Acne frequently asked questions FAQ

Here you will find our acne frequently asked questions. If your question is not answered here, please feel free to contact us.

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1. What causes acne?

2. Acne in teens

3. Information for parents on acne

4. Before you buy an acne treatment

5. Types of acne

6. Acne education

7. A complete acne guide

8. Acne: Dermatologic disease database extract

9. A guide to acne treatment

10. Acne causes and what causes acne?

11. Acne myths

12. Acne light / UV treatment for acne

1. What causes acne?

All acne is a disorder of the pilosebaceous unit, which is made up of a hair follicle, sebaceous gland, and a hair. These units are found everywhere on the body except on the palms, soles, top of the feet, and the lower lip. The number of pilosebaceous units is greatest on the face, upper neck, and chest. Sebaceous glands produce a substance called sebum, which is responsible for keeping the skin and hair moisturized. During adolescence sebaceous glands enlarge and produce more sebum under the influence of hormones, also called androgens. After about age 20, sebum production begins to decrease.

Acne & Bacteria

A bacteria, known as Propionibacterium acnes, is a normal inhabitant of the skin. It uses sebum as a nutrient for growth, therefore increases in follicles during puberty.

People with acne have more Propionibacterium acnes in their follicles than people without acne. The presence of bacteria attracts white blood cells to the follicle. These white blood cells produce an enzyme that damages the wall of the follicle, allowing the contents of the follicle to enter the dermis. This process causes an inflammatory response seen as papules (red bumps), pustules, and nodules. The bacteria also cause the formation of free fatty acids, which are irritants, increasing the inflammatory process in the follicle.

Normal Follicles

Sebum produced by the sebaceous gland combines with cells being sloughed off within the hair follicle and "fills up" the hair follicle. When the follicle is "full", the sebum spreads over the skin surface giving the skin an oily appearance. When this process works correctly, the skin is moisturized and remains healthy.

Obstructed Follicles

Problems arise when the sebum is trapped in the hair follicle. For reasons that are still unclear, some hair follicles become obstructed. The sebum is produced but gets trapped on the way out, and the cells that are normally sloughed off become "sticky", plugging up the follicle. The process of obstructing follicles is called comedogenesis. It causes some follicles to form a type of acne called comedones, also known as blackheads and whiteheads. [top of page]

2. Acne in teens

Acne commonly starts in the early teen years, when the oil glands in the body start making more sebum (oil). Some people also have too many "sticky" skin cells. In people who have acne, these cells mix with the oil and plug up the hair follicles in the skin.

A "whitehead" results when the hair follicle is plugged with oil and skin cells. If this plug reaches the surface of the skin and the air touches it, it turns black and is called a "blackhead." A blackhead isn't caused by dirt.

If the wall of a plugged follicle breaks, the area swells and turns into a red bump. If the follicle wall breaks near the skin surface, the bump usually becomes a pimple. If the wall breaks deep in the skin, acne nodules or cysts can form. This is called "cystic acne."

Things that often make acne worse;

• Oil-based makeup, suntan oil, hair gels and sprays
• Stress
• In girls: menstruation
• Squeezing or picking at blemishes
• Hard scrubbing of the skin
• Too much exposure to the sun
• Things that don't cause acne
• Dirt
• Foods such as chocolate or French fries
• Sexual activity
• Masturbation

Who gets acne?

Both boys and girls get acne. But it may be worse in boys because they have more skin oils.

Heredity also plays a role. If your mother and father had bad acne, you may too.

Your immune system plays a role too. Some people are extra sensitive to the bacteria that get trapped in their hair follicles.

How can acne be treated?

Acne can be treated in different ways. Talk with your doctor about the options.

Can an over-the-counter acne product help?

Yes. Benzoyl peroxide, resorcinol, salicylic acid and sulphur are the most common over-the-counter medications used to treat acne. Each works a little differently. These medications are available in many forms, such as gels, lotions, creams, soaps or pads. (Many have side effects!)

In some people, over-the-counter acne medications may cause side effects such as skin irritation, burning or redness. Tell your doctor if you have side effects that are severe or that don't go away over time.

Keep in mind that it can take between 4 and 8 weeks before you notice an improvement in your skin. If an over-the-counter acne product doesn't seem to help after 2 months, get advice from your doctor.

What can my doctor prescribe?

Your doctor may recommend antibiotics, which can be very effective for treating acne. They can be taken by mouth, or used on the skin in a lotion, cream or gel.

Retinoid, such as tretinoin (brand names: Retin-A, Avita, Altinac cream) and adapalene (brand name: Differin), are other medicines for treating acne. They are usually rubbed onto the skin once a day. Be sure not to get them near your eyes, mouth and the area under your nose.

If you use a retinoid, you must avoid the sun or use a strong sunscreen because this medicine increases your risk of getting a very bad sunburn. Girls who are pregnant or may become pregnant should not use a retinoid called tazarotene (brand name: Tazorac) because it can cause birth defects.

How is severe cystic acne treated?

Isotretinoin (brand name: Accutane) may be used to treat severe cystic acne that doesn't get better with other treatments. It's a pill that is taken once a day by mouth for 15 to 20 weeks.

In girls, isotretinoin can cause very serious side effects such as birth defects and miscarriages. It should never be taken during pregnancy or even 1 month before pregnancy. Girls must use 2 types of birth control or not have sex while they take isotretinoin, as well as 1 month before they start and 1 month after they stop taking it.

There is a possibility that other side effects may occur, so people taking isotretinoin should be closely monitored by their doctor.

Does acne cause scars?

