Acne is a condition that affects almost everyone at some point in their life. Some people experience mild acne that does not scar or cause significant problems. Others have more severe acne that does scar and hinders them from living their life in the manner they desire. Hormonal and inflammatory causes are the biggest reasons for people to have acne. Rarely is acne caused from the face being “dirty.” In fact, most people with acne have very “clean” skin because they wrongly think that scrubbing and excessively cleaning their skin will improve their acne; unfortunately, the excessive scrubbing is likely contributing to more acne than doing anything beneficial. Hormonal imbalances can cause more oil to form on the skin. This excess oil increases the likelihood that your “pores” will clog and produce pimples. Bacteria on the skin then eat this excess oil and create irritating byproducts. The irritating byproducts produce inflammation in your skin and make the acne much worse. Having the proper skin care products is a part of the equation to clear skin, and it is always suggested you see a Board Certified Dermatologist to help treat acne.
What Causes Acne
Acne begins when the pores in the skin become clogged and can no longer drain sebum (an oil made by the sebaceous glands that protects and moisturizes the skin.) The sebum build-up causes the surrounding hair follicle to swell. Bacteria called Propionibacterium acnes (P. acnes) that normally live on the top of the skin can enter the clogged pores and infect the sebum. This causes the skin to become swollen, red, and painful. Hair follicles swollen with sebum are called comedones. If the sebum stays beneath the skin, the comedones produce white bumps called whiteheads. If the sebum reaches the surface of the skin, the comedones produce darkened bumps called blackheads. This black discoloration is due to sebum darkening when it is exposed to air. It is not due to dirt. Both whiteheads and blackheads may stay in the skin for a long time. Infected sebaceous glands may burst, releasing sebum and bacteria into the surrounding skin, creating additional inflammation. In severe cases, larger nodules and cysts may form in the deeper layers of the skin.
Types of Acne Acne can be categorized by its severity:
1. Mild acne describes a few scattered comedones (whiteheads or blackheads) with minimal inflammation (no pustules).
2. Moderate acne describes a denser collection of comedones as well as red, inflamed, pus-filled lesions (pustules).
3. Severe acne, also called nodular or cystic acne, describes widespread and deep lesions that are painful, inflamed, and red. This form of acne is likely to lead to scarring if left untreated.
Who Gets Acne
Anyone at any age can get acne. Acne in teenagers is very common because the surging hormone levels (androgens) associated with puberty create more active sebaceous glands. Acne in adults is is also very common, especially among women.
Acne is more likely to afflict people whose parents had acne.
Almost all cases of acne can be effectively treated. The goal of acne treatment is to heal existing lesions, stop new lesions from forming, and prevent acne scars.
Different acne medications are available that control one or more of the underlying causes of acne. Common classes of acne medications include the following:
• Topical retinoids (Differin, Epiduo, Retin A Micro, Tazorac, or tretinoin) help unclog sebaceous glands and keep skin pores open.
• Antibiotics, such as doxycycline and minocycline (Solodyn), may be used to fight the P. acnes bacteria.
• Isotretinoin (Amnesteem, Sotret) remain a mainstay of treatment for severe acne by reducing sebum (oil) production.
• Hormonal agents, such as birth control pills, may be used by women to reduce sebum (oil) production .
Your doctor will prescribe acne medications based on the following factors:
• Severity of your acne. Mild acne may respond well to a topical retinoid alone. Moderate acne may respond better to a combination of topical retinoid with an antibiotic or other medication. Severe acne with scarring may need treatment with isotretinoin (Amnesteem, Sotret).
• Results of previous treatments. Medications may be added in a step-wise fashion, if previous acne treatments are found to be ineffective.
• Degree of scarring. More aggressive therapies may be started earlier if there already signs of acne scars.
• Gender. Some treatments are available only for women, such as birth control pills. Non-prescription acne medications may provide sufficient results for some people with mild acne. However, most people with moderate acne and all with severe acne will need to use prescription acne medications for effective treatment. Whatever your treatment plan, it is important that you give it enough time to work. This may mean waiting 6 to 8 weeks to see results. While the older acne lesions are healing, the medication is hard at work keeping new lesions from forming. Staying on your medication is the most important step to getting acne under control.
How Can I Keep My Acne Under Control?
After your acne clears, your doctor may recommend that you continue therapy with a topical retinoids to keep it under control. It is always a good idea to maintain good skin care and use skin care products. For ongoing acne skin care and prevention of acne, follow a few simple guidelines:
- Clean skin gently—Use a mild skin cleanser twice a day, and pat skin dry. Harsh cleansers and astringents can actually worsen acne.
- Do not pop, squeeze, or pick at acne lesions, as this can promote inflammation and infection. Keep hands away from your face and other acne-prone parts of the skin.
- Limit sun exposure—Tanning only masks acne at best. At worst, sun exposure can lead to skin damage, especially if you are using an acne treatment that makes your skin more sensitive to sunlight and UV rays (this includes tanning booths).
- Choose cosmetics with care—As mentioned above, choose non-greasy skin products, and look for words like “non-comedogenic,” “oil-free,” and “water-based.” Some facial products contain active acne-fighting ingredients, such as benzoyl peroxide or salicylic acid, to help keep mild acne at bay.
- Be patient with your treatment—Find out how much time it should take for your acne treatment to work (generally 6-8 weeks) and then stick with it. Stopping treatment early may prevent you from seeing good results or even cause a relapse of symptoms. Your skin may look worse before it begins to improve. You may need to try more than one type of treatment.