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 and even into their 40s can get acne. While acne usually clears up after several years even if untreated, you need not wait to outgrow it. Untreated acne can leave lifelong scars.
While not a life threatening condition, acne can be upsetting and disfiguring—severe acne can lead to serious and permanent scarring. Even less severe cases can lead to scarring.
Rising hormone levels during adolescence (puberty) cause the oil-producing glands (sebaceous) of the skin to get bigger. These glands are found in areas where acne is common (the face, upper back and chest) and are stimulated by male hormones found in both males and females.
The glands are connected to a hair-containing canal called a follicle. The sebaceous glands make an oily substance called sebum, which reaches the surface by emptying through the opening of the follicle onto the skin surface. The oil (sebum) seems to stimulate the lining of the follicle. The cells from the lining shed more rapidly and stick together, forming a plug at the skin surface. The mixture of oil and cells also helps bacteria in the follicles grow. These bacteria make chemicals that can cause the wall of the follicle to break. Then sebum, bacteria and shed skin cells spill into the skin causing redness, swelling and pus (a pimple!).
Acne is not caused by dirt. 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. Washing too often 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 routines.
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.
Acne is not caused by the foods you eat. Dermatologists have differing opinions on the importance of diets in the management of acne. One thing is certain: a strict diet by itself will not clear your skin. On the other hand, some people find that certain foods seem to make their acne worse. If that's the case, foods that clearly worsen your acne should be avoided. But be careful about jumping to conclusions as acne has many ups and downs on it’s own.
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 sunscreen.
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 fresh-tinted acne lotion 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. If the spray comes in contact with your facial skin, it can cause a cosmetic type of acne.
Control of acne is an ongoing process. All acne treatments work by preventing new acne, but existing blemishes must heal on their own and 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 makeup, lotions or oral medication. Rarely, acne can be due to a hormone imbalance. It's important to help your dermatologist by providing a history of what you are using on your skin or taking internally. Women will want to discuss changes in the menstrual pattern.
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 or lotions such as vitamin A acid or benzoyl peroxide to help unblock the pores and reduce the bacteria. These 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 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 pimples yourself; when the pimples are squeezed, more redness, swelling, inflammation and scarring may result.
Antibiotics taken by mouth such as tetracycline, minocycline or erythromycin are often prescribed for moderate or severe cases, especially when there is a lot of acne on the back or chest. The antibiotics reduce the bacteria in the follicle and may also decrease the redness directly. When taking oral antibiotics, some women develop a yeast infection in the vaginal area. If this occurs, continue your medicine and contact your dermatologist immediately for treatment of the yeast.
Women who are taking birth control pills may notice a significant improvement in their acne, and occasionally birth control pills are 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.
In cases of severe acne, other drugs may be used orally. These may include female hormones or medications that decrease the effects of male hormones. Another oral medication, isotretinoin, is sometimes used for severe acne that has not responded to other treatments. Patients using isotretinoin must thoroughly understand the side effects of this drug. Frequent follow-up visits are necessary to monitor side effects. Prevention of pregnancy is a must, since the drug causes severe birth defects if taken during pregnancy.
No matter what special treatments your physician may use, remember that you must continue to use proper skincare until the tendency to have acne has passed. There is no instant or permanent cure for acne, but it is controllable and proper treatment may prevent scars.