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What Is Acne?
Acne is a disorder resulting from the action of hormones and other substances on
the skin's oil glands (sebaceous glands) and hair follicles. These factors lead
to plugged pores and outbreaks of lesions commonly called pimples or zits. Acne
lesions usually occur on the face, neck, back, chest, and shoulders. Although acne
is usually not a serious health threat, it can be a source of significant emotional
distress. Severe acne can lead to permanent scarring.
People with acne frequently have a variety of lesions. The basic acne lesion, called
the comedo, is simply an enlarged and plugged hair follicle. If the plugged follicle,
or comedo, stays beneath the skin, it is called a closed comedo and produces a white
bump called a whitehead. A comedo that reaches the surface of the skin and opens
up is called an open comedo or blackhead because it looks black on the skin's surface.
This black discoloration is due to changes in sebum as it is exposed to air. It
is not due to dirt. Both whiteheads and blackheads may stay in the skin for a long
time. Other troublesome acne lesions can develop, including the following:
- Papules – inflamed lesions that usually appear as small, pink bumps on the skin
and can be tender to the touch
- Pustules (pimples) – papules topped by white or yellow pus-filled lesions that may
be red at the base
- Nodules – large, painful, solid lesions that are lodged deep within the skin
- Cysts – deep, painful, pus-filled lesions that can cause scarring.
What Causes Acne?
The exact cause of acne is unknown, but doctors believe it results from several
related factors. One important factor is an increase in hormones called androgens
(male sex hormones). These increase in both boys and girls during puberty and cause
the sebaceous glands to enlarge and make more sebum. Hormonal changes related to
pregnancy or starting or stopping birth control pills can also cause acne.
Another factor is heredity or genetics. Researchers believe that the tendency to
develop acne can be inherited from parents. For example, studies have shown that
many school-age boys with acne have a family history of the disorder. Certain drugs,
including androgens and lithium, are known to cause acne. Greasy cosmetics may alter
the cells of the follicles and make them stick together, producing a plug.
Factors That Can Make Acne Worse
Factors that can cause an acne flare include:
- Changing hormone levels in adolescent girls and adult women 2 to 7 days before their
menstrual period starts
- Oil from skin products (moisturizers or cosmetics) or grease encountered in the
work environment (for example, a kitchen with fry vats)
- Pressure from sports helmets or equipment, backpacks, tight collars, or tight sports
uniforms
- Environmental irritants, such as pollution and high humidity
- Squeezing or picking at blemishes
- Hard scrubbing of the skin
- Stress.
Myths About the Causes of Acne
There are many myths about what causes acne. Chocolate and greasy foods are often
blamed, but there is little evidence that foods have much effect on the development
and course of acne in most people. Another common myth is that dirty skin causes
acne; however, blackheads and other acne lesions are not caused by dirt. Stress
doesn't cause acne, but research suggests that for people who have acne, stress
can make it worse.
Who Gets Acne?
People of all races and ages get acne. It is most common in adolescents and young
adults. An estimated 80 percent of all people between the ages of 11 and 30 have
acne outbreaks at some point. For most people, acne tends to go away by the time
they reach their thirties; however, some people in their forties and fifties continue
to have this skin problem.
How Is Acne Treated?
The goals of treatment are to heal existing lesions, stop new lesions from forming,
prevent scarring, and minimize the psychological stress and embarrassment caused
by this disease. Drug treatment1 is aimed at reducing several problems that play
a part in causing acne:
- abnormal clumping of cells in the follicles
- increased oil production
- bacteria
- inflammation.
Depending on the extent of the problem, you may be recommended one of several over-the-counter
(OTC) medicines and/or prescription medicines. Some of these medicines may be topical
(applied to the skin), and others may be oral (taken by mouth). The doctor may suggest
using more than one topical medicine or combining oral and topical medicines.
Treatment for Blackheads, Whiteheads, and Mild Inflammatory Acne
We usually recommend an topical medicine for people with mild signs of acne. Topical
medicine is applied directly to the acne lesions or to the entire area of affected
skin.
There are several topical medicines used for mild acne. Each works a little differently.
Following are the most common ones:
- Benzoyl peroxide – destroys P. acnes, and may also reduce oil production
- Resorcinol – can help break down blackheads and whiteheads
- Salicylic acid – helps break down blackheads and whiteheads. Also helps cut down
the shedding of cells lining the hair follicles
- Sulfur – helps break down blackheads and whiteheads.
Topical medicines are available in many forms, such as gels, lotions, creams, soaps,
or pads. In some people, acne medicines may cause side effects such as skin irritation,
burning, or redness, which often get better or go away with continued use of the
medicine. If you experience severe or prolonged side effects, you should report
them to your doctor.
Topical medicines are somewhat effective in treating acne when used regularly; however,
it may take up to 8 weeks before you see noticeable improvement.
Treatment for Moderate to Severe Inflammatory Acne
People with moderate to severe inflammatory acne may be treated with prescription
topical or oral medicines, alone or in combination.
Topical Medicines
Several types of prescription topical medicines are used to treat acne. They include:
- Antibiotics – help stop or slow the growth of bacteria and reduce inflammation
- Vitamin A derivatives (retinoids) – unplug existing comedones (plural of comedo),
allowing other topical medicines, such as antibiotics, to enter the follicles. Some
may also help decrease the formation of comedones. These drugs contain an altered
form of vitamin A. Some examples are tretinoin (Retin-A2), adapalene (Differin),
and tazarotene (Tazorac)
- Others – may destroy P. acnes and reduce oil production or help stop or slow the
growth of bacteria and reduce inflammation. Some examples are prescription strength
Benzoyl peroxide, sodium sulfacetamide/sulfur-containing products, or Azelaic acid
(Azelex).
