Acne

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 acne—comedo, papule, pustule, nodule and cyst—are 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.Lesion—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—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 color 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. The following photos are characteristic of acne with comedones:

(Photos used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides and the Sulzberger Institute for Dermatologic Education)

Acne is the term for plugged pores (blackheads and whiteheads), pimples, and deeper lumps (cysts or nodules), that occur on the face, neck, chest, back, shoulders and even the upper arms. Most teenagers have some acne. However, adults in their 20\'s, even into their 40\'s or older, can get acne. Acne often clears up after several years even without treatment, but you need not wait to outgrow it. Untreated acne can leave scars, which can be treated by your dermatologist as well.

While not a life threatening condition, acne can be upsetting and disfiguring. Acne can also lead to serious and permanent scarring.

How Acne Forms

Male hormones found in both males and females rise during adolescence (puberty) and stimulate and enlarge the oil (sebaceous) glands of the skin. These glands are found in areas where acne is common (the face, upper back, and chest). Rarely, acne can be due to a hormonal imbalance.

The oil glands are connected to a hair-containing canal called a follicle. The sebaceous glands make an oily substance called sebum which reaches the skin surface by emptying through the skin surface opening of the follicle. The hair follicle opening is sometimes called the pore. The oil (sebum) causes the cells from the follicular lining to shed more rapidly and stick together, forming a plug at the hair follicle opening. Bacteria grow in the mixture of oil and cells in the follicle. These bacteria make chemicals that stimulate inflammation and cause the wall of the follicle to break. The sebum, bacteria, and shed skin cells spill into the skin causing redness, swelling, and pus - a pimple.

Cleansing

The black in a blackhead is dried oil and shed skin cells in the openings of the hair follicles, not dirt. For the normal care of your skin, wash your face with soap and warm water twice a day. Acne is not caused by dirt. Washing too often or too vigorously may actually make your acne worse. Regular shampooing is also recommended. If your hair is oily, you may want to wash it more often. Your dermatologist can recommend the best face and hair washing routine.

Men with acne who shave should try both an electric and a safety razor to see which is more comfortable. If you use a safety razor, soften your beard thoroughly with soap and warm water before applying shaving cream. To avoid nicking pimples, shave as lightly as possible. Shave only when necessary and always use a sharp blade.

Diet

Acne is not caused by the foods you eat. Dermatologists have differing opinions on the importance of your diet in the management of acne. One thing is certain; a strict diet by itself will not clear your skin. On the other hand, if certain foods seem to make your acne worse, then try to avoid them. But be careful about jumping to conclusions, acne may get better or worse on its own. It is always important to eat a well balanced diet.

Sunlight

A tan can mask your acne, but the benefits are temporary. Since sunlight ages the skin and can cause skin cancer, you should not sunburn, "bake in the sun," or use sunlamps. Choose a sunscreen that is oil-free, such as a gel or light lotion.

Cosmetics

If you wear a liquid foundation or use a moisturizer, look for ones that are oil-free and not just water-based. Choose products that are "non-comedogenic" (should not cause whiteheads or blackheads) or "non-acnegenic" (should not cause acne). Remove your cosmetics every night with soap and water. A flesh-tinted acne lotion containing benzoyl peroxide, salicylic acid or sulfur can safely hide blemishes. Loose powder mixed with oil-free product is also good for cover-up. Shield your face when applying hairsprays and gels.

Treatment

Control of acne is an ongoing process. All acne treatments work by preventing new acne. Existing blemishes must heal on their own. Improvement takes time. If your acne has not improved after 6 to 8 weeks, you may need a change in your treatment.The treatment your dermatologist recommends will vary according to your type of acne. Occasionally, an acne-like rash can be due to another cause - such as from makeup, lotions, or from an oral medication. It\'s important to help your dermatologist by providing a history of what you are using on your skin or taking internally.Many non-prescription acne lotions and creams help milder cases of acne. However, many will also make your skin dry if used too often. If you use these products, follow instructions carefully. Your dermatologist may prescribe topical creams, gels or lotions with vitamin A acid or benzoyl peroxide to help unblock the pores and reduce bacteria. These products may cause some drying and peeling. Your dermatologist will advise you on the correct use and how to handle side effects.There are also antibiotics that are applied to the skin. These are used in less severe cases of acne. When large red bumps (cysts) are present, the dermatologist may inject cortisone directly into the bumps to help them go away. Your physician may open pimples or remove blackheads and whiteheads. Don\'t pick, scratch, pop or squeeze your pimples yourself. When the pimples are squeezed, more redness, swelling, inflammation and scarring may result. Antibiotics taken by mouth such as tetracycline, doxycycline, minocycline or erythromycin are often prescribed for moderate or severe cases, especially when there is a lot of acne on the back or chest. Antibiotics reduce the bacteria in the follicle and may also decrease the skin redness directly. When taking oral antibiotics, some women may develop a vaginal yeast infection. If this occurs, discontinue your medicine and contact your dermatologist immediately for treatment of the yeast.

Mild acne vulgaris

Women who are taking birth control pills may notice a significant improvement in their acne, and these pills are sometimes used specifically for the treatment of acne. It is also important to know that oral antibiotics may decrease the effectiveness of birth control pills. This is uncommon but possible, especially if you notice break-through bleeding. As with most medicines, check with your doctor about taking antibiotics if you are pregnant or nursing, or if you are trying to get pregnant.

Acne Myths:

Myth: Acne is related to diet

Reality: After years of studies, no correlation between diet and acne has been found. There is no evidence that chocolate, sugar, oil, milk, seafood, or any other food causes acne. Some people absolutely insist that a certain food causes acne for them. In this case, doctors sometimes recommend that they avoid that food. The bottom line is that changing your diet will most likely not affect your acne, and avoiding foods in order to clear your acne is probably a waste of your time.

Myth: Washing your face more often will help clear up acne

Reality: Acne is not caused by dirt. Frequent washing can actually irritate your skin. Excess irritation can worsen acne. A washcloth can aggravate this situation further. Use bare hands to wash and only wash twice a day unless you play some sort of sport which requires the use of a face mask during the day. In that case, a third washing and application of medication may be appropriate. Sweat from exercise itself, however, does not aggravate acne and should not be met with excess washing.

Myth: Stress causes acne 

Reality: Stress is not a very important factor in acne despite what you may have heard. Drugs that treat severe stress may have acne as a side effect, but stress itself is no big deal. Your time is better spent determining the right course of acne treatment rather than feeling guilt about stress.  

Myth: Masturbation or sex causes acne

Reality: This antiquated notion, originating as early as the 17th century to dissuade young people from having pre-marital sex, is just plain wrong. Don\'t believe the hype.

Myth: The sun is good for acne

Reality: The sun may work in the short-term to hasten the clearing of existing acne while reddening your skin, thus blending your skin tone with red acne marks. However, a sun tan is actually skin damage. Sun exposure causes irritation which can make acne worse. The sun is a short-term band-aid which will bite back with more acne in the weeks following exposure.