Dermatology Center of Northwest Houston Dermatology Center of Northwest Houston - Lisa D Hitchins MD : (281) 256-2000
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AcneAcne is a common skin disorder that is caused by hormone action on the sebaceous glands (oil secreting glands) of the skin. Hormones act on the skin's oil glands and hair follicles leading to clogged pores and lesions which we commonly call pimples. These usually form on your face, neck, back, chest, and shoulders. Even though acne does not lead to a serious health problem, it can lead to emotional disturbances such as low self esteem. When it is severe, it can even leave behind permanent scars.

The sebaceous glands secrete an oily substance called sebum that is normally carried out to the skin surface through the tiny opening of the hair follicle, called a pore. The hair, sebum, and dead skin cells in the follicle may form a plug that prevents sebum from reaching the skin surface. The bacteria Propionibacterium acnes (P. acnes) found normally on your skin start to grow in these follicles and cause inflammation. When this plug breaks down, it causes pimples.

There are many types of pimples.  The most common types include:

  • Whiteheads: These pimples form under the surface of the skin and appear as a small white bump on the skin
  • Blackheads: These pimples form on the skin surface and are black in color
  • Papules: These are small pink bumps that can be painful when you touch them
  • Pustules: These pimples appear red at their base and are filled with pus
  • Nodules: These are large, painful, solid pimples
  • Cysts: These are deep, painful, pus-filled pimples and can cause scars


Acne is common in teenagers because of excessive hormone production of androgens during puberty. These hormones make the oil glands produce more sebum and also clog the pores of your skin. It can also occur as a result of hormonal changes during pregnancy or when birth control pills are started or stopped. In addition heredity may also play a role, where it runs in families. The use of certain drugs containing lithium and oily creams can also contribute to acne. In women, acne frequently worsens at the time of menstruation.


Acne is often treated by medicines that may be applied to the skin or taken by mouth. There are several over-the -counter medicines used, the most common ones are Benzoyl peroxide, Resorcinol, Salicylic acid, and Sulfur.

These medicines are available in many forms like gels, lotions, creams, or soaps. Prescription medicines such as antibiotics or Accutane (vitamin A derivative) are recommended if the problem persists.

Skin Care Tips

Practicing some skin care tips may prevent acne from developing or becoming worse.

  • Cleanse your skin gently with a mild cleanser twice a day. Avoid using strong soaps or rough scrubs as overstimulation can make the problem worse
  • After cleansing, astringent solution can be used to wipe off excess oil. Do not try to squeeze the lesions as this can lead to permanent scarring
  • Use cosmetics sparingly, and make sure to use products labeled "oil-free" and "non-comedogenic" which means it won’t block your pores and aggravate the condition
  • Protect your skin from tanning by wearing a sunscreen daily

Spironolactone Therapy for Recalcitrant Acne

Spironolactone Therapy for Recalcitrant AcneAcne is a skin condition which causes whiteheads, blackheads, and inflamed red lesions to form on the skin.  Recalcitrant acne is a condition where acne does not respond to any of the common treatments. Acne is caused from an over production of oil (sebum). Sebum is produced by androgens, one of the hormones secreted by the ovaries, which also increases hair follicle production.

Women with too much androgen, a condition called hyperandrogenism, can exhibit recalcitrant acne, truncal obesity, hair loss, hirsutism (excessive hairiness), infertility, polycystic ovaries (PCOs), and irregularities in menstrual cycle. Recalcitrant acne can be treated with hormonal preparations such as estrogen, oral contraceptive pills, and low-dose glucocorticoids. These hormones possess anti-androgenic characteristics and help in decreasing the production of androgen.  Your dermatologist may recommend treating your symptoms with Spironolactone if hormonal preparations are unsuccessful in resolving your symptoms.


Spironolactone has been widely used for over 50 years to treat fluid retention, mild high blood pressure, and a few rare hormonal problems. It was subsequently found to be highly effective in the treatment of certain hormonally-related conditions in women, including adult acne, unwanted facial or body hair, and pattern hair loss of the scalp. Spironolactone is used for treatment of acne in female patients who are resistant to any other treatment. It lowers the production and circulation of androgens which in turn reduces the follicle and sebum production. Spironolactone acts as anti-androgen where the androgen receptor is blocked and inhibits 5α-reductase enzyme activity in androgens.

Spironolactone is taken regularly for 4 months to have a beneficial effect.  If the result is effective, then it can be continued for 6 to 12 months.

