Lana Hawayek, MD, FAAD, FASDS, is a board-certified Kelsey-Seybold dermatologist who specializes in cosmetic procedures, including the treatment of acne and acne scarring. We spoke with her about her protocols for this emotionally challenging condition. Page ContentQ. Dr. Hawayek, what made you decide you wanted to specialize in the treatment of acne? I suffered from severe acne at age 19, so I know firsthand how it can impact a person’s psyche and quality of life. It is extremely gratifying to be a part of resolving this issue for others.Q. Why do teenagers typically begin to experience breakouts and what can be done to resolve these?Acne is common in teenagers due to multiple factors: Hormones like testosterone can cause an increase in oil secretion by facial oil glands.Any reason for clogged pores on the face that exacerbate the oil impaction.Propionibacterium acnes: a bacteria in skin glands that causes inflammation. Q. How is teenage acne typically treated?Many of the treatment parameters for teenage acne have been in place for years, so it’s a matter of refining the exact combination of things to use for a patient’s particular needs. These include: Oral and topical antibiotics (used for their antibacterial but mostly their anti-inflammatory effects)Topical retinoids, which provide anti-clogging and anti-inflammatory effectTopical benzoyl peroxide or salicylic acid, which also act to unclog poresThe big breakthrough came with the discovery of isotretinoin, an oral retinoid/Vitamin A derivative that works by shrinking oil glands and, hence, clearing acne for a longer remission time. Q. Do you have a general skincare regimen you recommend for teenagers?Washing the face with a gentle cleanser or soap, morning and evening, especially after doing sports or sweating to decrease the chances of obstructing pores.I explain the regimen of the prescribed topical prescription in detail. Some are to be applied in the morning (for example benzoyl peroxide or topical antibiotics) and some in the evening (typically a retinoid product). For anyone who is acne-prone, I always advise a specific sunscreen that’s non- comedogenic (non-pore-clogging). We are fortunate to have some great products available for this.Q. What about adult acne? Are there different treatment protocols for different life stages?In adult acne, there is usually no end point. In teenage acne, we hope they will grow out of the acne once they are out of their teenage years but, in adults, we don’t know when that end point will be reached. Some adults have acne well into their 50s and 60s. In these cases, I prescribe less of the oral antibiotics (to limit giving them for long periods of time) and more of either isotretinoin, which is a six-month course of treatment, or a medication called Spironolactone which has anti-androgenic effects, meaning it fights male hormones in our bodies, which is one of the root causes of acne, as noted above. The topicals are similar. One topical I like to use in darker skinned patients is azeleic acid, which does not bleach the skin, but treats the issues very well. Q. What about chemical peels for the treatment of acne? I definitely do a lot of chemical peels for patients with acne. Salicylic acid peels are great to treat active acne and also prevent scarring. They work well because salicylic acid is anti-inflammatory (like aspirin's active ingredient) and it is also lipid soluble, so it goes into the oil glands and cleans them from within. It is also a great keratolytic, which means it unclogs pores and peels off the superficial cells that are causing the blockage.Many other peels are available for acne and acne scarring, and many of them are combinations of different peeling solutions in one. It is very customized, depending on the patient’s particular scenario.Q. How is hormonal or menopausal acne treated?I consider this a type of adult acne and treat the same way. Spironolactone works particularly well in these women.Q. Are there effective treatments for acne scarring?Some deeper peels containing tetrachloroacetic acid work well on acne scarring if at least a medium-depth peel is achieved. This requires about a week of downtime.Also, there are several different lasers that improve the appearance of acne scars. A procedure called dermabrasion has also been used successfully to treat acne scarring. Another method for bound-down fibrotic scars is called subscision, in which a fine needle is used to tear the fibrous bands underneath a scar and lift the scar. Some scars are best excised and sutured as a method of treatment. Even dermal fillers have been used to fill certain types of acne scars.It’s important to evaluate what type of acne scars the patient is dealing with as there are different kinds of scars (for example: atrophic, rolling, boxcar, icepick scars) and each responds to different treatment.It is also important for the patient to have realistic expectations when it comes to treatment of acne scarring as there is no treatment currently available that will result in 100% improvement, though we can obtain significant results. Dr. Hawayek cares for patients at Kelsey-Seybold’s location in The Woodlands. Call 713-442-0427 to schedule a consultation with her. To view all of our locations where dermatologists can help with acne treatments, chemical peels and Fraxel laser skin resurfacing for scarring, visit kelsey-seybold.com/cosmeticservices.