What exactly is acne?
Acne (properly referred to as acne vulgaris) is a common, nearly universal, skin condition that can have a significant mental, emotional, and social impact on affected individuals to the point where it can actually affect their quality of life. Besides the psycho-social impact, acne can have a significant lasting impact on skin health and can result in permanent scarring. Fortunately, acne can be effectively treated to manage breakouts and limit or prevent scarring.
Symptoms of acne
Acne can cause several different types of blemishes, including:
- Blackheads: A blocked pore in which the top part of the plug, exposed to the air, turns dark
- Whiteheads: A blocked pore in which the plug stays below the skin surface and appears as a bump with a white top
- Pustules: pus-filled red bumps that occur when bacteria grow in the blocked pores
- Cysts: pus-filled sacs deep in the skin
What are the causes?
Below are some commons causes of acne.
- Hormones / Excess oil production: Acne happens when your skin makes too much sebum, an oily substance that normally lubricates and protects your skin and scalp. Sebum normally travels to the surface of your skin through your hair follicles. When there’s too much, some of it clogs and forms a plug in the follicle. Dead skin cells that don’t slough off fast enough can then make the problem worse, and when the Propionibacteria acnes bacteria start to grow in this blockage, you get pus-filled pimples. A number of different things can cause excess oil production, but the most common cause is hormones. During the teen years, hormone levels in your body increase, and some of these hormones cause your body to produce more oil.
- Heredity: Acne seems to run in families, so you’re likely to have it if your parents did.
- Oil-based beauty products: Using greasy or oily products on your skin can also promote clogged pores and cause breakouts.
- Anxiety and stress: Emotional and psychological stress directly affect the levels of hormones (cortisol and adrenaline) making acne worse.
- Certain medications: Some medications can cause acne as a side effect. These include:
- Hormones (especially testosterone)
- Certain birth control pills, injections or implants
- Medicines containing iodide or bromide
Effective treatment options
Depending on the severity of your acne, you may be able to treat it at home with over-the-counter topical treatments. If those don’t work, you may need to see a doctor for stronger options, such as prescription drugs or cosmetic procedures.
Many people see significant improvement with OTC treatments, so you should try those first. Creams, lotions or gels for acne often contain one of these medications:
Benzoyl Peroxide: You can get cleansers as well as lotions, creams and gels with this medication, which kills the Propionibacteria acnes bacteria. OTC strengths range from 2.5% to 10% and can take six weeks to work. It can cause a slight tingling or feeling of warmth as well as dryness or peeling when you first start using it. Products containing benzoyl peroxide include Clearasil, Oxy 10, PanOxyl, and others.
Salicylic acid: This drug gets deep into the follicle to help shed dead skin cells. It also reduces swelling and redness. Cleansers, creams, lotions and gels contain salicylic acid in concentrations ranging from 0.5% to 2%. It may initially cause irritation and stinging. You can find it in products from Clearasil, Oxy Balance, Stri-Dex and others.
Sulfur: Sulfur helps reduce skin oiliness and also helps it to peel, which in turn keeps pores clear. OTC strengths range from 5% to 8% in products from Clearasil, Queen Helene (face mask) and others.
Resorcinol: Some sulfur treatments also contain resorcinol at about 2%. It helps to break down rough skin and promote peeling.
Your doctor can prescribe stronger versions of either benzoyl peroxide or salicylic acid. If these still don’t work, you might try:
Topical antibiotics/antimicrobials: These substances kill or slow the growth of the P. acnes bacteria. Many also reduce inflammation. Antibiotics that work against the P. acnes bacteria include:
- Azelaic acid (Azelex, Finacea): This medication also helps keep pores clear by decreasing production of keratin, a skin protein. It may initially cause itching and burning, but these side effects should go away.
- Erythromycin: This antimicrobial is especially effective in combination with benzoyl peroxide.
- Sodium sulfacetamide: This antibiotic also opens clogged pores. Sodium sulfacetamide products often also contain sulfur.
Oral antibiotics: Erythromycin is also available as an oral drug. It and tetracycline are the two most commonly used oral antibiotics for treating acne.
Topical retinoids (vitamin A derivatives; Retin-A, Renova, Tretin X): Tretinoin and other synthetic retinoids increase cell turnover, which unplugs the hair follicles and reduces the formation of new pimples. You should not use other forms of topical acne medications, like benzoyl peroxide or salicylic acid, nor should you use dandruff shampoos with sulfur or resorcinol while using topical retinoids. One topical retinoid, tazarotene (Tazorac) has been shown to cause fetal abnormalities and should not be used by women who are or who may become pregnant.
Oral retinoid: Isotretinoin (Accutane) is very effective at treating acne, but can cause birth defects with a single dose. Women taking this drug are required to register with an FDA program called iPLEDGE in which they promise to use birth control and submit to monthly pregnancy tests while on the drug. You also should not breastfeed while on Accutane. Isotretinoin may also be linked to psychological disorders, including depression and psychosis. While it’s not clear that the drug causes these problems, it’s important to work closely with your doctor if you take it.
Low-dose birth control pills with estrogen: Ortho Tri-Cyclen and Yaz are two that have been shown to help reduce moderate acne in women. The estrogen in the pills helps to counteract the effects of testosterone and lower oil production. Doctors will usually try topical medications first. Oral medications tend to have more side effects.
If your acne has left obvious scars, you have a few choices for getting rid of them.
- Laser resurfacing: The doctor uses a laser to heat and damage the inner layer of skin, the dermis. New skin and collagen form to heal the wound, which plumps the skin and reduces the scars. It usually takes several treatments to get good results. More aggressive laser treatments also destroy the outer skin layer, which gets rid of more scars in just one treatment, but also requires a longer recovery time.
- Microdermabrasion, dermabrasion or dermaplaning:These techniques either scrub or shave off the top layer of skin, removing shallow scars and making deeper scars less noticeable. Microdermabrasion is the gentlest of these treatments. One potential side effect is changes in skin color, especially for people with dark skin.
- Chemical peels: Best for superficial scars, this treatment uses a chemical to remove the top layer of skin.
- Collagen injections: Collagen can fill in pitted scars and make them less noticeable. The results are temporary, so you will need regular treatments.
- Punch excision: In this surgical procedure, the doctor cuts out each scar and uses either stitches or skin grafts to repair the hole.
Acne is a frustrating condition, but with a little patience, you can find a treatment that works for you.
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