WHAT IS ACNE?
Acne is a chronic, inflammatory skin condition that causes spots and pimples, especially on the face, shoulders, back, neck, chest, and upper arms. It is caused by the skin’s oil glands making too much sebum, an oily substance, which leads to plugged pores. It also can be caused by the rapid production of a bacteria P. acnes. It commonly occurs during puberty, when the sebaceous glands activate, but it can occur at any age. It is not dangerous, but it can leave skin scars.
Four main factors cause acne:
- Excess oil production
- Hair follicles clogged by oil and dead skin cells
- Excess activity of a type of hormone (androgens)
Acne typically appears on your face, forehead, chest, upper back and shoulders because these areas of skin have the most oil (sebaceous) glands. The glands produce an oily liquid called sebum.
Sebum carries dead skin cells through the follicles to the surface of the skin. A small hair grows through the follicle out of the skin. Pimples grow when these follicles get blocked, and oil builds up under the skin. Skin cells, sebum, and hair can clump together into a plug. This plug gets infected with bacteria, and swelling results. A pimple starts to develop when the plug begins to break down.
Propionibacterium acnes (P. acnes) is the bacteria that live on the skin and contributes to the infection of pimples.
WHAT TRIGGERS ACNE?
- Hormones:Androgens are hormones that increase in boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy and the use of oral contraceptives also can affect sebum production. And low amounts of androgens circulate in the blood of women and can worsen acne.
- Certain medications:Examples include drugs containing corticosteroids, testosterone or lithium.
- Diet:Studies indicate that certain dietary factors, including skim milk and carbohydrate-rich foods — such as bread, bagels and chips — may worsen acne.
- Stress: Stress can make acne worse.
Risk factors for acne include:
- Age:People of all ages can get acne, but it’s most common in teenagers.
- Hormonal changes:Such changes are common in teenagers, women and girls, and people using certain medications, including those containing corticosteroids, androgens or lithium.
- Family history:Genetics plays a role in acne. If both parents had acne, you’re likely to develop it, too.
- Greasy or oily substances:You may develop acne where your skin comes into contact with oily lotions and creams or with grease in a work area, such as a kitchen with fry vats.
- Friction or pressure on your skin:This can be caused by items such as telephones, cellphones, helmets, tight collars and backpacks.
- Stress:Stress doesn’t cause acne, but if you have acne already, it may make it worse.
Acne pimples vary in size, color, and level of pain.
The following types are possible:
- Whiteheads: These remain under the skin; they are closed and plugged pores.
- Blackheads: Clearly visible, they are black and appear on the surface of the skin
- Papules: Small, usually pink bumps, these are visible on the surface of the skin
- Pustules: Clearly visible on the surface of the skin. They are red at their base and have pus at the top
- Nodules: Clearly visible on the surface of the skin. They are large, solid, painful pimples that are embedded deep in the skin
- Cysts: Clearly visible on the surface of the skin. They are painful and filled with pus. Cysts can cause scars.
TOPICAL MEDICATIONS: The most common topical prescription medications for acne are as follows:
- Retinoids and retinoid-like drugs:These come as creams, gels and lotions. Retinoid drugs are derived from vitamin A and include tretinoin (Avita, Retin-A, others), adapalene (Differin) and tazarotene (Tazorac, Avage). It works by preventing plugging of the hair follicles.
- Antibiotics:These work by killing excess skin bacteria and reducing redness. The antibiotics are often combined with benzoyl peroxide to reduce the likelihood of developing antibiotic resistance. Examples include clindamycin with benzoyl peroxide (Benzaclin, Duac, Acanya) and erythromycin with benzoyl peroxide (Benzamycin). Topical antibiotics alone aren’t recommended.
- Salicylic acid and azelaic acid:Azelaic acid is a naturally occurring acid found in whole-grain cereals and animal products. It has antibacterial properties. Side effects include skin discoloration and minor skin irritation.
Salicylic acid may help prevent plugged hair follicles and is available as both wash-off and leave-on products. Studies showing its effectiveness are limited.
- Dapsone:Dapsone (Aczone) 5 percent gel twice daily is recommended for inflammatory acne, especially in adult females with acne. Side effects include redness and dryness.
- Antibiotics:For moderate to severe acne, you may need oral antibiotics to reduce bacteria and fight inflammation. Usually the first choice for treating acne is tetracycline or a macrolide. Antibiotics may cause side effects, such as an upset stomach and dizziness. These drugs also increase your skin’s sun sensitivity.
- Combined oral contraceptives:They are products that combine estrogen and progestin (Ortho Tri-Cyclen, Yaz, others).
- Anti-androgen agents: The drug spironolactone (Aldactone) may be considered for women and adolescent girls if oral antibiotics aren’t helping. It works by blocking the effect of androgen hormones on the sebaceous glands.
- Isotretinoin:Isotretinoin (Amnesteem, Claravis, Sotret) is a powerful drug for people whose severe acne doesn’t respond to other treatments. Oral isotretinoin is very effective.
THERAPIES: These therapies may be suggested in select cases, either alone or in combination with medications.
- Lasers and photodynamic therapy:A variety of light-based therapies have been tried with some success.
- Chemical peel:This procedure uses repeated applications of a chemical solution, such as salicylic acid, glycolic acid or retinoic acid.
- Extraction of whiteheads and blackheads: Special tools are used to gently remove whiteheads and blackheads that haven’t cleared up with topical medications. This technique may cause scarring.
- Steroid injection:Nodular and cystic lesions can be treated by injecting a steroid drug directly into them. This therapy has resulted in rapid improvement and decreased pain.
WOMEN AND ACNE
Many things can trigger acne in women:
- Hormone changes during puberty: During puberty, girls have an increase in male sex hormones called androgens. This increase causes the glands to get larger and make more sebum.
- Hormone changes as an adult: The menstrual cycle is one of the most common acne triggers. Acne lesions tend to form a few days before the cycle begins and go away after the cycle is completed. Other hormone changes, such as pregnancy and menopause, improve acne in some women. But some women have worse acne during these times.
- Medicines: Certain medicines, such as those used to treat epilepsy and types of depression.
- Pressure or friction on the skin: Friction caused by bike helmets or backpacks can make acne worse.
- Family history: If other people in your family have acne, there is a greater chance you will have it