Acne, especially cystic acne, can cause scars in some people. You can help reduce scarring by not squeezing or picking at blemishes. Also, avoid scrubbing your skin. If you do get scars, treatments are available. [top of page]

3. Information for parents on acne

Acne... Pimples... and Zits

Think back, way back for some of us, to your teen years when you were standing in front of a mirror staring at the huge zit on your face. Thoughts were racing through your mind. 'How did it get there?' and more importantly, 'How were you going to get it off before someone actually sees it?' Now keep this thought in the back of your mind. You're going to need to draw some sympathy from it when your teen is asking for yet another five bucks to try yet another acne medication, face wash, cream, etc.

The truth is no one is sure what causes acne. Scientists think a hormone called androgen plays a role. Androgen stimulates the sebum-producing glands. After puberty, boys produce 10 times as much androgen as girls. Therefore, more boys tend to develop severe cases of acne than girls, but that does not mean that some girls won't develop a severe case.

Fast Facts:

• Acne most often starts at around age 11 for girls and 13 for boys
• There's no scientific evidence to back up the claims that junk food and greasy foods cause acne. But, if your see an increase in acne after your teen eats these foods, have them cut back on eating them.
• A whopping 85 percent of the U.S. population between ages 12 and 25 develops some form acne.
• There's no scientific evidence to back up the claims that oily skin or hair causes acne. But if your teen is experiencing more pimples under their bangs for instance, it might be a good idea to change their hair style.
  Some studies have shown that up to 70 percent of women notice their acne worsening the week before their periods.
• If you or your spouse had problem acne as a teenager, there is more of a likelihood that your teen will experience this.
• There's no scientific evidence to back up the claims that stress brings on acne. But many teens experience a break out right before big events in their lives. A little sympathy, and reassurance can help here.

What can you do about acne?

Mild acne can often be cleared up simply by washing your face once or twice daily. If this doesn't work, try some of the over the counter products that clear skin. These drugs are "peeling agents," which cause irritation and drying that help the body loosen plugs and shed dead cells. The drugs also can keep bacteria from forming, which reduces the fatty acids that contribute to acne.

Don't let them pick at or "pop" zits. This can injure skin and underlying tissues. If they have acne that won't clear up with home treatment, take them to a dermatologist, a doctor who specializes in treating skin problems. [top of page]

4. Before you buy an acne treatment

Everybody gets zits. True, some of us get more than others, but nobody escapes puberty (or life for that matter) without dealing with the odd flare up. Things like stress, hormones, environment and life style can cause break outs, but more often than not how badly you get acne depends on one thing -- genetics. Yes, it is sad but true, if zits are in your genes there is nothing you can do to stop them from coming. But don't despair, you can successfully control most break outs and flare ups with over-the-counter acne products and we've assembled a list of the most teen friendly products on the market. Whether you prefer medicated products or natural therapies, we can help you find the ones that work and avoid the ones that don't.

Before you buy any acne treatment product you should take the following into consideration:

Know your skin type. People with oily skin should choose a gel based product, those with dry skin should choose a cream. If you are like most people and have combination skin, choose the product that best works with the afflicted area. If your acne flares up in the oily spots, choose a gel, if it is the dry skin that gets the zits, choose a cream.

The more sensitive your skin, the lower concentration of active ingredient you will need. Choosing a product that is too strong could actually make the situation worse by over drying the area and causing the skin to react by increasing oil production. This can end up causing more acne. If you have sensitive skin, stick with the milder formulations.

Some mild creams can be used as a preventative measure, but most acne creams are too harsh to be used before you see or feel a zit. Read the labels carefully and only apply the medication to places that are acne prone or actually have acne present.

If the acne is excessively painful, or if it becomes painful after trying an OTC product, try taking an anti-inflammatory medication like ibuprofen and get to a doctor ASAP.
If your skin has large pustules that appear in clusters, if they are painful, if your acne causes scars, or if you can't seem to get rid of a blemish (it starts to go away only to reappear just when you thought it was gone), your acne may require treatment by a doctor.

Top 10 Overall

Regardless of category or active ingredients, these products are quite simply the best.

Medicated Products

Medicated products contain a chemical that dries up the pimple while acting as an exfoliant. The most common ingredients used for this purpose are Benzoyl peroxide and solicit acid. People with sensitive skin should choose a product that contains solicit acid over one containing Benzoyl peroxide. The amount of drying chemical added to a product is measured in terms of percentage, with the stronger creams having a higher percentage (or concentration) of the active ingredient. Contrary to the "more is better" instinct, the highest concentration is not always the most effective, it all depends on your skin type and the sort of acne you are dealing with. Some acne will not respond well to OTC products and must be treated by a doctor or dermatologist (skin specialist).

Natural Products

Natural products contain various naturally occurring ingredients, usually plant extracts, that work to dry up the pimple and sooth the effected area. Most of these products are blends of natural ingredients like Vitamin E, grape seed oil, calendula, aloe vera or witch hazel and essential oils, but there are a few essential oils that work well in treating acne when used alone or with a single carrier oil. Natural treatments contain ingredients to dry the blemish, sooth the redness and add moisture to the irritated area. It is important to note that just because a product is natural doesn't mean that it is mild. People with sensitive skin should be every bit as careful when using a natural treatment as they are when using one that is medicated. Natural products can be very irritating to sensitive skin and can even cause reactions in people with allergies like hay fever. As with medicated treatments, if a natural treatment makes the acne worse or causes a painful reaction you should stop using the product and see a doctor right away. [top of page]

5. Types of acne

Acne Basics

Acne is the most common skin disorder seen by doctors. In fact, it will affect almost every one of us at some time in our lives. It can happen at any time, but teenagers are the ones who get it most often.

