About Acne and Skincare
Questions
and Answers About Acne from
doctorsecret.com
This fact sheet contains
general information about acne and skincare. It describes
what acne is and how it develops, the causes
of acne, and the treatment options for
various forms of acne. Information is also
provided on caring for adult acne and your
skincare. If you have
further questions after reading this
booklet, you may wish to discuss them with
your doctor.
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. Go To
www.beautyskincare.com
|
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.
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, pediatricians, 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 sulfur 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
sulfur 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 sulfur.
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 color. Tetracycline is not
given to pregnant women, nor is it given to
children under 8 years of age because it
might discolor 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 fetus 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 cortisone 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 labeled 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.
Where Can People Find
More Information on Acne?
acne treatment | best acne treatments
National Institute of
Arthritis and Musculoskeletal and Skin
Diseases (NIAMS)
National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
Phone: 301-495-4484 or 877-22-NIAMS
(226-4267) (free of charge)
TTY: 301-565-2966
Fax: 301-718-6366
www.niams.nih.gov
NIAMS provides information
about various forms of arthritis and
rheumatic disease and bone, muscle, joint,
and skin diseases. It distributes patient
and professional education materials and
refers people to other sources of
information. Additional information and
updates can also be found on the NIAMS Web
site.
American Academy of
Dermatology
P.O. Box 4014
Schaumburg, IL 60168-4014
Phone: 847-330-0230 or 888-462-3376 (free of
charge)
Fax: 847-330-0050
www.aad.org
This national organization
can provide referrals to dermatologists. It
also publishes a brochure on acne for adults
and a fact sheet for young people. These are
available on the organization's Web site or
can be obtained by calling or writing to the
academy.
Acknowledgments
The NIAMS gratefully
acknowledges the assistance of Robert Katz,
M.D., Rockville, MD; Larry Miller, M.D.,
Chevy Chase, MD; Alan Moshell, M.D., NIAMS,
NIH; Gary Peck, M.D., Washington Hospital
Center, Washington, DC; and Maria Turner,
M.D., National Cancer Institute, NIH, in the
preparation and review of this booklet.
The mission of the National
Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS), a part of the
National Institutes of Health (NIH), is to
support research into the causes, treatment,
and prevention of arthritis and
musculoskeletal and skin diseases, the
training of basic and clinical scientists to
carry out this research, and the
dissemination of information on research
progress in these diseases. The National
Institute of Arthritis and Musculoskeletal
and Skin Diseases Information Clearinghouse
is a public service sponsored by the NIAMS
that provides health information and
information sources. Additional information
can be found on the NIAMS Web site at
www.niams.nih.gov.
This booklet is not
copyrighted. Readers are encouraged to
duplicate and distribute as many copies as
needed.
Additional copies of this
booklet are available from
National Institute of
Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) Information
Clearinghouse
National Institutes of Health (NIH)
1 AMS Circle
Bethesda, MD 20892-3675
NIH Publication No. 01-4998
Only $4.95 sent right to your Email.
More info
|
