Acne is a skin disorder resulting from the action of hormones and other substances on the skin's oil glands and hair follicles. These factors lead to plugged skin pores and outbreaks of pimples. Acne usually appears on the face, neck, back, chest, and shoulders. Although acne usually is not a serious health threat, it can be a source of emotional distress. Severe acne can also lead to permanent scars that may need treatment to remove.
Doctors describe acne as a disease of the pilosebaceous units (PSUs) in the skin. Found over most of the body, PSUs consist of a sebaceous gland connected to a canal, called a pore or follicle that contains a fine hair . These units are mostly found 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. Cells called keratinocytes line the follicle.
The hair, sebum, and keratinocytes that fill the narrow follicle may produce a plug on the pore, which is an early sign of acne. The plug prevents sebum from reaching the surface of the skin through a follicle, which allows bacteria Propionibacterium acnes (P. acnes) that normally live on the skin to grow in the plugged follicles due to the oiliness. These bacteria produces chemicals and enzymes that attract white blood cells, therefore causing inflammation. (Inflammation is a characteristic reaction of tissues to disease or injury and can be recognized 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, bacteria and all, which inflames the skin and leads to lesions or pimples.
What Causes Acne?
The exact cause of acne is unknown, but doctors believe it results from several related factors, including the hormone increase in teenage years (this can cause the oil glands to plug up more often), hormone changes during pregnancy, starting or stopping birth control pills. Other factors include heredity (if your parents had acne, you might get it, too), some types of medicine (especially sleeping pills) and greasy makeup.
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, Oil from skin products (moisturizers or cosmetics) or grease encountered in the work environment (for example, a kitchen with fry vats). Pressure from sports helmets or equipment, backpacks, tight collars, or tight sports uniforms, environmental irritants, such as pollution and high humidity, Squeezing or picking at blemishes, hard scrubbing of the skin and stress can also make Acne worse.
Who Gets Acne?
People of all races and ages get acne. But it is most common in teenagers and young adults. Nearly 85 percent of people between the ages of 12 and 24 get acne. For most people, acne tends to go away by the time they reach their thirties. But some people in their forties and fifties continue to have this skin problem.
How Is Acne Treated?
Acne is usually treated by dermatologists (doctors who specialize in skin problems). These doctors treat all kinds of acne, particularly in severe cases. Doctors who are general or family practitioners, pediatricians, or internists may also 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
1 is aimed at reducing several problems that play a part in causing acne: Healing pimples, stopping new pimples from forming, preventing scarring, stopping inflammation, killing the bacteria,lowering the production of oil and helping reduce the embarrassment of having acne.
Depending on the extent of the problem, the doctor may recommend one of several over-the-counter (OTC) medicines and/or prescription medicines. Some of these medicines may be applied to the skin, and others may be oral. The doctor may suggest using more than one topical medicine or combining oral and topical medicines.
All medicines can have side effects. Some medicines and side effects are mentioned in this booklet. Some side effects may be more severe than others. You should review the package insert that comes with your medicine and ask your health care provider or pharmacist if you have any questions about the possible side effects.
Treatment for Blackheads, Whiteheads, and Mild Inflammatory Acne
Doctors usually recommend an OTC or a milder prescription topical medicine for people with mild signs of acne. Topical medicine is usually applied directly to the acne lesions or to the entire area of affected skin.
There are several OTC topical medicines used for mild acne. Each works a little differently. The following are the most common ones: Benzoyl peroxide - it destroys P. acnes, and may also reduce oil production, Resorcinol – it can help break down blackheads and whiteheads. Salicylic acid – it helps break down blackheads and whiteheads. It also cuts down the shedding of cells lining the hair follicles. Sulfur – it also helps break down blackheads and whiteheads.
Topical OTC medicines are available in many forms, like gels, lotions, creams, soaps, or pads. In some people, OTC acne medicines may cause side effects such as skin irritation, burning or redness, which often gets better when you stop using the OTC. If you experience severe or prolonged side effects, you should report them to your doctor.
