Acne

Acne is a skin problem that affects almost all teenagers. The condition results from the action of hormones on the skin's oil glands (sebaceous glands). The sebaceous glands make an oily substance called sebum that empties onto the skin surface through the hair follicle opening (pore). The mixture of oil and cells allows bacteria that normally live on the skin to grow in the follicle openings. When this happens, pores become clogged and pimples develop.

Pimples can be one of the following kinds:

• Comedones: Non-inflammatory papules that can be open (blackheads) or closed (whiteheads).
• Papules: Lesions that are inflamed and can be tender to the touch. These usually appear as small, pink bumps on the skin.
• Pustules: Lesions that are inflamed and filled with pus. They may be red at the base.
• Nodules: Solid lesions that are large, painful, and lodged deep within the skin.
• Cysts: Pus-filled lesions deep under the skin. These may cause scarring and pain.

In most cases, pimples occur on the face, neck, back, chest, and shoulders. Acne does not present a serious health risk, but severe acne can result in permanent scarring. In addition, acne can have significant physical and psychological consequences, such as causing a poor self-image, social inhibition, and anxiety.

Why Do Some People Get Acne and Others Don't?

It is not clear why some people are more prone to acne than others. The exact cause of acne is not known, but one important factor is an increase in male sex hormones called androgens. Androgens increase in both boys and girls during puberty. Androgens cause the sebaceous glands (oil glands) to get larger and produce more sebum. Androgens also can increase because of hormonal changes related to pregnancy or starting or stopping birth control pills.

Another factor in the cause of acne is genetics. Researchers believe that the tendency to develop acne can be inherited from parents. In addition, some drugs (for example, anti-epilepsy medication, prednisone, androgens, and lithium) are known to cause acne. Cosmetics that have a greasy consistency may change the cells of the follicles, causing them to stick together and resulting in a plugged pore. Water-based products are less likely to cause acne.

Things that can make acne worse include:

• Friction caused by leaning on or rubbing the skin; harsh scrubbing
• Picking or squeezing blemishes
• Pressure from bike helmets, backpacks, or tight collars
• Changing hormone levels in adolescent girls and adult women two to seven days before the start of the menstrual period
• Stress

Other factors that were previously thought to make acne worse do not seem to have an effect on the development of acne. These factors include chocolate, greasy foods, and dirty skin.

What Does Acne Look Like?

Acne can appear as one of the following:

• Whiteheads: White dots that are pores impacted with oil and skin covered by skin layers.
• Blackheads: Black bumps that are impacted pores in which material pushes out through the follicles. The black color is not from dirt. It may be from bacteria and matter that react with oxygen.
• Papules, pustules or nodules: More serious lesions appearing red and swollen due to inflammation or infection of the tissue around the clogged follicles, which are often painful and feel hard.
• Cysts: Deep, painful, pus-filled lesions that can cause scarring.

How Is Acne Treated?

Dermatologists (doctors who specialize in skin problems) often treat acne, particularly in severe cases. Family or general practitioners, pediatricians or internists may treat milder forms of acne.

Treatments may include:

• OTC topical drug treatments: Over-the-counter (OTC) medications include salicylic acid, benzoyl peroxide, and sulfur. These treatments are available in many forms including gel, lotion, cream, soap, or pads. When these products are used regularly, they are moderately effective in the treatment of acne. It may take 4-8 weeks for an improvement to occur in the skin.
• Prescription topical drug treatments: The prescription topical drug treatments that are used to treat acne include benzoyl peroxide, antibiotics, tretinoin, tazarotene, adapalene, and azelaic acid.
• Prescription oral drug treatments: For patients with moderate to severe acne, doctors often prescribe oral antibiotics (taken by mouth) in addition to topical medication. Oral antibiotics are thought to help control acne by curbing the growth of bacteria, thereby decreasing inflammation. They are usually taken daily for a period of four to six months and then tapered and discontinued as acne improves. The most potent oral drug, isotretinoin, is usually taken once or twice a day for 16 to 20 weeks. It is believed to markedly reduce the size of the oil glands so that much less oil is produced and to help prevent clogged pores. As a result, the growth of acne-causing bacteria is decreased. However, isotretinoin can cause birth defects in the developing fetuses of women who are pregnant while taking the drug. Women of childbearing age must not be pregnant and must not become pregnant while taking isotretinoin.

Acne Prevention Tips

Here are tips that may help control acne.

• Don't over wash or use harsh scrubs. Remember, acne is not caused by dirt. Two gentle washings a day is sufficient. Too much cleaning can leave skin irritated and dry, triggering glands to produce more oil, increasing the likelihood of pimples.
• Use oil-free or non-comedogenic products (those that won't clog pores) on your face.
• Don't squeeze or pick blemishes. Popping pimples can drive acne bacteria deeper into the skin. Picking can lead to more inflammation and permanent scarring.

Don't let acne define who you are. Do the things you can to improve your skin, and then get back to doing the things you enjoy.