More than 90% of people have acne at some point in their lives. Although many different factors play a role in its development, acne usually begins soon after the start of puberty. Increased hormone levels apparently cause the oil glands in the skin to increase their production of an oily substance known as sebum. The hair follicle, the site of acne, becomes plugged with dead skin cells, and the sebum and bacteria tend to accumulate there, leading to pimples with redness and discomfort.
Types of Acne Lesions
Blackheads - Blackheads are formed when the pressure of the sebum and dead cells forces the plug to the surface of the skin. The combination of the skin pigment and dead skin cells results in the blackheads' dark color. Blackheads are not caused by dirt, and dirt does not cause acne. Blackheads cannot be washed or scrubbed away.
Whiteheads - A whitehead occurs when the plug remains below the skin surface.
Pimples, Pus Bumps & Cysts
When the pressure from the sebum and dead cells builds up, the trapped material may seep through the walls of the follicle and cause redness and discomfort. This causes the formation of pimples (papules) and pus bumps (pustules). A cyst is a particularly deep and uncomfortable swelling associated with acne.
Scarring may occur after papules, pustules and cysts. Once scarring occurs, the change is permanent. However, a dermatologist may perform certain procedures to improve the cosmetic appearance.
Individuals who are prone to acne should avoid any cosmetics and skin creams. If they must use cosmetics, the products should be water-based and/or oil-free. Skin creams that do not cause acne (known as "non-comedogenic") should be used. Stress and emotional tension can trigger an outbreak of acne on occasion. Foods usually do not cause acne, but eating sensibly and in moderation is always advisable. Recent data suggests that a high intake of processed sugars may cause worsening of acne.
There are a number of different ways to treat acne; therapy depends on the acne's severity and type:
- Benzoyl peroxide is a peeling agent that dries the skin and help to prevent the growth of bacteria; it is also inflammatory.
- Topical antibiotics (those applied directly to the skin's surface) help to destroy skin bacteria. They may be used alone or in combination with other agents.
- Topical Vitamin A products (such as Retin-A, Retin-A Micro, Differin, Tazorac) are peeling agents that loosens the plugs of skin cells. They are most helpful for blackheads and whiteheads and also may help to prevent new acne lesions.
- Oral antibiotics decrease inflammation and decrease bacteria found inside the skin and are most effective for acne with many papules, pustules and cysts.
- Some oral contraceptive agents can help treat acne and may be used in girls of child-bearing age; these medications can have other side effects though, and patients treated with them must be followed closely by their primary doctor or a gynecologist.
- Isotretinoin (Accutane and others) is an oral medication that should be reserved for treatment of severe forms of acne, including the cystic and nodular forms and for those that don't respond to other types of treatment. There are many potential side effects associated with the use of isotretinoin, and routine blood tests are checked while on this therapy.
Most of these medications are by prescription with the exception of some of the benzoyl peroxide products.
Remedies to Avoid
Avoid washing and scrubbing with harsh soaps and pads or brushes. This may make acne worse, as well as dry and irritate the skin. Gentle cleaning is usually best, using a gentle acne cleanser, warm water and the patient’s hands.
Sunlight may offer temporary relief by masking acne and subsequently peeling the skin. However, sun exposure is an important cause of aging and wrinkling of the skin, and it may lead to an increased risk of skin cancer. Sun protection is always recommended.