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Acne is a very common condition caused by blocked oil glands on the face, neck, back, chest,
and shoulders. Acne lesions are highly variable and 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 may draw more unwanted attention to the acne. Some types of acne
leave scarring which is permanent.
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Acne is caused by blocked oil glands (called sebaceous glands). The sebaceous glands naturally
produce oil called sebum which keeps the skin from drying out. During puberty, sebum
production dramatically increases and some of the oil glands become plugged as 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.
Acne often 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 connect acne with excessive quantities of milk, stress,
and heredity plus bacteria called Propionibacterium acnes that are normally present on the
skin likely plays a role in acne, but the precise link is still unclear.
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Most mild and moderate acne has no symptoms other than the acne lesions. Severe acne, however,
can be very painful.
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Diagnosis of acne during puberty is usually straightforward. The type of lesion and the
distribution of the lesions are usually distinctive. In adults, however, the diagnosis can
be more challenging as acne can overlap with rosacea, allergic reactions, and some types of
folliculitis. In adults, the underlying cause of the acne may need to be investigated as well.
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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
treatment options.
Creams (topical therapies)
- What over the counter treatments are available?
Effective over-the-counter medications usually contain benzoyl peroxide and/or salicylic acid formulations.
- 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
outer 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 while
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 plus there are other side effects that must be discussed
with your doctor. For women, oral contraceptives ("the pill") may also improve acne and
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 alos 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 which need to be discussed in detail with your doctor.
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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.
- Light Therapy
Blue light therapy takes advantage of the fact that bacteria in the skin produce a
product called porphyrin which can absorb blue light, leading to a chemical reaction in
the skin that destroys the bacteria. As a result, red light therapy reduces inflammation in
the skin which in turn improves acne. Unfortunately, acne lesions treated with light therapy
tend to reoccur over 3-12 months and in one study patients with severe acne had no
improvement compared to patients with moderate acne who did improve. There have been no
reported side effects.
- 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, with no serious side effects, after a single treatment.
The 1450 nm infrared laser was used in one uncontrolled study and decreased lesion counts
by 83% after three treatments. Side effects included temporary pain, redness, and swelling
which was reported in most patients and in patients with darker skin tones, hyperpigmentation
(darkening of the skin) was reported.
- Photodynamic Therapy (PDT)
This therapy 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 as 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 afterwards.
- 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
Chemical peels have long been used for facial rejuvenation and to reverse the signs of
aging and more recently, 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 improved acne.
- Microdermabrasion
In a few preliminary studies, microdermabrasion treatments have reduced acne lesions and
improved the texture of the skin in the majority of patients.
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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 not how
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 which
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 a 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 lessen the 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 to form. 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.
Also, clean your makeup brushes on a regular basis.
- Acne prone people should avoid oily products such as hair pomade, intense oil-based
facial moisturizers, and oily cleansers which may contribute to 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 a stress-free lifestyle. Studies show that stress may worsen acne flare-ups.
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 decrease stress.
- 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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