What is Acne?
Acne is a skin condition which has plugged pores (blackheads and whiteheads), inflamed pimples (pustules), and deeper lumps (nodules). Acne occurs on the face, as well as the neck, chest, back, shoulders, and upper arms. Although most teenagers get some form of acne, adults in their 20’s, 30’s, 40’s, or even older, can develop acne. Often, acne clears up after several years, even without treatment. Acne can be disfiguring and upsetting to the patient. Untreated acne can leave permanent scars; these may be treated by your dermatologist in the future. However, it is best to avoid acne scarring, some of which cannot be corrected. Treating acne is important.
Types of Acne and How Acne Forms
Acne is not caused by dirt. Testosterone, a hormone which is present in both males and females, increases during adolescence (puberty). It stimulates the oil (sebaceous) glands of the skin to enlarge, produce oil, and plug the pores. Whiteheads (closed comedones), blackheads (open comedones), and pimples (pustules) are present in teenage acne. Early acne occurs before the first period in young girls is called prepubertal acne. When acne is severe and forms deep “pus-filled” lumps, it is called cystic acne. This may be more common in males. Adult acne develops later in life and may be related to hormones, childbirth, menopause, stopping the pill, some medications or for no apparent reason. Adult women may be treated at the period and at ovulation when acne is especially severe, or throughout the entire cycle. Adult acne is not rosacea, a disease in which blackheads and whiteheads do not occur.
Acne has nothing to do with not washing your face. However, it is best to wash your face with a mild cleanser and warm water daily. Washing too often or too vigorously may actually make your acne worse.
Acne is not caused by foods. However, if certain foods seem to make your acne worse, try to avoid them.
Wear as little cosmetics as possible. Oil-free, water-based moisturizers and make-up should be used. 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 mild soap or gentle cleanser and water. A flesh-tinted acne lotion containing acne medications can safely hide blemishes. Loose powder in combination with an oil-free foundation is also good for cover-up. Shield your face when applying sprays and gels on your hair.
Control of acne is an ongoing process. All acne treatments work by preventing new acne breakouts. Existing blemishes must heal on their own, and therefore, improvement takes time. If your acne has not improved within two to three months, your treatment may need to be changed. The treatment your dermatologist recommends will vary according to the type of acne. Occasionally, an acne-like rash can be due to another cause such as make-up or lotions, or from oral medication. It is important to help your dermatologist by providing an updated history of what you are using on your skin or taking internally. Many non-prescription acne lotions and creams help mild cases of acne. However, many will also make your skin dry. Follow instructions carefully.
Your doctor may prescribe topical creams, gels, or lotions with vitamin A acid-like drugs, benzoyl peroxide, or antibiotics to help unblock the pores and reduce bacteria. These products may cause some drying and peeling. He will advise you about correct usage and how to handle side effects. Before starting any medication, even topical medications, inform your doctor if you are pregnant or nursing, or if you are trying to get pregnant.
Acne surgery may be used by your doctor to remove blackheads and whiteheads. Do not pick, scratch, pop, or squeeze pimples yourself. When the pimples are squeezed, more redness, swelling, inflammation, and scarring may result. Microdermabrasion may be used to remove the upper layers of the skin improving irregularities in the surface, contour, and generating new skin. Light chemical peels with salicylic acid, lactic acid or glycolic acid help to unblock the pores, open the blackheads and whiteheads, and stimulate new skin growth. Injections of corticosteroids may be used for treating large red bumps (nodules). This may help them go away quickly.
Antibiotics taken by mouth such as tetracycline, doxycycline, minocycline, erythromycin or sulfa-based antibiotics are often prescribed.
Birth Control Pills
Birth control pills may significantly improve acne, and may be used specifically for the treatment of acne. It is also important to know that oral antibiotics may decrease the effectiveness of birth control pills as contraceptives. This is uncommon, but possible, especially if you notice break-through bleeding. As a precautionary measure, use a second form of birth control if you are on an oral antibiotic.
In cases of unresponsive or severe acne, isotretinoin may be used. Patients using isotretinoin must understand the side effects of this drug. Monitoring with frequent follow-up visits is necessary. Pregnancy must be prevented while taking the medication, since the drug causes birth defects.
- Women may also use female hormones or medications that decrease the effects of male hormones to help their acne.
- Photodynamic therapy using the blue wavelength of light can be helpful in treating acne as well.
- Your dermatologist will evaluate you and suggest the appropriate treatment regimes considering your age, sex, and the type of acne you have.
Treatment of Acne Scarring
Your doctor can treat acne scars by a variety of methods. Skin resurfacing with laser, dermabrasion, chemical peels, or electrosurgery can flatten depressed scars. Soft tissue elevation with collagen or fat-filling products can elevate scars. Scar revision with a microexcision and the punch grafting technique can correct pitted scars, and combinations of these dermatologic surgical treatments can make noticeable differences in appearance. Nonetheless, none of these treatments will give you the “perfect” complexion that you had before experiencing acne – so early treatment is essential.
Proper Care is Necessary
No matter what special treatments your doctor may use, remember that you must continue proper skin care. Acne is not curable, but it is controllable; proper treatment helps you to feel and look better and may prevent scars.