Prescription topical medicines come as creams, lotions, solutions, gels, or pads.
Your doctor will consider your skin type when prescribing a product. Creams and
lotions provide moisture and tend to be good choices for people with sensitive skin.
If you have very oily skin or live in a hot, humid climate, you may prefer an alcohol-based
gel or solution, which tends to dry the skin. Your doctor will tell you how to apply
the medicine and how often to use it.
For some people, prescription topical medicines cause minor side effects, including
stinging, burning, redness, peeling, scaling, or discoloration of the skin. With
some medicines, such as tretinoin, these side effects usually decrease or go away
after the medicine is used for a period of time. If side effects are severe or don't
go away, notify your doctor.
The benefits of prescription topical medicines are not immediate. Your skin may
seem worse before it gets better. It may take from 4 to 8 weeks to notice improvement.
Prescription Oral Medicines
For patients with moderate to severe acne, doctors often prescribe oral antibiotics.
Oral antibiotics are thought to help control acne by curbing the growth of bacteria
and reducing inflammation. Prescription oral and topical medicines may be combined.
Common antibiotics used to treat acne are tetracycline, minocycline and doxycycline.
Because tetracyclines may affect tooth and bone formation in fetuses and young children,
these drugs are not given to pregnant women or children under age 14.
Treatment for Severe Nodular or Cystic Acne
For patients with severe inflammatory acne that does not improve with medicines
such as those described above, a doctor may prescribe isotretinoin (Accutane), a
retinoid (vitamin A derivative). Isotretinoin is an oral drug that is usually taken
once or twice a day with food for 15 to 20 weeks. It markedly reduces the size of
the oil glands so that much less oil is produced. As a result, the growth of bacteria
is decreased.
Treatments for Hormonally Influenced Acne in Women
In some women, acne is caused by an excess of androgen (male) hormones. Clues that
this may be the case include hirsutism (excessive growth of hair on the face or
body), premenstrual acne flares, irregular menstrual cycles, and elevated blood
levels of certain androgens.
The doctor may prescribe one of several drugs to treat women with this type of acne:
- Birth control pills – to help suppress the androgen produced by the ovaries
- Low-dose corticosteroid drugs, such as prednisone (Deltasone) or dexamethasone (Decadron,
Hexadrol) – to help suppress the androgen produced by the adrenal glands
- Antiandrogen drugs such as spironolactone (Aldactone) – to reduce the excessive
oil production.
Side effects of antiandrogen drugs may include irregular menstruation, tender breasts,
headaches, and fatigue.
Other Treatments for Acne
Doctors may use other types of procedures in addition to drug therapy to treat patients
with acne. For example, the doctor may remove the patient's comedones during office
visits using Glycolic acid / Salicylic acid peels. Sometimes the doctor will inject
corticosteroids directly into lesions to help reduce the size and pain of inflamed
cysts and nodules. Early treatment is the best way to prevent acne scars. Once scarring
has occurred, the doctor may suggest a medical or surgical procedure to help reduce
the scars. A superficial laser may be used to treat irregular scars. Dermabrasion
(or microdermabrasion), which is a form of "sanding down" scars, is sometimes used.
Another treatment option for deep scars caused by cystic acne is the transfer of
fat from another part of the body to the scar. A doctor may also inject a synthetic
filling material under the scar to improve its appearance.
How Should People With Acne Care for Their Skin?
Clean Skin Gently
If you have acne, you should gently wash your face with a mild cleanser (Ph balanced),
once in the morning and once in the evening, as well as after heavy exercise. Wash
your face from under the jaw to the hairline and be sure to thoroughly rinse your
skin.
Using strong soaps or rough scrub pads is not helpful and can actually make the
problem worse. Astringents are not recommended unless the skin is very oily, and
then they should be used only on oily spots.
It is also important to shampoo your hair regularly. If you have oily hair, you
may want to wash it every day.
Avoid Frequent Handling of the Skin
Avoid rubbing and touching skin lesions. Squeezing, pinching or picking blemishes
can lead to the development of scars or dark blotches.
Shave Carefully
Men who shave and who have acne should test both electric and safety razors to see
which is more comfortable. When using a safety razor, make sure the blade is sharp
and soften your beard thoroughly with soap and water before applying shaving cream.
Shave gently and only when necessary to reduce the risk of nicking blemishes.
Avoid a Sunburn or Suntan
Many of the medicines used to treat acne can make you more prone to sunburn. A sunburn
that reddens the skin or suntan that darkens the skin may make blemishes less visible
and make the skin feel drier. However, these benefits are only temporary, and there
are known risks of excessive sun exposure, such as more rapid skin aging and a risk
of developing skin cancer.
Choose Cosmetics Carefully
While undergoing acne treatment, you may need to change some of the cosmetics you
use. All cosmetics, such as foundation, blush, eye shadow, moisturizers, and hair-care
products should be oil free. Choose products labeled non comedogenic (meaning they
don't promote the formation of closed pores). In some people, however, even these
products may make acne worse.
For the first few weeks of treatment, applying foundation evenly may be difficult
because the skin may be red or scaly, particularly with the use of topical tretinoin
or benzoyl peroxide.
Should you have any further questions, call your Kosmoderma
practitioner on 98457 70005
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