Spironolactone should not be used with drugs called angiotensin converting enzyme (ACE) inhibitors. If your blood pressure is normal, spironolactone will not affect it. If you are being treated for high blood pressure now, please tell Dr. Hitchins as spironolactone may increase their effect. This drug is not safe for pregnant women and is not to be used by men as it can cause feminization. Also it is not prescribed for any patients with kidney related disorders. Potassium and salt contents in food, whole-grain cereals, chickpeas, potatoes, and bananas should be avoided.

In women this treatment may cause irregularity in their menstrual cycle. Hence, spironolactone plus oral contraceptives such as OrthoTricyclin or OrthoCyclen is an excellent combination treatment for androgenic acne.

Acne Scar Revision

Acne is a common skin condition that about 80% of people develop in their teenage years. Often, acne may resolve itself without leaving behind permanent marks on the skin; however certain individuals may get displeasing acne scars. If any skin defects remain even after 1 year, it is considered to be a permanent defect or scar.

New Techniques for Acne Scar Revisions

Types of Acne Scars

Acne scars can be classified into two major types based on the response of the tissues to the inflammation as follows:

  • Scars formed by increased tissue formation-Hypertrophic or Keloid scars
  • Scars formed by loss of tissue
    • Ice-pick scars
    • Boxcar scars
    • Rolling scars
    • Depressed fibrotic scars
    • Superficial and deep soft scars
    • Atrophic macules

Treatment Options

There are several new techniques available for acne scar revision and your dermatologist will discuss the most suitable option for your particular situation.

  • Chemical peel: This technique involves applying a high-potency acid to remove the top layer of the skin. New skin forms within 15days. It is helpful to treat small scars. It is necessary to protect your skin from the sun exposure after a chemical peel is done to prevent further irritation

  • Dermabrasion: This procedure is performed at your doctor’s office under local or general anesthesia. Your doctor will abrade the top layer of your skin with a handheld device which moves in a back and forth or in a circular motion over the skin. Cold compresses are used to control bleeding and the area will be covered with a sterile dressing

  • Laser resurfacing of scars: This is a newer technology used to treat depressed acne scars. The tissue penetration power of a YAG laser helps to improve the scars and the infrared beam of the carbon dioxide laser may be used to elevate depressed scars by tightening the collagen fibers. After the treatment, antibiotics will be prescribed to help healing and a surgical dressing is applied. You can resume normal activities within 2 weeks

  • Soft-tissue augmentation: This technique is used to treat scars caused by loss of tissue. Your doctor may inject fat fillers such as collagen, hyaluronic acid, or polymethylmethacrylate (PMMA) into subcutaneous fat below the scars to elevate the scar to skin surface level and give your skin an even surface. Repeated treatments may be recommended

  • Intralesional steroid injection: Steroids are directly injected into the scars. This helps to improve keloid scars

  • Excisional surgery: Acne scar surgery is considered the most effective treatment method to treat depressed acne scars. It aims to convert a bigger, deep scar to a smaller, flat scar which can be treated with laser resurfacing. All these techniques are performed under anesthesia

    • Punch excision - Punch excision is a technique used to correct icepick and deep boxcar scars. In this method a round, sharp and small sized (matched to the size of the scar) punch biopsy tool is used to remove the entire defect. The edges will be sutured

    • Punch elevation - Punch elevation is a technique used for wide boxcar scars. A punch tool similar to a punch excision tool is used to excise the base of the scar but the walls of the scar remain intact. After the scar is removed, the remaining basal tissue is then raised to the surface of the skin and attached with sutures or steri-strips

    • Subcutaneous incision - This technique is used to treat rolling and depressed scars. A special needle is inserted under the skin to separate the skin from the scarred surface. The scarred surface will then be flattened

    • Shave Excision - Shave excision is a technique to treat elevated and hypertrophic scars or keloids. The scar is removed with a flexible blade or scalpel to bring it in level with the surrounding skin

    • Fusiform (Elliptical) Excision - This commonly used technique is preferred for elevated and hypertrophic scars as well as depressed wide scars

It is important to remember when undergoing any treatment for acne scars that improvement is the goal. Several treatments may be necessary to achieve optimal correction. Combining these different procedures may be needed to better address individual problems. Additional sessions to treat other areas or to retreat previously addressed areas can be scheduled at monthly intervals.

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