What is acne?
Acne is a very
common condition caused by blocked oil glands on the
face, neck, back, chest, and shoulders. Acne lesions
are highly variable; common lesions include: small red
bumps, white bumps (white heads), enlarged pores with
a black center (black heads), large, painful, red nodules
under the skin, and scabbed lesions. In people with
darker skin tones (i.e. African-Americans, Hispanics,
Asians, Middle-Easterners), acne lesions may be surrounded
by an area of darker skin (called hyperpigmentation).
This discoloration may last longer than the acne lesion
itself and can draw more unwanted attention to the acne.
Some types of acne leave scarring which is permanent.
What causes acne?
Acne is caused by blocked
oil glands (called sebaceous glands). The sebaceous
glands naturally produces oil called sebum which keeps
the skin from drying out. During puberty, sebum production
dramatically increases. Some of the oil glands become
plugged and trapped oil builds up within the gland,
causing inflammation. The swelling within the oil gland
can become so intense that the oil gland (and associated
hair follicle) can rupture, leading to further inflammation.
Surging hormones during puberty is the most common cause
of acne. Often, acne persists throughout puberty and
then improves with adulthood. In some, however, acne
never improves and may worsen during middle age. Women
more often have acne in middle age and many believe
this is caused from abnormal hormone levels. For example,
many adult women with acne have excessive hair growth
(i.e. on the face), irregular periods, and weight problems.
There are studies that correlate acne with excessive
quantities of milk, stress, and heredity. A bacteria
called Propionibacterium acnes that is normally present
on the skin likely plays a role in acne, but the precise
link is still unclear.
What are the symptoms of acne?
Most mild and moderate acne has
no symptoms other than the acne lesions. Severe acne,
however, can be very painful.
How is the diagnosis of acne made?
Diagnosis of acne
during puberty is usually straightforward. The type
of lesion and the distribution of the lesions is usually
characteristic. In adults, however, the diagnosis can
be more challenging as acne can overlap with rosacea,
allergic reactions, and some kinds of folliculitis.
In adults, the underlying cause of the acne may need
to be investigated as well.
What acne treatment options are available?
There are a multitude
of treatment options available for acne. If you have
not been able to control your acne with over-the-counter
medications, you should visit your doctor and discuss
Creams (topical therapies):
What over the counter treatments are available?
Effective over-the-counter medications
usually contain benzoyl peroxide and/or salicylic acid
• What are the risks?
Mild irritation is
a common side effect.
• What prescription creams are available?
Many different prescription topical medications are available. In general, there are higher strength benzoyl peroxide washes and creams, antibiotic creams (i.e. erythromycin, clindamycin), and the vitamin A derivatives called retinoids. Retinoids (Trentinoin (Retin A), Adapalene (Differin), Tazerotene (Tazorac)), are very effective because they prevent the oil glands from becoming blocked. Retinoids can also improve the texture of the skin and even out skin color. When used properly, topical medications can be very effective for most people.
• What are the risks?
The major down side to the topical medications is that they have to be used daily, sometimes for years. In terms of side effects, each medication has its own side effect profile. In general, the most common side effect is irritation and redness. You and your physician will decide on the right treatment for you.
• What pills are used to treat acne?
When acne does not respond to topical medications or
is severe, systemic medications (pills) are used. The
tetracycline antibiotics are effective in many people.
Erythromycin, Bactrim, and other antibiotics are second-line
antibiotic therapies. However, long term antibiotic
use can cause bacterial resistance in those who use
them and should be used with caution. There are other
side effects that must be discussed with your doctor.
For women, oral contraceptives ("the pill") may also
improve acne. For adult woman with acne, other hormonal
therapies may be considered. For severe acne that is
associated with scarring, isotretinoin (Accutane) is
prescribed. This drug is very effective and can cure
acne but must be used very cautiously because of the
risk of severe birth defects when taken during pregnancy.
There are other common side effects (dry lips, peeling
skin, etc) of isotretinoin that may limit its use as
well. Some people believe that isotretinoin can lead
to suicidal symptoms. This is controversial and should
be discussed with your doctor.
• What are the risks?
See the above discussion and know that systemic acne medications have a long list of possible side effects and these need to be discussed in detail with your doctor.
Are there any new acne treatments available?
Light therapy, photodynamic therapy, laser therapy, and chemical peels are all being tried for the treatment of acne, with some initial success. See below for discussion of specific treatments. Because these treatments are new, you need to discuss all the treatment options with your doctor.