Acne can cause a great deal of embarrassment and anxiety. If it s really bad it can cause people to become depressed. They may withdraw from their friends, and perform poorly at school or work.

Visible Signs Of Acne:

The following are visible signs of acne:

Comedones:

An early acne blemish is caused by blocked pores, and at first the skin does not look red and inflamed. These early blemishes are called open comedones (black specks/blackheads) and closed comedones (white heads).

Papules and pustules:

As these early spots get larger and inflamed, they become papules and pustules (pimples or zits).

Nodules:

Very large and deep lumps can also develop in some people, these are called nodules and cysts (like boils), and can be painful.

Oily skin:

The sebum production increases so that your skin looks and feels oily.

Hyperpigmentation:

After the inflammation subsides, the skin can be discoloured by brown acne stains, (called Hyperpigmentation), and damaged by scars. Acne scars are common and may occur even in mild acne.

Who Gets Acne?

Acne is the most common of all skin disorders. Almost everyone will have acne - most get mild cases, some moderate, and a few are severe. Teens aren't the only ones who get it. Acne has been diagnosed in young infants as well as in the elderly, but it is most often seen in teens and young adults with 85-100% of adolescents and up to 10% of young adults getting it.

Acne seems to affect the sexes somewhat differently. Before children reach puberty, acne is more commonly seen in girls. During puberty, acne affects boys and girls almost equally, but boys generally have more severe cases, and in adulthood, it tends to be seen more often in women.

Where Does Acne Develop?

You can have acne on any part of your skin where sebaceous glands are found. These are the glands that produce oil for the skin. Most, but not all people get acne on their face, but the skin on the chest and back can also be affected. Acne can also be seen on the arms and thighs, but it s much less common.

When Do People Get Acne?

Acne usually starts around the time you reach puberty, and usually will be mild. Often it will last for about 5 years, but can persist for as long as 10-20 years. About 25% of teens who have acne will still have it when they turn 25. The cause is not understood, but it s becoming more common for women who are in their 20s, 30s, and 40s to develop acne, often for the first time. Temporary acne is often seen on the faces of newborns.

How Does Acne Affect You?

Acne not only causes physical discomfort and damage, but it can also have a big emotional and social impact on your life. Acne pimples, or zits can be tender and painful, and in extreme cases, the pimples can drain pus and blood, soiling pillowcases and clothing.

But, if you re feeling embarrassed and anxious about your appearance, that can be even more painful. Emotional effects can lead to mood changes, depression, social withdrawal and poor performance in school or at work. If acne is bad enough to leave scars, you may have to endure these emotional issues for years, because scarring is not readily correctable. While laser therapy and skin fillers certainly improve scars, it is best if you can prevent their formation in the first place. [top of page]

6. Acne education

What is Acne?

Acne is the term for plugged pores (blackheads and whiteheads), pimples, and even deeper lumps (cysts or nodules) that occur on the face, neck, chest, back, shoulders and even the upper arms. Acne affects most teenagers to some extent. However, the disease is not restricted to any age group; adults in their 20s - even into their 40s - can get acne. While not a life threatening condition, acne can be upsetting and disfiguring. When severe, acne can lead to serious and permanent scarring. Even less severe cases can lead to scarring.

Types of Acne

When you read about acne or other skin diseases, you encounter words or phrases that may be confusing. For example, the words used to describe the lesions of acnecomedo, papule, pustule, nodule and cystare understandable only if you know each word s definition. It also is helpful to have a photo that is characteristic for each type of lesion.

Here is a brief summary of definitions of words used to describe acne, with accompanying photos. Let s begin, though, with the definition of lesion, an all-purpose word:

Lesions are a physical change in body tissue caused by disease or injury. A lesion may be external (e.g., acne, skin cancer, psoriatic plaque, knife cut), or internal (e.g., lung cancer, atherosclerosis in a blood vessel, cirrhosis of the liver).

Thus, when you read about acne lesions you understand what is meant by a physical change in the skin caused by a disease process in the sebaceous follicle.

Acne lesions range in severity from comedones (blackheads and whiteheads) to nodules and cysts. Here is a brief definition of acne lesions:

Comedo (plural comedones) A comedo is a sebaceous follicle plugged with sebum, dead cells from inside the sebaceous follicle, tiny hairs, and sometimes bacteria. When a comedo is open, it is commonly called a blackhead because the surface of the plug in the follicle has a blackish appearance. A closed comedo is commonly called a whitehead; its appearance is that of a skin-colored or slightly inflamed "bump" in the skin. The whitehead differs in colour from the blackhead because the opening of the plugged sebaceous follicle to the skin s surface is closed or very narrow, in contrast to the distended follicular opening of the blackhead. Neither blackheads nor whiteheads should be squeezed or picked open, unless extracted by a dermatologist under sterile conditions. Tissue injured by squeezing or picking can become infected by staphylococci, streptococci and other skin bacteria.

PapuleA papule is defined as a small (5 millimetres or less), solid lesion slightly elevated above the surface of the skin. A group of very small papules and microcomedone may be almost invisible but have a "sandpaper" feel to the touch. A papule is caused by localized cellular reaction to the process of acne.

PustuleA dome-shaped, fragile lesion containing pus that typically consists of a mixture of white blood cells, dead skin cells, and bacteria. A pustule that forms over a sebaceous follicle usually has a hair in the centre. Acne pustules that heal without progressing to cystic form usually leave no scars.

MaculeA macule is the temporary red spot left by a healed acne lesion. It is flat, usually red or red-pink, with a well defined border. A macule may persist for days to weeks before disappearing. When a number of macules are present at one time they can contribute to the "inflamed face" appearance of acne.

