Acne

Acne is a condition in which the pores of the skin become clogged, inflamed, and sometimes infected. These clogged pores can result in blackheads, whiteheads, or pimples. Acne tends to occur in teenagers, but can also occur in adults.

 

Causes

Acne starts in the skin's sebaceous glands, which secrete an oily substance called \"sebum.\" The sebum normally travels from the sebaceous gland to the skin's surface via a tiny hair follicle. But with acne, the sebum becomes trapped, sometimes mixing with dead skin cells and bacteria, causing a clogged pore called a \"comedo\" (plural: \"comedones\"). Blackheads are comedones that reach the skin's surface, while whiteheads are comedones that stay beneath the surface of the skin. Small red bumps, pimples, and cysts may also develop. Contrary to popular myths, chocolate, greasy foods, and dirty skin have not been shown to cause acne.

The main causes of acne include:
  • Changes in levels of hormones called androgens
  • Increased sebum production
  • Changes inside the hair follicle
  • Bacteria

Risk Factors

A Risk Factor is something that increases your chances of getting a disease or condition.
  • Age: Between 12 and 24 years old
  • Race: Caucasian
  • Changes in hormone levels (such as during puberty, the menstrual cycle, or pregnancy)
  • Stress
  • Certain medications (such as androgens, lithium, and barbiturates)

Symptoms

The symptoms of acne vary from person to person and can range from mild to severe. They include:
  • Excess oil in the skin
  • Blackheads
  • Whiteheads
  • Papules - small pink bumps that may be tender to the touch
  • Pimples - inflamed, pus-filled bumps that may be red at the base (also called \"pustules\")
  • Nodules - large, painful, solid lumps that are lodged deep within the skin
  • Cysts - deep, inflamed, pus-filled lumps that can cause pain and scarring

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. A doctor will examine the areas of your skin with the most sebaceous glands, where acne is most likely to occur. These are the face, neck, back, chest, and shoulders. You may be referred to a doctor who specializes in skin disorders (a dermatologist).

Treatment

There are several over-the-counter and prescription medications for acne. Some are applied directly to the skin (topical medication), others are taken by mouth (oral medication), and others are injected into the acne cysts or pustules. Most cases of acne require a combination of oral, topical, and surgical treatments. Some treatments may take several weeks to work, and your skin may actually appear to get worse before it gets better.

Over-the-counter Topical Medications
These include cleansers, creams, lotions, and gels aimed at reducing the amount of oil and/or bacteria in the pores. They may contain one or more of the following ingredients:
  • Benzoyl peroxide
  • Salicylic acid
  • Sulfur
  • Resorcinol
Prescription Topical Medications
These include cleansers, creams, lotions, and gels aimed at reducing the amount of oil and/or bacteria in the pores. They include:
  • Benzoyl peroxide
  • Sulfur
  • Resorcinol
  • Salicylic acid
  • Antibiotics, such as clindamycin phosphate (Cleocin T), erythromycin, tetracylcine HCL
  • Tretinoin (Retin-A, Avita)
  • Adapalene (Differin)
  • Azelic acid (Azelex)
Prescription Oral Medications
These include antibiotics, medications for hormone-related acne, and vitamin A derivatives called \"retinoids.\" They are generally reserved for moderate to severe cases of acne, in which topical treatments are not strong enough.

Oral Antibiotics - aimed at controlling the amount of bacteria in pores include:
  • Erythromycin
  • Tetracycline
  • Doxycycline
  • Minocycline
  • Clindamycin
  • Ampicillin
  • Cephalosporins
  • Trimethoprim-sulfamethoxazole
Oral Medications - aimed at controlling androgen levels include:
  • Birth control pills (in female patients)
  • Prednisone
  • Dexamethasone
  • Spironolactone
Oral Retinoids - aimed at reducing the size and secretions of sebaceous glands include:
  • Isotretinoin (Accutane). This is a potent drug used only for severe cases of cystic acne. It must not be taken by women who are pregnant or who may become pregnant, because of the risk of serious birth defects.
Intralesional Corticostreoids
This is mostly used for large, cystic acne lesions. A steroid preparation is injected directly into the pustule.

Acne Surgery
Specialized extractors and/or scalpels are used to open, drain, and remove the contents of acne lesions. Multiple lesions can be removed per session. May require repeated sessions.

Acne Scar Revision
Procedures performed to minimize acne scars. Scar revision procedures include dermabrasion (essentially sandpapers the skin to smooth it out), scar excision (uses a tiny punch tool or a scalpel to remove scars), and gelatin matrix collagen implants and bovine dermal collagen implants (which fills in the pits of scars with a collagen substance).

Prevention

It can be difficult to prevent acne from occurring, because it can be difficult to control the factors that cause it. But there are some things you can do to keep your acne from getting worse:
  • Don't wash your face too often. This can irritate the skin and actually make acne worse. Two to three times per day is plenty.
  • When washing your face:
  • Use your hands rather than a washcloth.
  • Use mild soap to wash your face rather than a harsh \"acne cleanser.\"
  • Allow your face to thoroughly dry before applying any topical preparations.
     
  • Don't pick at or squeeze blemishes.
  • Use lotions, soaps, and cosmetics labeled \"noncomedogenic.\" These won't clog your pores.
  • Use topical acne treatments only as directed. Using them more often could make the condition worse.
  • Recognize and limit emotional stress.
  • Be sure to wear sunscreen year-round. This is especially important if you are taking antibiotics. Antibiotics make your skin more sensitive to the sun.