Acne

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Acne is the term for plugged pores (blackheads and whiteheads), pimples, and deeper lumps (cysts or nodules), that occur on the face, neck, chest, back, shoulders and even the upper arms. Most teenagers have some acne. However, adults in their 20's, even into their 40's or older, can get acne. Acne often clears up after several years even without treatment, but you need not wait to outgrow it. Untreated acne can leave scars, which can be treated by your dermatologist as well.

While not a life threatening condition, acne can be upsetting and disfiguring. Acne can also lead to serious and permanent scarring.

How Acne Forms
Male hormones found in both males and females rise during adolescence (puberty) and stimulate and enlarge the oil (sebaceous) glands of the skin. These glands are found in areas where acne is common (the face, upper back, and chest). Rarely, acne can be due to a hormonal imbalance.

The oil glands are connected to a hair-containing canal called a follicle. The sebaceous glands make an oily substance called sebum which reaches the skin surface by emptying through the skin surface opening of the follicle. The hair follicle opening is sometimes called the pore. The oil (sebum) causes the cells from the follicular lining to shed more rapidly and stick together, forming a plug at the hair follicle opening. Bacteria grow in the mixture of oil and cells in the follicle. These bacteria make chemicals that stimulate inflammation and cause the wall of the follicle to break. The sebum, bacteria, and shed skin cells spill into the skin causing redness, swelling, and pus - a pimple.

Cleansing
The black in a blackhead is dried oil and shed skin cells in the openings of the hair follicles, not dirt. For the normal care of your skin, wash your face with soap and warm water twice a day. Acne is not caused by dirt. Washing too often or too vigorously may actually make your acne worse. Regular shampooing is also recommended. If your hair is oily, you may want to wash it more often. Your dermatologist can recommend the best face and hair washing routine.

Men with acne who shave should try both an electric and a safety razor to see which is more comfortable. If you use a safety razor, soften your beard thoroughly with soap and warm water before applying shaving cream. To avoid nicking pimples, shave as lightly as possible. Shave only when necessary and always use a sharp blade.

Diet
Acne is not caused by the foods you eat. Dermatologists have differing opinions on the importance of your diet in the management of acne. One thing is certain; a strict diet by itself will not clear your skin. On the other hand, if certain foods seem to make your acne worse, then try to avoid them. But be careful about jumping to conclusions, acne may get better or worse on its own. It is always important to eat a well balanced diet.

Sunlight
A tan can mask your acne, but the benefits are temporary. Since sunlight ages the skin and can cause skin cancer, you should not sunburn, "bake in the sun," or use sunlamps. Choose a sunscreen that is oil-free, such as a gel or light lotion.

Cosmetics
If you wear a liquid foundation or use a moisturizer, look for ones that are oil-free and not just water-based. Choose products that are "non-comedogenic" (should not cause whiteheads or blackheads) or "non-acnegenic" (should not cause acne). Remove your cosmetics every night with soap and water.

A flesh-tinted acne lotion containing benzoyl peroxide, salicylic acid or sulfur can safely hide blemishes. Loose powder mixed with oil-free product is also good for cover-up.

Shield your face when applying hairsprays and gels.

Treatment
Control of acne is an ongoing process. All acne treatments work by preventing new acne. Existing blemishes must heal on their own. Improvement takes time. If your acne has not improved after 6 to 8 weeks, you may need a change in your treatment.

The treatment your dermatologist recommends will vary according to your type of acne. Occasionally, an acne-like rash can be due to another cause - such as from makeup, lotions, or from an oral medication. It's important to help your dermatologist by providing a history of what you are using on your skin or taking internally.

Many non-prescription acne lotions and creams help milder cases of acne. However, many will also make your skin dry if used too often. If you use these products, follow instructions carefully.

Your dermatologist may prescribe topical creams, gels or lotions with vitamin A acid or benzoyl peroxide to help unblock the pores and reduce bacteria. These products may cause some drying and peeling. Your dermatologist will advise you on the correct use and how to handle side effects.

There are also antibiotics that are applied to the skin. These are used in less severe cases of acne. When large red bumps (cysts) are present, the dermatologist may inject cortisone directly into the bumps to help them go away.

Your physician may open pimples or remove blackheads and whiteheads. Don't pick, scratch, pop or squeeze your pimples yourself. When the pimples are squeezed, more redness, swelling, inflammation and scarring may result.

Antibiotics taken by mouth such as tetracycline, doxycycline, minocycline or erythromycin are often prescribed for moderate or severe cases, especially when there is a lot of acne on the back or chest. Antibiotics reduce the bacteria in the follicle and may also decrease the skin redness directly. When taking oral antibiotics, some women may develop a vaginal yeast infection. If this occurs, discontinue your medicine and contact your dermatologist immediately for treatment of the yeast.

Mild acne vulgaris

Women who are taking birth control pills may notice a significant improvement in their acne, and these pills are sometimes used specifically for the treatment of acne. It is also important to know that oral antibiotics may decrease the effectiveness of birth control pills. This is uncommon but possible, especially if you notice break-through bleeding. As with most medicines, check with your doctor about taking antibiotics if you are pregnant or nursing, or if you are trying to get pregnant.

In cases of severe acne, other drugs may be used. These may include female hormones or medications that decrease the effects of male hormones. Another oral medication, isotretinoin is sometimes used for severe acne that has not responded to other treatments. Patients using isotretinoin must thoroughly understand the side effects of this drug. Frequent follow-up visits are necessary to monitor side effects. Prevention of pregnancy is a must, since the drug causes severe birth defects if taken during pregnancy.

Moderate Acne

Treatment of Acne Scarring
Should scarring be already present prior to treatment or be a residual of treatment, your dermatologist can treat these scars by a variety of methods. Combination skin resurfacing with laser, dermabrasion, chemical peeling or electrosurgery, can flatten depressed scars. Soft tissue elevation with collagen, filling products or fat can elevate scars. Scar revision by your dermatologic surgeon with a microexcision and punch grafting can correct pitted scars, and combinations of these dermatologic surgical treatments can make noticeable differences on the appearance of the scars.

Proper care is necessary
No matter what special treatments your dermatologist may use, remember that you must continue proper skin care until the tendency to have acne has passed. There is no instant or permanent cure for acne, but it is controllable, and proper treatment may prevent scars.

Severe nodular acne

More information on acne.
Locate a dermatologist in your area.

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