Nodule Like a papule, a nodule is a solid, dome-shaped or irregularly-shaped lesion. Unlike a papule, a nodule is characterized by inflammation, extends into deeper layers of the skin and may cause tissue destruction that results in scarring. A nodule may be very painful. Nodular acne is a severe form of acne that may not respond to therapies other than isotretinoin

CystA cyst is a sac-like lesion containing liquid or semi-liquid material consisting of white blood cells, dead cells, and bacteria. It is larger than a pustule, may be severely inflamed, extends into deeper layers of the skin, may be very painful, and can result in scarring. Cysts and nodules often occur together in a severe form of acne called nodulocystic. Systemic therapy with isotretinoin is sometimes the only effective treatment for nodulocystic acne. Some acne investigators believe that true cysts rarely occur in acne, and that (1) the lesions called cysts are usually severely inflamed nodules, and (2) the term nodulocystic should be abandoned. Regardless of terminology, this is a severe form of acne that is often resistant to treatment and likely to leave scars after healing.

Who gets acne?

Close to 100% of people between the ages of twelve and seventeen have at least an occasional whitehead, blackhead or pimple, regardless of race or ethnicity. Many of these young people are able to manage their acne with over-the-counter (non-prescription) treatments. For some, however, acne is more serious. In fact, by their mid-teens, more than 40% of adolescents have acne severe enough to require some treatment by a physician.

In most cases, acne starts between the ages of ten and thirteen and usually lasts for five to ten years. It normally goes away on its own sometime in the early twenties. However, acne can persist into the late twenties or thirties or even beyond. Some people get acne for the first time as adults.

Acne affects young men and young women about equally, but there are differences. Young men are more likely than young women to have more severe, longer lasting forms of acne. Despite this fact, young men are less likely than young women to visit a dermatologist for their acne. In contrast, young women are more likely to have intermittent acne due to hormonal changes associated with their menstrual cycle and acne caused by cosmetics. These kinds of acne may afflict young women well into adulthood.

Acne lesions are most common on the face, but they can also occur on the neck, chest, back, shoulders, scalp, and upper arms and legs.

Normal distribution of acne

Acne also has significant economic impact. Americans spend well over a hundred million dollars a year for non-prescription acne treatments, not even taking into account special soaps and cleansers. But there are also the costs of prescription therapies, visits to physicians and time lost from school or work. [top of page]

7. A complete acne guide

What Is Acne?

Acne is a disorder resulting from the action of hormones on the skin's oil glands (sebaceous glands), which leads to plugged pores and outbreaks of lesions commonly called pimples or zits. Acne lesions usually occur on the face, neck, back, chest, and shoulders. Nearly 17 million people in the United States have acne, making it the most common skin disease. Although acne is not a serious health threat, severe acne can lead to disfiguring, permanent scarring, which can be upsetting to people who are affected by the disorder.

How Does Acne Develop?

Doctors describe acne as a disease of the pilosebaceous units (PSUs). Found over most of the body, PSUs consist of a sebaceous gland connected to a canal, called a follicle, that contains a fine hair (see "Normal Pilosebaceous Unit" diagram, below). These units are most numerous on the face, upper back, and chest. The sebaceous glands make an oily substance called sebum that normally empties onto the skin surface through the opening of the follicle, commonly called a pore. Cells called keratinocytes line the follicle.

Normal Pilosebaceous Unit

The hair, sebum, and keratinocytes that fill the narrow follicle may produce a plug, which is an early sign of acne. The plug prevents sebum from reaching the surface of the skin through a pore. The mixture of oil and cells allows bacteria Propionibacterium acnes (P. acnes) that normally live on the skin to grow in the plugged follicles. These bacteria produce chemicals and enzymes and attract white blood cells that cause inflammation. (Inflammation is a characteristic reaction of tissues to disease or injury and is marked by four signs: swelling, redness, heat, and pain.) When the wall of the plugged follicle breaks down, it spills everything into the nearby skin--sebum, shed skin cells, and bacteria--leading to lesions or pimples.

People with acne frequently have a variety of lesions, some of which are shown in the diagrams below. The basic acne lesion, called the comedo (KOM-e-do), is simply an enlarged and plugged hair follicle. If the plugged follicle, or comedo, stays beneath the skin, it is called a closed comedo and produces a white bump called a whitehead. A comedo that reaches the surface of the skin and opens up is called a blackhead because it looks black on the skin's surface. This black discoloration is not due to dirt. Both whiteheads and blackheads may stay in the skin for a long time.

Types of Lesions

Other troublesome acne lesions can develop, including the following:

Papules--inflamed lesions that usually appear as small, pink bumps on the skin and can be tender to the touch
Pustules (pimples)--papules topped by pus-filled lesions that may be red at the base
Nodules--large, painful, solid lesions that are lodged deep within the skin
Cysts--deep, painful, pus-filled lesions that can cause scarring.
What Causes Acne?

The exact cause of acne is unknown, but doctors believe it results from several related factors. One important factor is an increase in hormones called androgens (male sex hormones). These increase in both boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy or starting or stopping birth control pills can also cause acne.

Another factor is heredity or genetics. Researchers believe that the tendency to develop acne can be inherited from parents. For example, studies have shown that many school-age boys with acne have a family history of the disorder. Certain drugs, including androgens and lithium, are known to cause acne. Greasy cosmetics may alter the cells of the follicles and make them stick together, producing a plug.