OTC topical medicines are somewhat effective in treating acne when used regularly. However, it may take up to 8 weeks before you see noticeable improvement.
Treatment for Moderate to Severe Inflammatory Acne
People 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. They include: Antibiotics – They help stopping or slow the growth of bacteria and reduces inflammation. Vitamin A derivatives (retinoids) – They unplug existing comedones (plural of comedo), allowing other topical medicines, such as antibiotics, to enter the follicles. Some may also help decrease the formation of comedones. These drugs contain an altered form of vitamin A. Some examples of Vitamin A derivatives include tretinoin (Retin-A
2), adapalene (Differin), and tazarotene (Tazorac)
Like OTC topical medicines, prescription topical medicines come as creams, lotions, solutions, gels, or pads. Your doctor will consider your skin type when prescribing a product. Creams and lotions provide moisture and tend to be good choices for people with sensitive skin. If you have very oily skin or live in a hot, humid climate, you may prefer an alcohol-based gel or solution, which usually dries the skin. Your doctor will tell you how to apply the medicine and how often to use it.
Prescription topical medicines may cause some minor side effects, including stinging, burning, redness, peeling, scaling, or discoloration of the skin. With some medicines, such as tretinoin, these side effects usually decrease or go away after the medicine is used for a period of time. If the side effects are severe or don't go away, you should notify your doctor.
As with OTC medicines, the benefits of prescription topical medicines are not immediate. Your skin may seem worse before it gets better. It may take from 4 to 8 weeks to notice improvement, so be patient
Prescription Oral Medicines
They are for patients with moderate to severe acne, doctors often prescribe oral antibiotics. 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. Common antibiotics used to treat acne are tetracycline (Achromycin V), minocycline (Dynacin, Minocin), and doxycycline (Adoxa, Doryx, and Monodox).
Other oral medicines less commonly used are clindamycin (Cleocin), erythromycin, or sulfonamides (Bactrim). Some people taking these antibiotics have side effects, such as an upset stomach, dizziness or lightheadedness, changes in skin color, and increased tendency to sunburn. Because tetracyclines may affect tooth and bone formation in fetuses and young children, these drugs are not given to pregnant women or children under age 14. There is some concern, although it has not been proven, that tetracycline and minocycline may 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 vitamin A derivative. 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.
Advantages of Isotretinoin (Accutane)
Isotretinoin is a very effective medicine that can help to prevent permanent scarring. After 15 to 20 weeks of treatment with isotretinoin, the acne completely or almost completely disappears in most 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)
Accutane can cause birth defects in the developing fetus of a pregnant woman. It is very important that women of childbearing age are not pregnant while taking this medicine and do not get pregnant during the period. 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. You should also ask your GP when it is safe to get pregnant after you have stopped taking the medicene.
People with acne might become depressed and embarrassed by the changes in the appearance of their skin. Changes in mood may be intensified during treatment or soon after completing a course of medicines like isotretinoin. There have been a number of reported suicides and suicide attempts in people taking isotretinoin. However, the connection between isotretinoin and suicide or depression is not known. Nevertheless, if you or someone you know feels strangely sad, has other symptoms of depression, such as loss of appetite, loss of interest in once-loved activities, or trouble concentrating, or wants to commit suicide, it's important to consult your doctor.
Other possible side effects of isotretinoin include: dry eyes, mouth, lips, nose, or skin (very common), itching, frequent nosebleeds, muscle aches, sensitivity to the sun, poor night vision (due to the loss of vitamin A), changes in the blood, such as an increase in fats in the blood (triglycerides and cholesterol) and a change in liver function. To be able to determine if isotretinoin should be stopped if side effects occur, your doctor may test your blood before you start treatment and periodically during treatment. Side effects often go away after the medicine is stopped.
