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As many as 50 million Americans experience acne each year. Despite how commonplace acne is, dermatologists still have a lot to learn about its pathogenesis, epidemiology, and treatment. Here, Quenby Erickson, DO, FAAD, FACMS, of Erickson Cosmetic Dermatology, Laser & MedSpa in Chicago, discusses some recent advances in acne prevention and treatment and what they mean for patients.

What has been the most exciting discovery in acne in the past year?

Quenby Erickson, DO: The most exciting discovery for the treatment of acne in the past year, if not in the past two decades, is Cutera’s Aviclear, a laser treatment that provides results similar to oral isotretinoin, with only three treatments given one month apart. We finally have a treatment option that avoids the potential side effects of oral isotretinoin, such as depression, elevated triglycerides, possible liver damage, bone and joint pain, birth defects with fetal exposure, and the possible association with irritable bowel syndrome.

Speaking of isotretinoin, do you prescribe it to your acne patients?

Dr. Erickson: Isotretinoin is a medication that works very well, but the side effect profile and risk of birth defects if mistakenly taken during pregnancy makes using the medication very challenging. For these reasons, I have not prescribed it in more than 10 years and have become known for using alternative methods to help people avoid using isotretinoin.

What are some of the biggest misconceptions about acne?

Dr. Erickson: The biggest misconception about acne that I encounter is when patients think what they are doing (e.g., washing their face with the wrong products) or what they are eating (dairy or junk food) is causing their acne. This myth is dispelled by educating them about the pathogenesis of acne.

What is the current thinking about antibiotics to treat or prevent acne?

Dr. Erickson: Current thinking about treating acne with oral antibiotics is that it is sometimes necessary, but that long-term treatment is not ideal and likely contributes to antibiotic resistance as well as disturbing the proper gut flora.

How has the understanding of acne changed throughout your career?

Dr. Erickson: Over the course of my 20-year career in dermatology, my understanding of acne has evolved from thinking that it was mainly a teenager issue and that adult acne was much more uncommon to realizing that adult acne is very prevalent and is challenging to treat without using long-term oral medications.

Is compliance the main barrier to acne treatment?

Dr. Erickson: Compliance can be a barrier to successful acne treatment, mainly because patients really do not want to be on oral medications and find some of the topical treatments difficult to tolerate.

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