Factors That Can Make Acne Worse

Factors that can cause an acne flare include:

Changing hormone levels in adolescent girls and adult women 2 to 7 days before their menstrual period starts
Friction caused by leaning on or rubbing the skin
Pressure from bike helmets, backpacks, or tight collars
Environmental irritants, such as pollution and high humidity
Squeezing or picking at blemishes
Hard scrubbing of the skin.
Myths About the Causes of Acne

There are many myths about what causes acne. Chocolate and greasy foods are often blamed, but foods seem to have little effect on the development and course of acne in most people. Another common myth is that dirty skin causes acne; however, blackheads and other acne lesions are not caused by dirt. Finally, stress does not cause acne.

Who Gets Acne?

People of all races and ages get acne. It is most common in adolescents and young adults. Nearly 85 percent of people between the ages of 12 and 24 develop the disorder. For most people, acne tends to go away by the time they reach their thirties; however, some people in their forties and fifties continue to have this skin problem.

How Is Acne Treated?

Acne is often treated by dermatologists (doctors who specialize in skin problems). These doctors treat all kinds of acne, particularly severe cases. Doctors who are general or family practitioners, paediatricians, or internists may treat patients with milder cases of acne.

The goals of treatment are to heal existing lesions, stop new lesions from forming, prevent scarring, and minimize the psychological stress and embarrassment caused by this disease. Drug treatment is aimed at reducing several problems that play a part in causing acne: abnormal clumping of cells in the follicles, increased oil production, bacteria, and inflammation. Depending on the extent of the person's acne, the doctor will recommend one of several over-the-counter (OTC) medicines or prescription medicines that are topical (applied to the skin) or systemic (taken by mouth). The doctor may suggest using more than one topical medicine or combining oral and topical medicines.

Treatment for Blackheads, Whiteheads, and Mild Inflammatory Acne

Doctors usually recommend an OTC or prescription topical medication for people with mild signs of acne. Topical medicine is applied directly to the acne lesions or to the entire area of affected skin.

Benzoyl peroxide, resorcinol, salicylic acid, and sulphur are the most common topical OTC medicines used to treat acne. Each works a little differently. Benzoyl peroxide is best at killing P. acnes and may reduce oil production. Resorcinol, salicylic acid, and sulphur help break down blackheads and whiteheads. Salicylic acid also helps cut down the shedding of cells lining the follicles of the oil glands. Topical OTC medications are available in many forms, such as gel, lotion, cream, soap, or pad.

In some patients, OTC acne medicines may cause side effects such as skin irritation, burning, or redness. Some people find that the side effects lessen or go away with continued use of the medicine. Severe or prolonged side effects should be reported to the doctor.

OTC topical medicines are somewhat effective in treating acne when used regularly. Patients must keep in mind that it can take 8 weeks or more before they notice their skin looks and feels better.

Treatment for Moderate to Severe Inflammatory Acne

Patients with moderate to severe inflammatory acne may be treated with prescription topical or oral medicines, alone or in combination.

Prescription Topical Medicines

Several types of prescription topical medicines are used to treat acne, including antibiotics, Benzoyl peroxide, tretinoin, adapalene, and azelaic acid. Antibiotics and azelaic acid help stop or slow the growth of bacteria and reduce inflammation. Tretinoin, a type of drug called a retinoid that contains an altered form of vitamin A, is an effective topical medicine for stopping the development of new comedones. It works by unplugging existing comedones, thereby allowing other topical medicines, such as antibiotics, to enter the follicles. The doctor may also prescribe newer retinoids or retinoid-like drugs, such as tazarotene or adapalene, that help decrease comedo formation.

Like OTC topical medicines, prescription topical medicines come as creams, lotions, solutions, or gels. The doctor will consider the patient's skin type when prescribing a product. Creams and lotions provide moisture and tend to be good for people with sensitive skin. Gels and solutions are generally alcohol based and tend to dry the skin. Therefore, patients with very oily skin or those who live in hot, humid climates may prefer them. The doctor will tell the patient how to apply the medicine and how often to use it.

Some people develop side effects from using prescription topical medicines. Initially, the skin may look worse before improving. Common side effects include stinging, burning, redness, peeling, scaling, or discoloration of the skin. With some medicines, like retinoids, these side effects usually decrease or go away after the medicine is used for a period of time. Patients should report prolonged or severe side effects to their doctor. Between 4 and 8 weeks will most likely pass before patients see their skin improve.

Prescription Oral Medicines

For patients with moderate to severe acne, the doctor often prescribes oral antibiotics (taken by mouth). Oral antibiotics are thought to help control acne by curbing the growth of bacteria and reducing inflammation. Prescription oral and topical medicines may be combined. For example, Benzoyl peroxide may be combined with clindamycin, erythromycin, or sulphur. Other common antibiotics used to treat acne are tetracycline, minocycline, and doxycycline. Some people have side effects when taking these antibiotics, such as an increased tendency to sunburn, upset stomach, dizziness or lightheadedness, and changes in skin colour. Tetracycline is not given to pregnant women, nor is it given to children under 8 years of age because it might discolour developing teeth. Tetracycline and minocycline may also decrease the effectiveness of birth control pills. Therefore, a backup or another form of birth control may be needed. Prolonged treatment with oral antibiotics may be necessary to achieve the desired results.

Treatment for Severe Nodular or Cystic Acne

People with nodules or cysts should be treated by a dermatologist. For patients with severe inflammatory acne that does not improve with medicines such as those described above, a doctor may prescribe isotretinoin (Accutane*), a retinoid. Isotretinoin is an oral drug that is usually taken once or twice a day with food for 15 to 20 weeks. It markedly reduces the size of the oil glands so that much less oil is produced. As a result, the growth of bacteria is decreased.

