Acne is a common skin condition that occurs when your hair follicles become
plugged with oil and dead skin cells. Acne most commonly causes spots to
develop and appears on your face, neck, chest, back and shoulders. Acne can be
distressing and annoyingly persistent because the spots range from whiteheads
and blackheads which are often mild, to inflamed pus-filled pustules and cysts.
Acne lesions heal rather slowly, and when one begins to resolve, others seem to
crop up.
So depending on its severity, acne can cause emotional distress and lead to
scarring of the skin. But the good news is that effective treatments are
available and the earlier treatment is started, the lower your risk of
lasting physical and emotional damage.
Acne can take the following forms:
Noninflammatory lesions
- Comedones (whiteheads and blackheads) are created when the openings of hair follicles become
clogged and blocked with oil secretions, dead skin cells and sometimes
bacteria. When comedones (koe-muh-DOE-neez) are open at the skin surface,
they're called blackheads because of the dark appearance of the plugs in
the hair follicles. When comedones are closed, they're called whiteheads slightly raised, skin-colored bumps.
Inflammatory lesions
- Papules
are small raised bumps that signal inflammation or infection in the hair
follicles. Papules may be red and tender.
- Pustules (pimples)
are red, tender bumps with white pus at their tips.
- Nodules
are large, solid, painful lumps beneath the surface of the skin. They're
formed by the buildup of secretions deep within hair follicles.
- Cysts
are painful, pus-filled lumps beneath the surface of the skin. These
boil-like infections can cause scars.
When to see a doctor
Acne usually isn't a serious medical
condition. But you may want to seek medical treatment from a dermatologist for
persistent pimples or inflamed cysts to avoid scarring or other damage to your
skin. If acne and the scars it may have left are affecting your social
relationships or self-esteem, you may also want to ask a dermatologist if your
acne can be controlled or if your scars can be diminished.
What
to do if I have acne?
Keeping your skin clean is important
to prevent new spots fromdeveloping. Wash the affected area twice a day with a
mild soap or cleanser, but do not scrub the skin too hard to avoid
irritating it.
Although acne can’t be cured, it can
be controlled with treatment. Several creams, lotions and gels to treat
spots are available at pharmacies. If you develop acne, it’s a good idea to
speak to your pharmacist for advice.
If your acne is severe and appears
on your chest and back, it may need to be treated with antibiotics or stronger
creams that are available on prescription.
Why do I have acne?
It is thought that acne is linked to the changes in hormone levels during puberty.
Acne occurs when the hair follicles become plugged with oil and dead skin cells
The glands in the skin begin to produce excessive amounts
of an oily substance known as Sebum to lubricate
your hair and skin. Sebum normally travels up along the hair shafts and then
out through the openings of the hair follicles onto the surface of your skin.
When your body produces an excess amount of sebum and dead skin cells, the two
can build up in the hair follicles and form together as a soft plug, creating
an environment where bacteria can thrive.
This blocks small holes in the skin through which hairs grow (hair
follicles), causing blackheads and whiteheads.
Pimples are raised red spots with a white center that develop when blocked
hair follicles become inflamed or infected. Blockages and inflammation that
develop deep inside hair follicles produce lumps beneath the surface of your
skin called cysts. Other pores in your skin, which are the openings of the
sweat Normally harmless bacteria that live on the skin can then infect a
blocked follicle, causing pus-filled papules or cysts.
There is no evidence that diet, poor hygiene or sexual activity play a role
in acne.
Read more about the causes of acne including some common
acne hree factors contribute to the formation of acne:
- Overproduction of oil (sebum)
- Irregular shedding of dead skin cells resulting in
irritation of the hair follicles of your skin
- Buildup of bacteria
Factors that may worsen acne
These factors can trigger or
aggravate an existing case of acne:
- Hormones.
Androgens are hormones that increase in boys and girls during puberty and
cause the sebaceous glands to enlarge and make more sebum. Hormonal
changes related to pregnancy and the use of oral contraceptives can also
affect sebum production.
- Certain medications.
Drugs containing corticosteroids, androgens or lithium are known to cause
acne.
- Diet.
Studies indicate that certain dietary factors, including dairy products
and carbohydrate-rich foods — such as bread, bagels and chips, which
increase blood sugar — may trigger acne.
Who is affected and What are the Risk Factors involved:
Acne is very common in teenagers and younger adults. About 80% of people
between the ages of 10 and 32 will be affected by acne.
Acne is most common between the ages of 14 and 17 in girls, and
between 16 and 19 in boys.
Most people have acne on and off for several years before their symptoms
start to improve as they get older. Acne usually disappears when a person is in
their twenties.
