Acne

Acne: Description

AcneAcne is a common skin disease characterized by pimples on the face, chest, and back. It occurs when the pores of the skin become clogged with oil, dead skin cells, and bacteria.

The medical term for acne is acne vulgaris. It is the most common of all skin diseases, affecting about seventeen million Americans. It can occur at any age, but it is most common among adolescents. Nearly 85 percent of people between the ages of twelve and twenty-five develop acne. Up to 20 percent of women over twenty-five develop mild acne. The disease is also sometimes found in newborns.

It is a disease of the sebaceous glands. These glands lie just beneath the surface of the skin. They produce an oil called sebum, which keeps the skin moist. At puberty, a person's body may begin to produce an excess of sebum. Puberty is the period of life when a person's sex hormones become active. The male sex hormone called androgen causes an over-production of sebum.

When excess sebum combines with dead skin, a hard plug, or comedo is formed. The comedo can block skin pores. Two types of comedos can occur. They are known as whiteheads and blackheads.

More serious forms of acne develop when bacteria invade blocked pores. A pimple forms when sebum, bacteria, skin cells, and white blood cells are released into tissue around the pore. The pimple may then become inflamed. Inflamed pimples near the skin are called papules. Those that form deeper in the skin are called pustules. The most severe type of acne occurs when cysts (closed sacs) or nodules (hard swellings) form.

It often causes scarring of the skin. This occurs when new skin cells form to replace damaged cells. The new skin is usually not formed very easily, causing an unevenness that produces scars. It occurs most commonly on the face, chest, shoulders, and back because those are the places that sebaceous cells occur.

Acne can be divided into two categories: inflamed and non-inflamed. Non-inflamed acne breakouts consist of microcomedones, blackheads, and milia. These types of comedones are not red or painful. Symptoms of non-inflamed acne include bumps or bumpiness across the skin's surface, or an uneven skin texture. Even if comedones are not readily visible, they will make the skin feel rough or "sandpapery."

People with non-inflamed acne experience blackheads, milia, and closed comedones but rarely have reddened breakouts, such as papules or pustules. Left untreated, non-inflamed acne may progress to inflamed acne.

Inflamed acne is characterized by redness and inflammation. Those with inflamed acne will have microcomedones, blackheads, and milia, as well as papules, pustules, and possibly nodules and cysts. Symptoms also include redness, swelling, and irritation of the skin, along with possible crusting, oozing, or scabbing of the lesions.

Inflamed acne ranges in acuity from very mild to extremely severe. Some inflamed acne sufferers will experience only the occasional pustule while others will battle angry-looking cysts. Cystic acne is the most serious form of inflamed acne. Inflamed acne sufferers are most at risk for skin damage and scarring.

Symptoms

Blackheads.

  • Crusting of skin eruptions.
  • Cysts Inflammation around the skin eruptions.
  • Pustules.
  • Redness around the skin eruptions.
  • Scarring of the skin.
  • Whiteheads.

Causes and Risk factors

Acne occurs when tiny holes on the surface of the skin, called pores, become clogged. Each pore is an opening to a canal called a follicle, which contains a hair and an oil gland. Normally, the oil glands help keep the skin lubricated and help remove old skin cells. When glands produce too much oil, the pores can become blocked, accumulating dirt, debris, and bacteria. The blockage is called a plug or comedone.

The top of the plug may be white (whitehead) or dark (blackhead). If it ruptures, the material inside, including oil and bacteria, can spread to the surrounding area and cause an inflammatory reaction. If the inflammation is deep in your skin, the pimples may enlarge to form firm, painful cysts.

Acne commonly appears on the face and shoulders, but may also occur on the trunk, arms, legs, and buttocks.

It is most common in teenagers, but it can happen at any age, even as an infant. Three out of four teenagers have acne to some extent, probably caused by hormonal changes that stimulate oil production. However, people in their 30s and 40s may also have acne.

Acne tends to run in families and can be triggered by:

Hormonal changes related to menstrual periods, pregnancy, birth control pills, or stress Greasy or oily cosmetic and hair products Certain drugs (such as steroids, testosterone, estrogen, and phenytoin) High levels of humidity and sweating Despite the popular belief that chocolate, nuts, and other foods cause acne, this does not seem to be true.

The exact cause of acne is not known, however, several risk factors have been identified.