* Brand names included in this booklet are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

Advantages of Isotretinoin (Accutane)

Isotretinoin is a very effective medicine that can help prevent scarring. After 15 to 20 weeks of treatment with isotretinoin, acne completely or almost completely goes away in up to 90 percent of patients. In those patients where acne recurs after a course of isotretinoin, the doctor may institute another course of the same treatment or prescribe other medicines.

Disadvantages of Isotretinoin (Accutane)

Isotretinoin can cause birth defects in the developing foetus of a pregnant woman. It is important that women of childbearing age are not pregnant and do not get pregnant while taking this medicine. Women must use two separate effective forms of birth control at the same time for 1 month before treatment begins, during the entire course of treatment, and for 1 full month after stopping the drug. They should ask their doctor when it is safe to get pregnant after they have stopped taking Accutane.

Some people with acne become depressed by the changes in the appearance of their skin. Changes in mental health may be intensified during treatment or soon after completing a course of medicines like Accutane. A doctor should be consulted if a person feels unusually sad or has other symptoms of depression, such as loss of appetite or trouble concentrating.

Other possible side effects include dry eyes, mouth, lips, nose, or skin; itching; nosebleeds; muscle aches; sensitivity to the sun; and, sometimes, poor night vision. More serious side effects include changes in the blood, such as an increase in triglycerides and cholesterol, or a change in liver function. To make sure Accutane is stopped if side effects occur, the doctor monitors blood studies that are done before treatment is started and periodically during treatment. Side effects usually go away after the medicine is stopped.

Treatments for Hormonally Influenced Acne in Women

Clues that help the doctor determine whether acne in an adult woman is due to an excess of androgen hormones are hirsutism (excessive growth of hair in unusual places), premenstrual acne flares, irregular menstrual cycles, and elevated blood levels of certain androgens. The doctor may prescribe one of several drugs to treat women with this type of acne. Low-dose estrogen birth control pills help suppress the androgen produced by the ovaries. Low-dose corticosteroid drugs, such as prednisone or dexamethasone, may suppress the androgen produced by the adrenal glands. Finally, the doctor may prescribe an antiandrogen drug, such as spironolactone (Aldactone). This medicine reduces excessive oil production. Side effects of antiandrogen drugs may include irregular menstruation, tender breasts, headache, and fatigue.

Other Treatments for Acne

Doctors may use other types of procedures in addition to drug therapy to treat patients with acne. For example, the doctor may remove the patient's comedones during office visits. Sometimes the doctor will inject Hydrocortisone directly into lesions to help reduce the size and pain of inflamed cysts and nodules.

Early treatment is the best way to prevent acne scars. Once scarring has occurred, the doctor may suggest a medical or surgical procedure to help reduce the scars. A superficial laser may be used to treat irregular scars. Another kind of laser allows energy to go deeper into the skin and tighten the underlying tissue and plump out depressed scars. Dermabrasion (or microdermabrasion), which is a form of "sanding down" scars, is sometimes combined with the subsurface laser treatment. Another treatment option for deep scars caused by cystic acne is the transfer of fat from one part of the body to the face.

How Should People With Acne Care for Their Skin?

Clean Skin Gently

Most doctors recommend that people with acne gently wash their skin with a mild cleanser, once in the morning and once in the evening and after heavy exercise. Some people with acne may try to stop outbreaks and oil production by scrubbing their skin and using strong detergent soaps and rough scrub pads. However, scrubbing will not improve acne; in fact, it can make the problem worse. Patients should ask their doctor or another health professional for advice on the best type of cleanser to use. Patients should wash their face from under the jaw to the hairline. It is important that patients thoroughly rinse their skin after washing it. Astringents are not recommended unless the skin is very oily, and then they should be used only on oily spots. Doctors also recommend that patients regularly shampoo their hair. Those with oily hair may want to shampoo it every day.

Avoid Frequent Handling of the Skin

People who squeeze, pinch, or pick their blemishes risk developing scars or dark blotches. People should avoid rubbing and touching their skin lesions.

Shave Carefully

Men who shave and who have acne can test both electric and safety razors to see which is more comfortable. Men who use a safety razor should use a sharp blade and soften their beard thoroughly with soap and water before applying shaving cream. Nicking blemishes can be avoided by shaving lightly and only when necessary.

Avoid a Sunburn or Suntan

Many of the medicines used to treat acne can make a person more prone to sunburn. A sunburn that reddens the skin or suntan that darkens the skin may make blemishes less visible and make the skin feel drier. However, these benefits are only temporary, and there are known risks of excessive sun exposure, such as more rapid skin aging and a risk of developing skin cancer.

Choose Cosmetics Carefully

People being treated for acne often need to change some of the cosmetics they use. All cosmetics, such as foundation, blush, eye shadow, and moisturizers, should be oil free. Patients may find it difficult to apply foundation evenly during the first few weeks of treatment because the skin may be red or scaly, particularly with the use of topical tretinoin or Benzoyl peroxide. Oily hair products may eventually spread over the forehead, causing closed comedones. Products that are labelled as noncomedogenic (do not promote the formation of closed pores) should be used; in some people, however, even these products may cause acne.

What Research Is Being Done on Acne?

Medical researchers are working on new drugs to treat acne, particularly topical antibiotics to replace some of those in current use. As with many other types of bacterial infections, doctors are finding that, over time, the bacteria that are associated with acne are becoming resistant to treatment with certain antibiotics. Research is also being conducted by industry on the potential side effects of isotretinoin and the long-term use of medicines used for treating acne.