In some cases, acne can continue into adult life. About 5%
of women and 1% of men have acne over the age of 25.
Hormonal changes in your body can
provoke or aggravate acne. Such changes are common in:
- Teenagers
- Women and girls, two to seven days before their periods
- Pregnant women
- People using certain medications, including those
containing corticosteroids, androgens or lithium
Other risk factors include:
- Direct skin contact with greasy or oily substances, or
to certain cosmetics applied directly to the skin
- A family history of acne — if your parents had acne,
you're likely to develop it, too
- Friction or pressure on your skin caused by various
items, such as telephones or cellphones, helmets, tight collars and
backpacks
- Stress doesn't cause acne, but if you have acne
already, stress may make it worse
Diagnosing Acne
Your Dermatologist will be able to diagnosis acne by looking at
your skin. This will involve examining your face, chest and back for the
different types of spot, such as blackheads or sore, red nodules.
Your doctor is likely to ask you a number of questions. Being ready to
answer them may reserve time to go over any points you want to talk about
in-depth. Your doctor may ask:
- When did you first develop acne?
- Does anything in particular seem to trigger an acne
flare, such as stress or — in girls and women — your menstrual cycle?
- What medications are you currently taking, including
over-the-counter and prescription drugs as well as vitamins and
supplements?
- In girls and women: Do you use oral contraceptives?
- In girls and women: Do you have regular menstrual
periods?
- In girls and women: Are you pregnant, or do you plan to
become pregnant soon?
- What types of soaps, lotions, hair products or
cosmetics do you use?
- How is acne affecting your self-esteem and your confidence
in social situations?
- Do you have a family history of acne?
- What treatments have you tried so far? Have any been
effective?
How many spots you have and how painful and inflamed they are will help
determine how severe your acne is. This is important in planning your
treatment.
Four grades can be used to measure the severity of acne:
- Grade 1 (mild) – acne is
mostly confined to whiteheads and blackheads with just a few papules and
pustules.
- Grade 2 (moderate) –
there are multiple papules and pustules which are mostly confined to the
face.
- Grade 3 (moderately severe) –
there is a large number of papules and pustules as well as the
occasional inflamed nodule. The back and the chest are also affected by
acne.
- Grade 4 (severe) –
there is a large number of large painful pustules and nodules.
Treatments for Acne
Treatment for acne depends on
how severe it is. It can take several months of treatment before acne
symptoms improve. Acne
treatments work by reducing oil production, speeding up skin cell turnover, fighting
bacterial infection, reducing the inflammation or doing all four. With most
prescription acne treatments, you may not see results for four to eight weeks,
and your skin may get worse before it gets better so do not expect to see
results overnight.
Your
Dermatologist may recommend a
prescription medication you apply to your skin (topical medication) or take by
mouth (oral medication). Oral prescription medications for acne should never be
used during pregnancy, especially during the first trimester.
Prescription medications that can be used to treat acne include:
- topical retinoids
- topical antibiotics
- azelaic acid
- antibiotic tablets and many more as below
The acne treatments include:
- Over-the-counter topical treatments. Acne lotions may dry up the oil, kill bacteria and
promote sloughing of dead skin cells. Over-the-counter (OTC) lotions are
generally mild and contain benzoyl peroxide, sulfur, resorcinol, salicylic
acid or sulfur as their active ingredient. These products can be helpful
for very mild acne. OTC acne medications may cause initial side effects
such as skin irritation, dryness that often improve after
the first month of therapy.
- Topical treatments available by prescription.
If your
acne doesn't respond to Over The Counter treatments, consider seeing a doctor
or dermatologist to get a stronger prescription lotion. Tretinoin (Avita,
Retin-A, others), adapalene (Differin) and tazarotene (Tazorac, Avage) are
examples of topical prescription products derived from vitamin A. They work by
promoting cell turnover and preventing plugging of the hair follicles. A number
of topical antibiotics also are available which work by killing excess skin
bacteria.
Often, a
combination of such products is required to achieve the best results. A number
of benzoyl peroxide and antibiotic combination medications are available,
including different dose combinations of benzoyl peroxide and clindamycin
(Benzaclin, Duac, Acanya) and benzoyl peroxide and erythromycin (Benzamycin).