Blue light therapy
takes advantage of the fact that bacteria in the skin
produce a product called porphyrin. Porphyrin can absorb
blue light, leading to a chemical reaction in the skin
that destroys the bacteria. Red light therapy can reduce
inflammation in the skin which in turn improves acne.
Acne lesions treated with light therapy tend to reoccur
over 3-12 months. In one study, patients who had severe
acne had no improvement compared to patients who had
moderate acne who did improve. There have been no reported
• Laser Therapy
Although there are
many different lasers available only a few of them have
successfully been used in the treatment of acne. For
example, the pulsed-dye laser was tested in a randomized,
double blinded controlled trial (the best kind of trial
available) and was shown to significantly reduce acne
after a single treatment with no serious side effects.
The 1450 nm infrared laser has been used in one uncontrolled
study and decreased lesion counts by 83% after three
treatments. Temporary pain, redness, and swelling was
reported in most patients. In patients with darker skin
tones, hyperpigmentation (darkening of the skin) was
combines a drug (called a photosensitizer) that is preferentially
absorbed by certain kinds of cells and a special light
source. When used together, the photosensitizer and
the light destroy the targeted cells. For acne, the
hyperactive sebaceous glands are targeted. The photosensitizer,
called amino-levulinic acid, is applied to the skin
and is left on for a variable period of time. The skin
is exposed to the light source (blue, red, or laser
light) and the photosensitizer is then removed. Side
effects include pain during the procedure and discoloration
• Radiofrequency Therapy
A few studies have evaluated the effect
of radiofrequency energy in the treatment of acne. One
uncontrolled study reported a 75% improvement in 81%
of the patients. Elamax, a topical anesthetic was used
during the procedure for pain control.
Chemical peels have long been used
for facial rejuvenation and to reverse the signs of
aging. More recently, they have been used for the treatment
of acne. In one study of Asian patients, salicylic acid
peels performed twice a week for 12 weeks significantly
In a few preliminary studies, microdermabrasion
treatments have reduced acne lesions and improved the
texture of the skin in the majority of patients.
What can I do to prevent acne?
Throughout adolescence and into adulthood, we are bombarded with messages of how to correct acne
inducing situations. We know what to do once we have a pimple attack- but how about the ways to
avoid them in the first place? Here are some simple techniques aestheticians advise us of...
- Don’t pick, press or rub your pimples or white heads. This actually increases sebum production
and ruptures the area below your skin. The infection and sebum will spread causing more pimples,
not to mention the possibility of scarring.
- Wash twice daily, using a mild soap. Sulfur-based soap has been shown to be especially
effective on acne. If your skin is too oily, use soap with benzyl peroxide. Do not use loofah’s,
sponges, or brushes on your face. Avoid over-washing your face- it will actually stimulate your
sebaceous glands to produce more sebum which will increase your acne.
- Allergies - diet may actually contribute to acne. For many people, food allergy can cause
very serious acne-like condition. Note what triggers acne in your diet, and carefully avoid
those items. Studies have shown that acne may also be caused by milk which contains hormones
as well as seafood with relatively high levels of iodine. Other foods that have shown
allergy - prone acne symptoms are: sugar, dairy products, deep-fried food, meat, nut butters,
etc. Alternatively, green vegetables, vegetable juices and foods rich in zinc help alleviate
acne condition and keep your metabolism running strong.
- Drink more water every day. Since our bodies are made up of water, it is easy to flush out
toxins by drinking lots of water. It really helps heal and prevent acne flare-ups, not to mention
keeping skin hydrated and glowing.
- Avoid an overindulgence of makeup. Makeup products may clog pores, causing more blackheads
and pimples. If you have to wear makeup, make sure it is water-based. Many lines are in
development to help people with sensitive, and acne prone skin. It also helps to clean your
makeup brushes regularly.
- Acne prone people should avoid oily products. Products such as hair pomade, intense
oil-based facial moisturizers, and oily cleansers may contribute to your break-outs.
- Avoid touching your face excessively. By regularly shampooing your hair and keeping it
off your face, you can avoid external sources from contributing to acne.
- Exercising keeps your metabolism pumping and you will sweat out excess toxins.
- Practice serenity - stay stress-free. Studies show that stress may worsen acne flare-ups,
in addition to your overall outlook on life. Talk to someone who can listen, participate in
activities that bring you joy, or take a walk in the park with your dog. There are many things
you can do to be stress free.
- Get outside. Sunshine stimulates vitamin D in the body, an essential vitamin for healthy
skin. Fresh air and sunshine can help reduce stress and increase oxygen to the skin. Remember
your sunscreen - skin that it burnt or tanned can contribute to black-head prone pores.
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