Scientists are working on other means of treating acne. For example, researchers are studying the biology of sebaceous cells and testing a laser in laboratory animals to treat acne by disrupting sebaceous glands. Scientists are also studying the treatment of androgenic disorders, including acne, in men by inhibiting an enzyme that changes testosterone to a more potent androgen. [top of page]

8. Acne: Dermatologic disease database extract

Acne is a common skin condition that afflicts most people, to a varying degree, during the teen years. However, the disease is by no means restricted to this age group; adults in their 20's or 30's may have acne. Don't think that because acne is common, treatment is unnecessary. Waiting to "outgrow" acne can be a serious mistake. Medical treatment can improve your appearance and self esteem, and prevent the development of lifelong scars.

The Cause of Acne

Acne is actually caused by a combination of several factors:

Rising hormone levels during adolescence cause enlargement and over activity of the oil glands in the skin.

The canals that bring this oil to the surface become blocked with keratin (a protein that is part o f the skin).

When these oil glands are overactive and the canals are blocked, the bacteria that normally l have on the skin and in the oil multiply, and inflame the skin.

Cleansing and Cosmetics

Even though you may be told to wash frequently, acne is not a disease caused by dirt. For example, the blackness of a blackhead is not dirt, but is due to the accumulation of the normal skin pigment in the oil gland ducts.

Wash your face with a mild antibacterial soap recommended by your dermatologist twice a day. If one's skin is very oily, it may be washed more often. Over washing or scrubbing tends to irritate the skin and will make acne worse. Therefore, do not use any abrasive cleaners or cleansing pads.

Shampooing is also important in acne therapy. The oilier your hair is, the more often you should shampoo it. Also, it is best to keep hair off the face as much as possible to avoid hair oils.

For covering blemishes, many preparations have been formulated to match skin colour. These cosmetics should be water based (i.e. the first ingredient on the label should be water). Greasy applications such as Vaseline, cocoa butter, cold cream, and vitamin E oil should be avoided. If the face is dry, your dermatologist can recommend a moisturizer for your type skin.

Diet

A generation ago, it was widely believed that greasy type foods aggravated acne. Since then, well-controlled studies have shown that in the great majority of people there is no relationship between diet and acne. So in addition to a well balanced diet, pizza, fried foods, chocolate, potato chips, and soft drinks may be eaten. If you are allergic to any of these, or they do not agree with you, don't eat them.

Treatment of Acne

Acne need not be feared as something untreatable. In recent years many effective forms of therapy have been developed. Dermatologists want to prevent scars that acne can leave. Years of untreated acne can leave a lifelong imprint on a person's face and can have an effect on his or her self-image. While acne may not be curable, it is usually controllable.

Since acne has many forms, your dermatologist designs an individual approach to care for successful control. Thus, the course of therapy will vary according to such factors as type of acne, it's severity and extent, and the patient's day-to-day activities.

Mild acne is treated with one or a combination of creams and solutions. The purpose of these topical medicines is to prevent new blemishes from forming. Therefore, apply these all over your affected areas, not just directly on the present pimples. In addition, in some people these creams may cause the face to become a little dry, pink or feel taught. This is normal. If your face becomes too irritated or 'raw' feeling, don't stop the creams, just decrease the frequency of application (i.e. apply every second or third day).

Moderate and severe acne is usually treated by topical medicines with the addition of antibiotic pills. Since different combinations work better for some patients than others, you are usually evaluated every four to six weeks until the acne is well controlled.

In addition to this conventional therapy, your dermatologist may recommend one or more of these treatments to speed healing and clearing of your acne:

Acne Surgery: This procedure greatly speeds acne clearing and appearance by manually removing blackheads and whiteheads. A round loop extractor is used to apply uniform smooth pressure to dislodge the material. Inserting a pointed instrument to carefully expose the contents loosens lesions that offer resistance.

Intralesional Corticosteroid Therapy: If one or several painful acne cysts develop, fast relief is available with this relatively painless procedure. Each cyst is given a single injection of a dilute Hydrocortisone solution, using a very tiny needle.

Accutane Therapy: In 1982 a new oral medication, isotretinoin (Accutane), became available for the treatment of patients with severe acne not responsive to conventional treatments. The duration of treatment is usually 5 months, and one such course is often curative of acne forever. Use of this medication does require a thorough understanding of its side effects and precautions (e.g. the prevention of pregnancy).

Treatment of Acne Scarring

Prior to correcting acne scarring, it is generally advisable to wait until acne activity has been low or absent for several months. Scars improve with time as the body softens their appearance. The colour contrast is often the most troublesome aspect of resolving large acne blemishes. These lesions may leave a flat or depressed red scar that is so obvious, patients mistake the mark for an active lesion. The colour will fade and approach skin tones in 4 to 12 months. Many patients are self-conscious about the pitted and crater like scars that do not fade. These remain as a permanent record of previous severe acne. Your dermatologist may a variety of procedures to you to remove or revise these marks:

Chemical Peel: Superficial acne scarring, and irregular pigmentation of the skin are easily treated with this technique. Chemical agents are applied to the skin, which cause the outer layer to be removed. Different chemicals and concentrations are used, depending on ones skin type and degree of scarring.

Laser Resurfacing: More prominent scarring from acne is best treated by this technique. The top several layers of skin are removed with this high energy light. This action evens out the skin to give it a smoother, more pleasing contour.

Punch Excision and/or Grafting: Some narrow pitted scars are too deep to be removed by dermabrasion. These can be removed with a surgical instrument called a punch. The resulting defect is closed, either primarily or with a tiny skin graft, with gratifying results. Sometimes this procedure is followed by chemical peel or laser resurfacing for patients with a mixed type of scarring.

Collagen Implantation: Patients with a few soft depressed scars with smooth edges respond well to collagen. This natural protein is injected under the lesion to elevate it to the level of the skin.

