation of more keloids. Sometimes a topical retinoid is applied. In other cases steroid-type drugs are injected directly into the skin around the scar. They’re difficult to treat by any means and results vary widely from person to person.
Whatever treatment method you seek, it’s important to consult a professional for proper diagnosis. That’s the best way to find out about all the available alternatives, and their potential risks and benefits.