Age: Because of the effect of sex hormones, teenagers are quite likely to develop acne.

  • Cosmetics: Make-up and hair sprays that contain oils can make acne worse.
  • Diet: It is not caused by diet, but some foods can make the disease more serious.
  • Disease: Hormonal disorders can increase the severity of acne problems in girls.
  • Drugs: Acne can develop as a result of using certain drugs, such as tranquilizers, antibiotics, oral contraceptives, and anabolic steroids. Steroids are synthetic hormones that may sometimes be abused by athletes to increase the size of their muscles.
  • Environment: It can become worse as a result of exposure to oils, greases, and polluted air. Sweating in hot weather can also make the condition worse.
  • Gender: Boys are more likely to develop acne and tend to have more serious cases than girls.
  • Heredity: It is more common in some families than in others.
  • Hormonal changes: It can flare up during menstruation, pregnancy, and menopause. Menopause is the period in a woman's life when her body stops producing certain hormones.
  • Personal hygiene: Strong soaps, hard scrubbing, and picking at pimples can make acne worse.
  • Stress: Emotional stress can contribute to acne.

Diagnosis

People with acne are often treated by family doctors. More serious cases are referred to a dermatologist (a specialist in skin disorders) or an endocrinologist (a specialist in hormonal disorders).

Because of its appearance, acne is not difficult to diagnose. A doctor takes a complete medical history, which includes questions about skin, diet, medication use, and other factors associated with risk for acne. He or she conducts a physical examination of the face, upper neck, chest, shoulders, back, and other affected areas. The doctor determines the number and type of blemishes, whether they are inflamed or not, whether they are deep or near the surface of the skin, and whether there is scarring or skin discoloration.

Laboratory tests are not done unless the patient appears to have a hormonal disorder. In that case, blood tests and other tests may be ordered.

Treatment

Take the following self-care steps to lessen the effects of acne:

Clean your skin gently with a mild, non-drying soap (such as Dove, Neutrogena, or Basics). Remove all dirt or make-up. Wash once or twice a day, including after exercising. However, avoid excessive or repeated skin washing. Shampoo your hair daily, especially if it's oily. Comb or pull your hair back to keep the hair out of your face. Avoid tight headbands. Try not to squeeze, scratch, pick, or rub the pimples. Although it might be tempting to do this, it can lead to scarring and skin infections. Avoid touching your face with your hands or fingers. Avoid greasy cosmetics or creams. Look for water-based or "non-comedogenic" formulas. Take make-up off at night. If these steps do not clear up the blemishes to an acceptable level, try over-the-counter acne medications. These creams and lotions are applied directly to the skin. They may contain benzoyl peroxide, sulfur, resorcinol, or salicylic acid. They work by killing bacteria, drying up the oil, and causing your skin to peel.

If the pimples are still a problem, a dermatologist can prescribe stronger medications and discuss other options with you.

Prescription medicines include:

Oral antibiotics (taken by mouth) such as minocycline, doxycycline, and tetracycline Topical antibiotics (applied to the skin) such as clindamycin or erythromycin Retinoic acid cream or gel (Retin-A) and isotretinoin pills (Accutane) -- pregnant women and sexually active adolescent females should not take Accutane, as it causes severe birth defects; Women taking Accutane should use two forms of birth control before starting the drug Prescription formulas of benzoyl peroxide, sulfur, resorcinol, salicylic acid Birth control pills can sometimes help clear up acne. (In some cases, though, they may make it worse.)

Your doctor may also suggest chemical skin peeling, removal of scars by dermabrasion, or removal or drainage of cysts.

A small amount of sun exposure may improve acne. However, excessive exposure to sunlight or ultraviolet rays is not recommended because it increases the risk of skin cancer.

Acne treatment consists of reducing sebum production, removing dead skin cells, and killing bacteria. Treatment methods differ depending on how serious the acne is.

Topical Drugs: Topical drugs are applied directly to the affected areas of the skin. They are available in the form of creams, gels, lotions, or pads. They are used primarily to treat mild forms of acne in which there is little or no inflammation.

One group of topical drugs used for acne includes antibiotics. These drugs kill the bacteria that contribute to the disease. Another group of drugs is called comedolytics. These drugs loosen hard plugs and open pores. Still another group of drugs works by increasing the rate at which new skin cells form. These drugs prevent the formation of new comedos.