Dapsone gel (Aczone) is a newer acne treatment that's particularly effective in
treating inflammatory acne. Prescription topical treatments for acne may cause
skin side effects, such as stinging, burning, redness or peeling. Your doctor
may recommend steps to minimize these side effects, including using a gradually
increased dose, washing off the medication after a short application or switching
to another medication immediately
For moderate to severe acne, you may need a short
course of prescription oral antibiotics to reduce bacteria and fight
inflammation. Since oral antibiotics were first used to treat acne, antibiotic
resistance has increased significantly in people with acne. For this reason,
your doctor likely will recommend tapering off these medications as soon as
your symptoms begin to improve, or as soon as it becomes clear the drugs aren't
helping — usually, within three to four months. In most cases, you'll use
topical medications and oral antibiotics together. Studies have found that
using topical benzoyl peroxide along with oral antibiotics may reduce the risk
of developing antibiotic resistance. Antibiotics may cause side effects, such
as an upset stomach, dizziness or skin discoloration. These drugs also increase
your skin's sun sensitivity and may reduce the effectiveness of oral
contraceptives.
For deep
cysts, antibiotics may not be enough. Isotretinoin (Amnesteem, Claravis,
Sotret) is a powerful medication available for scarring cystic acne or acne
that doesn't respond to other treatments. This medicine is reserved for the
most severe forms of acne. It's very effective, but people who take it need
close monitoring by a dermatologist because of the possibility of severe side
effects. Isotretinoin is associated with severe birth defects, so it can't be
safely taken by pregnant women or women who may become pregnant during the
course of treatment or within several weeks of concluding treatment. In fact,
the drug carries such serious potential side effects that women of reproductive
age must participate in a Food and Drug Administration-approved monitoring
program to receive a prescription for the drug.
Isotretinoin
commonly causes side effects such as dry eyes, mouth, lips, nose and skin, as
well as itching, nosebleeds, muscle aches, sun sensitivity and poor night
vision. The drug may also increase the levels of triglycerides and cholesterol
in the blood and may increase liver enzyme levels also.
Isotretinoin and Birth Defects
Isotretinoin will damage an unborn baby. If you're a woman of childbearing
age:
- Don’t use
isotretinoin if you are pregnant or you think you are pregnant.
- Use one
or ideally two methods of contraception for one month before treatment
begins, during treatment and for one month after treatment has finished.
- Have a
pregnancy test before, during and after treatment.
You will be asked to sign a form confirming that you understand the risk of
birth defects and are willing to use contraceptives to prevent this risk, even
if you are not currently sexually active.
If you think you may have become pregnant when taking isotretinoin,
contact your dermatologist immediately.
Isotretinoin is also not suitable if you are breastfeeding.
Isotretinoin and Mood Changes
There have been reports of people experiencing mood changes while taking
isotretinoin. There is no evidence that these mood changes were the result of
the medication.
However, as a precaution, contact your dermatologist immediately if you feel
depressed or anxious, have feelings of aggression or suicidal thoughts.
Hormonal therapies
Hormonal therapies can often benefit women with acne, especially if their
acne is associated with hormonal conditions such as polycystic ovary syndrome.
If you don't already use it, your GP may recommended that you start taking
the combined oral contraceptive pill, even if you are not sexually active. This
combined pill can often help improve acne in women.
Co-Cyprindiol
Co-cyprindiol is a hormonal treatment that can be used for more severe acne
which doesn't respond to antibiotics. Co-cyprindiol helps reduce the production
of sebum.
One will probably have to use co-cyprindiol for two to six months before you
notice a significant improvement in your acne.
There is a small risk that women taking co-cyprindiol may
develop breast cancer in later life.
For example, out of a group of 5,000 women who have not taken co-cyprindiol,
you would expect 14 of them to develop breast cancer by the time they were 35.
This figure rises to 16 or 17 for women who were treated with co-cyprindiol for
at least five years in their early twenties.
There is also a very small chance of co-cyprindiol causing a blood clot
which is estimated to be around 1 in 2,500 in any given year in
risk
It is not thought to be safe to take co-cyprindiol if you are pregnant or
breastfeeding therefore women may need to have a pregnancy test before
treatment can begin.
Other side effects of co-cyprindiol include:
- bleeding
and spotting between your periods, which can sometimes occur for the
first few months
- headaches
- sore
breasts
- mood
changes
- loss of
interest in sex
- weight
gain or weight loss depending.
- Oral contraceptives.
Oral contraceptives, including a combination of norgestimate and ethinyl
estradiol (Ortho Tri-Cyclen, Previfem, others), can improve acne in women.
However, oral contraceptives may cause other side effects — such as
headaches, breast tenderness, nausea and depression — that you'll want to
discuss with your doctor. The most serious potential complication is a
slightly increased risk of heart disease, high blood pressure and blood
clots.
-
- Laser and light therapy. Laser- and light-based therapies reach the deeper
layers of skin without harming the skin's surface. Laser treatment is
thought to damage the oil (sebaceous) glands, causing them to produce less
oil. Light therapy targets the bacteria that cause acne inflammation.
