Welcome to Derm Day, a regular column where we talk with the best dermatologists in the acne biz about all things breakouts - the good (but wait, is there anything good?), the bad and the ugly.
Today’s installment features Dr. Lavanya Krishnan MD, FAAD, a board certified derm and founder of Arya Derm in San Francisco, CA.
Let’s pretend we want to create an acne dictionary, like an overall guide to acne. We’ll call it The Zitionary - what are the different kinds of acne that should go in it?
There are three different types of acne we see the most with patients.
First, there’s Superficial Acne - pretty mild. It’s usually present on foreheads, noses and t-zones and this person will often struggle with excess oil and sebum.
Next, there’s Inflammatory Acne. This type of acne is a bit deeper than superficial acne, plus will look redder and more inflamed. The cheeks are a hot spot for this type.
Then, there’s Cystic Acne. This is even deeper than the first two and is under the surface of skin. It can be based on genetics, hormones or diets and thrives on jawlines and chins. While it can hit both dry or oily skin - it isn’t picky with who it plagues - we do see it more commonly in people who have oilier skin. It’s the most severe type of acne and is usually pretty painful.
So how do those types play into adult acne vs. teen acne? And what types of treatments do you recommend to patients?
Teen acne can happen between the ages of 9 to early 20’s. It’s usually superficial acne that happens in this time, meaning it’s closer to the surface and causes skin to produce sebum. Teen acne can respond really well to topical treatments - things like salicylic acid, retinoids & chemical exfoliants!
Adult acne happens between late teen years until about 50ish. This acne relates more to the deeper, more cystic type - it’s already under the surface of the skin. It has a stronger hormonal influence and can be caused by stress or diets. There’s really multiple factors as to the ‘why’ for this one, so treatments aren’t as easy and need to be personal to the person.
How do products play into acne? Can using too many have a negative effect?
Oh, absolutely! Products that have excess oil can contribute to both superficial and deep acne as a teenager or an adult. If you remember one thing about acne, it is to always, always, always check your products!
Gotcha! Ok, now what about acne in men vs. women?
Men tend to develop more deep scarring acne than women do.
Scarring is another difficult thing to tackle. Can you talk to us a bit more about that?
There’s two different types of acne scars: ones that change texture and ones that change color.
Texture-changing scars cause changes by binding skin down. There’s a few different types that do this: pitting scars, boxcar scars, deeper scars and rolling scars. These can respond to deeper treatments like chemical peels, microneedling or fillers.
Color-changing scars can be hyperpigmentation (darker) or hypopigmentation (lighter). Both types can be treated with topicals or chemical peels to exfoliate away that dead skin.
When would you say it’s time to see a dermatologist?
When your acne is not being controlled with or responding to over the counter products. If you are using sophisticated products already and seeing no change, then it’s time to come see us.
Acne is very personal and all about trial & error. For example, what works for your friend may not work for you. But there are many treatments that can treat more than one type of acne.
Last question! Let’s play Acne MythBusters. What’s the biggest misconception you hear as a derm?
There are two things I hear the most often:
1. The acne myth
“I can’t get adult acne if I didn’t have acne as a teen!”
The breakout bust
This is untrue but most people believe it. It’s very common to get adult acne if you didn’t have it as a teen. There are many factors at play that can cause this.
2. The acne myth
“Oil-based cleansers are good for my acne-prone skin!”
The breakout bust
No! No! Oil-based cleansers or serums are NOT good for your acne. If you are acne-prone, you should get into the habit of only buying OIL-FREE products.
Interested in visiting Dr. Kishnan IRL? Check out Arya Derm.
About The Expert:
Lavanya Krishnan, MD founded Arya Derm in 2017 after three years of practicing dermatology in San Francisco. A board certified dermatologist specializing in medical and cosmetic dermatology, Dr. Krishnan strives to provide patients with high quality medical care. Her approach combines cutting edge treatments backed by science with a detailed understanding of patient needs.
Originally from Atlanta, Dr. Krishnan completed her undergraduate studies from MIT and attended medical school at Medical College of Georgia and completed her dermatology residency at New York Medical College. When not in the office, Dr. Krishnan enjoys traveling and exploring the world with her husband and young daughter.