A Final Word

Treatment of acne is a continuing process if the disorder is to be controlled successfully. You must follow your dermatologist's instructions, since you are the only one who can accomplish the necessary daily care. If you are willing to spend the time and extend the effort, you can expect a pleasing result. [top of page]

9. A guide to acne treatment

Acne Treatment

Today, virtually every case of acne can be resolved. The key to getting rid of acne lesions and preventing new ones from forming lies in knowing that:

Resolution takes time.

What works for one person may not work for another.

A dermatologist s help may be required.

Resolution takes time. Treatments that promise fast, miraculous or overnight results often capture the attention of acne sufferers hoping for quick resolution. However, the fact remains that acne does not clear overnight. On average, 6 to 8 weeks are needed to see initial results. Once acne significantly improves or clears, continued treatment is needed to keep acne from re-appearing. If acne does not improve in 6 to 8 weeks, treatment may need to be adjusted as not every acne treatment clears every case of acne.

What works for one person may not work for another. What is an appropriate treatment for one person may not clear another s acne because many factors affect resolution, including the cause(s) of the acne, a person s skin type and the kind of acne lesions present.

A dermatologist s help may be required. With so many factors affecting clearance and a multitude of treatment options available (some only by prescription), a dermatologist s help can make a difference. Before prescribing treatment, dermatologists consider several factors, including the severity of the acne, types of lesions present, co-existing conditions, as well as the patient s age, skin type, lifestyle and motivation.

The knowledge gained from considering these factors allows dermatologists to create effective individualized therapy that will resolve the patient s acne over time and prevent new lesions from forming.

Sometimes a dermatologist may combine two or more treatment options. A patient may be instructed to use one medication in the morning and the other at night. Or, two medications may be combined in one prescription medication. Due to possible side effects, over-the-counter medications should not be combined unless directed by a dermatologist or other medical practitioner.

Acne responds especially well to early treatment. Dermatologists recommend that acne be treated early to maximize effectiveness as well as help prevent scarring. [top of page]

10. Acne causes and what causes acne?

What Causes Acne

Almost all teenagers get acne at one time or another. You haven't done anything to cause your acne. It's not your fault if you have it. Pimples are caused when oil ducts in the skin get plugged up and then burst, causing redness and swelling. Although there are many myths about acne, the following are the three main factors that cause it.

1. Hormones

When you begin puberty, certain hormones, called androgens, increase in both males and females. These hormones trigger oil ducts on the face, back and upper chest to begin producing oil. This can cause acne in some people.

2. Heredity

If other members of your family had acne as teenagers, there may be a chance that you've inherited a tendency toward getting acne as well.

3. Plugged oil ducts

If you are prone to acne, the cells that line the oil ducts in your skin tend to get larger and produce more oil, and the ducts get plugged. This traps the oil and leads to the formation of blackheads or whiteheads. The plugged ducts allow germs in the skin to multiply and produce chemicals that cause redness and swelling. This is why simple blackheads and whiteheads may turn red and bumpy and turn into the pimples of acne.

There is not much you can do about heredity, so your best control efforts are those that keep the oil ducts unplugged.

What doesn't cause acne?

Acne is not caused by foods you eat. Despite what you may have heard, there is no proof that soft drinks, chocolate and greasy foods cause acne.

It's not caused by dirt. The black plug in a blackhead is caused by a chemical reaction. It's not dirt. No matter how carefully you wash your face, you can still have acne.

It's not something you can "catch" or "give" to another person.
It's not caused by sexual thoughts or masturbation.
If you have acne, there are some things that can make it worse. To keep acne under control, try to avoid the following:

• Pinching (or "popping") pimples, which forces oil from the oil ducts into the surrounding normal skin, causing redness and swelling
• Harsh scrubbing, which irritates the skin
• Things that rub on the skin, such as headbands, hats, hair and chin straps, which also cause irritation
• Certain cosmetics (makeup), such as creams and oily hair products, which can block oil ducts and aggravate acne
• Some medications
• For young women, changes in hormone levels brought on by menstrual periods
• Emotional stress and nervous tension  

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11. Acne myths

Acne is caused by poor hygiene. This is not true. As mentioned before, acne is caused by extra skin and oil, but if you wash your skin hard and too often, you can make your acne worse. Remember: acne is not caused by dirt or surface skin oils, therefore, 'over washing' your epidermis will not help.

Acne is caused by certain foods. This is not true. All too many studies have found no connection between diet and acne. Not chocolate, nor French fries, nor pizza. If you happen to be one of the few who actually are affected by a certain food, then don't eat it! As a general rule, however, your body will always respond better to a good diet and lots of water.

Acne is caused by stress. This is not true, especially in young people. If anything, stress may worsen acne. The worsening of acne from stress is because more sebum, or oil, is released when you are stressed out.

You have to grow out of acne. This is not true a lot of the time. There are many products and methods for treating acne. If nothing is working for you, always see a dermatologist.

Acne is just a cosmetic disease. It is obvious that acne can worsen your looks and can result in permanent physical scars, however, it is usually never life-threatening. This does not mean acne is a simple cosmetic disease though. Acne and its negatives can affect the way people feel about themselves to the point of affecting their lives. If someone doesn't handle their life properly, acne can become a type of mental disease as well. [top of page]

12. Acne light / UV treatment for acne

The use of light, specifically ultra violet light frequency, has been shown to provide excellent results for acne sufferers. UV light penetrates the skin subcutaneously to help kill bacteria build up which clogs pores and causes acne. In theory it makes a lot of sense to use higher frequency UV light to affect and alter problematic skin which is vibrating at the lower hertzian frequency level.   [top of page]

Source: About Health.

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