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 and greasy foods have not been shown to cause acne.
The main causes of acne include:
- Changes in levels of male hormones called androgens
- Increased sebum production
- Changes inside the hair follicle
- Bacteria
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
- Pregnancy
- Before a menstrual period
• 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. The doctor will examine the areas of your skin with the most sebaceous glands, which is where acne is most likely to occur. These are the face, neck, back, chest, and shoulders. In some situations (usually only if your acne is severe), 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. Acne may require a combination of oral, topical, and surgical treatments (although, most acne does not require surgery). 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 Medication
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 (Cleocin T), erythromycin, tetracycline
• Tretinoin (Retin-A, Avita)
• Adapalene (Differin)
• Azelaic acid (Azelex)
• Tazarotene (Tazorac)
Prescription Oral Medications
These include antibiotics, medications for hormone-related acne, and vitamin A derivatives called "retinoids." They are generally used for moderate to severe cases of acne.
Oral Antibiotics - aimed at controlling the amount of bacteria in pores. These drugs include:
• Erythromycin
• Tetracycline
• Doxycycline
• Minocycline
• Clindamycin
• Ampicillin
• Cephalosporins
• Trimethoprim-sulfamethoxazole
Oral Medications - aimed at controlling androgen levels. These drugs include:
• Birth control pills (in female patients)
• Prednisone
• Dexamethasone
• Spironolactone
Oral Retinoids - aimed at reducing the size and secretions of sebaceous glands. The main drug in this category is 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 Corticosteroids
The injection of a steroid preparation directly into the cyst. This treatment is mostly used for large, cystic acne lesions.
Acne Surgery
Specialized (comedo) extractors are used to open, drain, and remove the contents of acne lesions. Multiple lesions can be removed per session. May require repeated sessions. If you are considering this surgery, discuss the risks, such as scarring and infection, with your surgeon.
Acne Scar Revision
These are procedures done to minimize acne scars. Scar revision procedures include:
• Chemical peels – glycolic acid and other chemical agents are applied to loosen blackheads and decrease acne papules
• Dermabrasion – "sandpapers" the skin to smooth it out
• Scar excision – uses a tiny punch tool or a scalpel to remove scars
• Collagen fillers – fill the pits of scars with a collagen substance
• Laser resurfacing – a laser is used to remove scars and tighten underlying skin
If you are considering one of these treatments, discuss the risks, such as scarring and infection, with your doctor or surgeon.
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:
• Gently wash your face with mild soap and warm water twice a day (no more than twice) to remove excess oil. Scrubbing or washing too often can make acne worse.
• When washing your face:
- Use your hands rather than a washcloth.
- Use mild soap rather than a harsh "acne cleanser."
- Allow your face to thoroughly dry before applying any topical preparations.
• 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 your condition worse.
• Recognize and limit emotional stress.
• Wear sunscreen year-round. This is especially important if you are using medications. Medications can make your skin more sensitive to the sun.
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