September 18, 2010
Also called acne vulgaris, acne is the most common skin condition in the United States. Approximately 40 million to 50 million Americans have acne. Acne can occur at any age, but most people who have acne are teenagers and young adults. Each year, 85 percent of U.S. teenagers will have acne. Common, reliable information about acne can seems scarce, and misinformation can make it difficult to achieve clearer skin. The following answers some frequently asked questions that can help you understand why acne develops and how it can be successfully treated.
The exact cause remains a mystery, but research has revealed four key players: excess oil, clogged pores, bacteria, and inflammation. The excess oil is sebum, an oil that our bodies make to prevent the skin from drying out. Sebum increases dramatically during adolescence when hormones known as androgens spur sebum production into overdrive. Not all of the excess sebum can flow freely to the skin's surface, and clogged pores result. P. acnes, bacteria found on everyone's skin, flourish in the excess oil and causes inflammation.
Inflammation determines what type of acne appears. A little inflammation means that sebum flow is blocked close to the skin's surface. The result is a blackhead or whitehead. Your dermatologist may call this a comedo. If the blockage develops deeper within the skin, a papule (pimple) forms. A bit deeper and a pustule (pus-filled pimple) develops. A very deep blockage causes intense inflammation, resulting in a painful nodule or cyst. Nodules and cysts are the most severe types of acne lesions.
CARING FOR YOUR SKIN
Excessive washing and scrubbing will not prevent nor cure acne, but these can irritate the skin and make acne worse. Dermatologists recommend gently washing the face once or twice a day with a mild cleanser and lukewarm water. This helps remove excess sebum, which is crucial for controlling acne. If you have oily hair, shampooing daily will reduce the likelihood that oil from your hair gets on your skin.
Mild acne vulgaris
DIET AND YOUR SKIN
Acne is not caused by specific foods, but certain foods may make some people's acne worse. If certain foods seem to worsen your acne, try to avoid these foods. It also is important to know that very greasy foods do not necessarily make the skin oilier, but eating these foods can leave oil on the face, especially around the mouth. When some vegetable oils get on the skin, they can make acne worse.
Research also has shown that the following can trigger or make acne worse:
• Emotional stress
COSMETICS AND ACNE
People with acne and acne-prone skin can use some cosmetics. To avoid clogging pores, cosmetics, as well as toiletries and sunscreens, should be oil-free. An oil-free product will be labeled "non-comedogenic" (should not cause blackheads or whiteheads) or "non-acnegenic" (should not cause pimples). These oil-free cosmetics can be applied daily and should be removed every night with a mild cleanser and lukewarm water.
Hair products also can be used. When applying a spray, gel, or other product to your hair, shield your face so that the product does not get on your skin.
Waiting for acne to clear on its own can be frustrating. It also can lead to permanent scarring, poor self-image, depression, and anxiety. To avoid these physical and emotional scars, dermatologists recommend that acne be properly treated. Treatment should continue for as long as needed to prevent the acne from recurring.
Promises of overnight results and acne cures sound great, but the truth is:
• An overnight treatment or immediate cure for acne does not exist.
• Acne treatment takes time (about four to eight weeks.)
• Acne treatment must be ongoing to be effective.
The reason acne treatment takes time to work is that treatment prevents new breakouts. Treatment does not target existing blemishes, which can heal unaided. As anyone with acne knows, new blemishes are constantly appearing. As a result, acne treatment is ongoing.
While waiting for treatment to work, it can be tempting to squeeze acne lesions to get rid of them. Dermatologists do not recommend this. Picking, scratching, popping, and squeezing tend to make acne worse and can cause scars.
Dermatologists offer many effective treatments. Before recommending a treatment plan, your dermatologist considers many factors including your gender, age, and acne severity. For women, other considerations are whether you are pregnant, nursing, or trying to become pregnant. Before starting any acne treatment, be sure to tell your dermatologist if any of these apply. This information will help your dermatologist create an appropriate treatment plan.
The medication in the plan may be topical (applied to the skin) or systemic (works inside the body). Some patients receive a plan that combines topical and systemic treatment. Another type of treatment is laser and light-based technologies. These technologies continue to be researched for their effects on mild to moderate acne.
◦This is the standard of care for mild acne.
◦Some common topical medications dermatologists prescribe include benzoyl peroxide, antibiotics, retinoids, and salicylic acid.
◦Topical medications come in many forms, including gels, lotions, and creams. Your dermatologist will determine the most appropriate form for your skin.
◦Oral antibiotics are the standard of care in managing moderate to severe acne, and acne that resists topical treatment therapy, and acne that covers large body surface areas. Oral antibiotics that may be prescribed to treat acne include tetracycline, doxycycline, minocycline, erythromycin, trimethoprim-sulfamethoxazole, trimethoprim, and azithromycin.
◦Combination therapy (the use of two or more therapies) that uses oral antibiotics and topical medication (often retinoids) may help manage acne.
◦Birth control pills that contain estrogen or medication that decreases the effects of male hormones (antiandrogens) may help certain women. Some birth control pills have been approved for the treatment of acne. Your dermatologist can help you determine if this is an effective treatment option for you.
◦Corticosteroid injections may be used to treat large, painful acne lesions. These injections can ease the pain and help clear a large lesion more quickly.
A systemic treatment that you may have heard about is isotretinoin. This is the only medication approved by the U.S. Food and Drug Administration (FDA) to treat severe resistant nodular cystic acne, the most severe form of acne. A patient who is pregnant or may become pregnant must not take isotretinoin. The risk of a severe birth defect is extremely high. Even taking this medication for a short time can cause severe birth defects. To prevent birth defects, a risk-management program called iPLEDGE was developed. Both female and male patients must register before taking isotretinoin.
While a patient is taking isotretinoin, a dermatologist monitors the patient for physical and psychological effects. It is important to keep all follow-up appointments with your dermatologist.
Today, there are many effective treatments for acne, but no one treatment is right for everyone. Nor does any specific treatment work for everyone. If you do not see the results you want after four to eight weeks, be sure to tell your dermatologist.
TREATMENT OF ACNE SCARS
Research advances have led to a variety of treatments for acne scars. Dermatologists now use laser resurfacing, dermabrasion, chemical peels, surgery, and skin fillers to provide safe and effective treatments. Because acne scars can be unique and often have complex characteristics, the most successful results come from an individualized treatment plan.
Severe acne vulgaris
PROPER CARE IS NECESSARY
Acne is not curable, but it is controllable. Proper treatment can prevent scars and help you to feel and look your best. Seeing your dermatologist helps ensure that you are getting exceptional acne care.
• • •
A dermatologist is a physician who specializes in treating the medical, surgical, and cosmetic conditions of the skin, hair, and nails. To learn more about ac