These therapies can also improve skin texture and lessen the appearance of
scars. More research is needed to understand the most effective use of
light and laser therapies in acne treatment, and experts currently
recommend these approaches as stand-alone therapy only in people who can't
tolerate approved acne medications. These therapies may be uncomfortable
and may cause temporary skin problems that mimic a severe sunburn.
- Cosmetic procedures.
Chemical peels and microdermabrasion may be helpful in controlling acne.
These cosmetic procedures — which have traditionally been used to lessen
the appearance of fine lines, sun damage and minor facial scars — are most
effective when used in combination with other acne treatments. They may
cause temporary, severe redness, scaling and blistering, and long-term
discoloration of the skin.
Acne scar treatment
Doctors may be able to use certain
procedures to diminish scars left by acne.
- Soft tissue fillers.
Collagen or fat can be injected under the skin and into scars to fill out
or stretch the skin, making the scars less noticeable. Results from this
acne scar treatment are temporary, so you need to repeat the injections
periodically.
- Chemical peels.
High-potency acid is applied to your skin to remove the top layer and
minimize deeper scars. Some stronger peels reach even deeper into the
skin.
- Dermabrasion.
Usually reserved for more severe scarring, dermabrasion involves removing
the top layer of skin with a rapidly rotating wire brush. Surface scars
may be completely removed, and deeper acne scars may appear less
noticeable. Dermabrasion may cause pigmentation changes for people with
darker skin.
- Microdermabrasion.
This newer acne scar treatment involves a hand-held device that blows
crystals onto skin. These crystals gently abrade or "polish" the
skin's surface. Then, a vacuum tube removes the crystals and skin cells.
Because just the surface cells are removed, the skin isn't damaged.
However, results are subtle and scars may still be noticeable, even after
several sessions.
- Laser, light source and radiofrequency treatments. In laser resurfacing, a laser beam destroys the outer
layer of skin (epidermis) and heats the underlying skin (dermis). As the
wound heals, new skin forms. Less intense lasers (nonablative lasers),
pulsed light sources and radiofrequency devices don't injure the
epidermis. These treatments heat the dermis and cause new skin formation.
After several treatments, acne scars may appear less noticeable. This
means shorter recovery times, but treatment typically needs to be repeated
more often and results are subtle.
Skin surgery. A minor procedure (punch
excision) cuts out individual acne scars. Stitches or a skin graft repairs the
hole left at the scar site.
Non-pharmaceutical
treatments
Many treatments for acne do not
involve medication.
These include:
- comedone extractor – a small pen-shaped instrument that
can be used to clean out blackheads and whiteheads
- chemical peels – where a chemical solution is applied
to the face, causing the skin to peel off and new skin to replace it
- photodynamic therapy – where light is applied to the
skin in an attempt to improve symptoms of acne
There is only limited evidence to
support these types of treatment.
Natural Remedies
- Tea tree oil.
Gels containing 5 percent tea tree oil may be as effective as are lotions
containing 5 percent benzoyl peroxide, although tea tree oil might work
more slowly. Tea tree oil may cause a skin reaction known as contact
dermatitis. There's also some concern that topical products containing tea
tree oil might cause breast development in young boys. Don't use tea tree
oil if you have acne rosacea because it can worsen symptoms.
- Alpha hydroxy acids.
These natural acids — found in foods such as citrus fruits, sugar cane,
apples and grapes — help remove dead skin cells and unclog pores when
applied topically. Alpha hydroxy acids may also improve the appearance of
acne scars. Adverse reactions to alpha hydroxy acids include redness, mild
stinging and skin irritation.
- Azelaic acid.
This naturally occurring acid is found in whole-grain cereals and animal
products and has antibacterial properties. A 20 percent azelaic acid cream
seems to be as effective as many other conventional acne treatments,
including 5 percent benzoyl peroxide and oral tetracycline.
- Zinc supplements.
The mineral zinc plays a role in wound healing and reduces inflammation,
which could help improve acne. Taking a zinc supplement with food may
reduce side effects, including a bad taste in your mouth and nausea. Zinc
can also be added to lotions or creams and may reduce acne breakouts.
- Brewer's yeast.
A specific strain of brewer's yeast, called CBS 5926, seems to help decrease
acne but may cause migraines in susceptible people and may cause
intestinal upset.
Therefore some more research is
needed to understand the potential role of these and other dietary supplements
in the treatment of acne.
All patients are advised to talk
with their doctors or dermatologists before trying any natural remedy because
they too have side effects and may therefore may intervene in the effectiveness
of certain prescribed medications