Topical drugs are applied once or twice a day after washing with mild soap. Treatment may have to continue anywhere from a few weeks to a few months to a few years. Side effects such as mild redness, peeling, irritation, dryness, and an increased sensitivity to sunlight may occur.

Oral Drugs: Oral drugs are taken by mouth. Doctors sometimes prescribe oral antibiotics for moderate cases of acne. These antibiotics prevent the formation of new comedos and reduce inflammation. They are usually taken once a day for two to four months. Side effects may include allergic reactions, stomach upset, vaginal yeast infections, dizziness, and tooth discoloration.

A drug that is used for severe cases of acne is isotretinoin. This drug reduces the production of sebum and the stickiness of skin cells. It is used when cysts and nodules are present. The drug may be used alone or with other topical or oral antibiotics.

Isotretinoin treatment usually lasts for four or five months. It is effective in about 60 percent of all patients. If the acne reappears, another course of treatments may be necessary. Some side effects that may accompany the use of isotretinoin include nosebleeds, dry skin, a temporary worsening of the acne, vision disorders, and increased production of liver enzymes, blood fats, and cholesterol. It may also cause birth defects and cannot, therefore, be used by pregnant women.

Women who do not respond to any of these treatments may be given another type of oral drug, an anti-androgen. Anti-androgens reduce the production of androgen and therefore reduce the formation of comedos. Certain types of oral contraceptives are also effective as anti-androgens.

The most serious forms of acne require other types of drugs, including oral corticosteroids, or anti-inflammatory drugs. These drugs are often used for the treatment of a form of acne known as acne fulminans, which occurs mostly among adolescent males. They are also used with acne that produces numerous deep, inflamed nodules that heal with scarring.

Other Treatments: Several surgical or medical treatments may be used to reduce acne or the scars caused by the disease.

Chemical peel: A chemical known as glycolic acid is first applied to the skin. When it dries, it is peeled off, taking the top layer of skin with it. This treatment helps reduce scarring.

  • Collagen injection: Shallow scars are filled in by injecting collagen, a skin protein, beneath the scars.
  • Comedo extraction: A special tool is used to remove a comedo from a pore.
  • Dermabrasion: The affected skin is first frozen with a chemical spray. Then it is removed with a brush or sandpaper-like instrument.
  • Intralesional injection: Anti-inflammatory drugs are injected directly into inflamed pimples.
  • Punch grafting: Deep scars are removed and the area repaired with small skin grafts.

Alternative Treatment: Alternative treatments for acne focus on proper hygiene and diet. Patients are advised to keep their skin clean and oil-free. They are also encouraged to eat a well-balanced diet high in fiber, zinc, and raw fruits and vegetables. They should also avoid alcohol, dairy products, caffeine, sugar, smoking, processed foods, and foods high in iodine, such as table salt.

Some doctors recommend the use of herbs to supplement the diet. Some herbs that have been used in the treatment of acne include burdock root, red clover, and milk thistle. Additional nutrients that may help to control acne include B-complex vitamins and chromium. Chinese herbal treatments that are recommended include cnidium seed and honeysuckle flower. Another herbal treatment is tea tree oil. The proper dose of these substances can be recommended by physicians or nutritionists.

Possible complications include:

Changes in skin color.

  • Cysts.
  • Damage to self-esteem, confidence, personality.
  • Side effects of Accutane (including very dry skin and mucous membranes, high triglyceride levels, liver damage, and birth defects in an unborn baby; call your doctor right away if you become pregnant while taking this drug) Side effects of other medications

Medicine and medications

ANTI-ACNE DRUGS:

  • Accutane (isotretinoin), side effects dry skin, dry mouth, conjunctivitis.
  • Benzamycin, side effects dry and itchy skin.
  • Cleocin T (clindamycin phosphate), side effects dry skin.
  • Desquam-E (benzoyl peroxide) Itching, red and peeling skin.
  • Erythromycin topical (A/T/S, erycette, t-stat), side effects burning, dry skin, hives, red and peeling skin.
  • Minocin (minocycline hydrochloride), side effects headache, hives, diarrhea, peeling skin, vomiting.
  • Retin-A (tretinoin), side effects darkening of the skin, blistering, crusted, or puffy skin.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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