Treatments for Hormonally Influenced Acne in Women
In some women, acne is caused by an excess of androgen (male) hormones. Clues that this may be the case include hirsutism (excessive growth of hair on the face or body), premenstrual acne flares, irregular menstrual cycles, and elevated blood levels of certain androgens, which only happen in men.
The doctor may prescribe one of several drugs to treat women with this type of acne: Birth control pills – they suppress the androgen produced by the ovaries, Low-dose corticosteroid drugs, such as prednisone (Deltasone) or dexamethasone (Decadron, Hexadrol) – they suppress the androgen produced by the adrenal gland. Other common drugs include Antiandrogen drugs such as spironolactone (Aldactone) – which reduce the excessive oil production.
Side effects of antiandrogen drugs may include irregular menstruation, tender breasts, headaches, and fatigue.
Other Treatments for Acne
Doctors may use other types of procedures in addition to prescribing drugs to treat patients with acne. For example, the doctor may remove the patient's comedones during visits. The doctor may inject corticosteroids directly into lesions to help reduce the size and pain of inflamed cysts and nodules.
Early treatment is the best way to prevent scars caused by acne. Once scarring has occurred, it is permanent, so the doctor may suggest a medical or surgical procedure to help reduce the scars. A superficial laser may also be used to treat irregular scars. Dermabrasion (or microdermabrasion), which is a form of "sanding down" scars, is also used. Another treatment option for deep scars caused by cystic acne is the transfer of fat from another part of the body to the scar. A doctor may also inject a synthetic filling material under the scar to improve its appearance.
How Should People With Acne Care for Their Skin?
Clean Skin Gently
If you have acne, use a mild cleanser in the morning, evening, and after heavy workouts. Scrubbing the skin does not stop acne. It can even make the problem worse. Using strong soaps or rough scrub pads is not helpful and can make the problem worse too. Astringents are also not recommended unless the skin is very oily, and they should be used only on oily spots then. It is also important to shampoo your hair regularly. If you have really oily hair, you may want to wash it every day. .
Avoid Frequent Handling of the Skin
Try not to touch your skin. People who squeeze, pinch, or pick their pimples can get scars or dark spots on their skin.
Shave Carefully
Shave carefully. If you shave, you can try both electric and safety razors to see which works best. With safety razors, use a sharp blade. Also, it helps to soften your beard with soap and water before putting on shaving cream. Shave lightly and only when you have to. Also, shave gently and only when necessary to reduce the risk of nicking blemishes.
Avoid a Sunburn or Suntan
Many acne medicines can make people more likely 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, wrinkled skin and a higher risk of developing skin cancer.
Choose Cosmetics Carefully
While undergoing acne treatment, you may need to change some of the cosmetics you use. All cosmetics, such as foundation, blush, eye shadow, moisturizers, and hair-care products should be oil free. Look for the word "noncomedogenic" on the label. This means that the makeup will not clog up your pores. In some people, however, even these products may make acne worse.
For the first few weeks of treatment, applying foundation evenly may be difficult because the skin may be red or scaly, particularly with the use of topical tretinoin or benzoyl peroxide.
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, though it is not clear how significant a problem this resistance represents. They are looking at ways to prevent plugs and looking at ways to stop the hormone testosterone from causing acne too.
Scientists are also trying to better understand the mechanisms involved in acne so that they can develop new treatments that work on those mechanisms. For example, one group of researchers are studying the mechanisms that regulate sebum production in order to identify ways to effectively reduce its production without the side effects of drugs. Another group is trying to understand how P. acnes activates the immune system so that they can identify possible immunologic interventions. Other areas of research involve examining the effects of isotretinoin on an area of the brain that might lead to depression and developing a laser system to treat acne and acne-related scars without damaging the outer layers of the skin, which happens with the current superficial lasers .
Researchers in Germany, funded by German institutions, have taken P. acnes and identified its genome. This information may help researchers develop genetic treatments to kill the bacteria.