What is acne?
Acne vulgaris is typical teenage acne which is characterized by three types of lesions:
Acne appears on the skin as
- occluded pores ('comedones'), also known as blackheads or whiteheads,
- tender red bumps also are known as pimples or zits,
- pustules (bumps containing pus), and occasionally as
- cysts (the deep pimples and boils of cystic acne).
One can do a lot to treat acne using products available at a drugstore or cosmetic counter that does not require a prescription. However, for tougher cases of acne, one should consult a physician for treatment options.
Acne & Rosacea
Is rosacea like acne?
Unlike common acne, rosacea is not primarily a plague of teenagers but occurs most often in adults (ages 30-50), especially in those with fair skin. Different than acne, there are usually no blackheads or whiteheads in rosacea.
What causes acne?
No one factor causes acne. Acne occurs when sebaceous (oil) glands attached to the hair follicles are stimulated at the time of puberty or due to other hormonal changes. Sebum (oil) is a natural substance that lubricates and protects the skin. Associated with increased oil production is a change in the manner in which the skin cells mature, predisposing them to plug the follicular pore. The plug can appear as a whitehead if it is covered by a thin layer of skin, or if exposed to the air, the darker exposed portion of the plug is called a 'blackhead.' The plugged hair follicle gradually enlarges, producing a bump. As the follicle enlarges, the wall may rupture, allowing irritating substances and normal skin bacteria access into the deeper layers of the skin, ultimately producing inflammation. Inflammation near the skin's surface produces a pustule; deeper inflammation results in a papule (pimple); if the inflammation is deeper still, it forms a cyst.
Here are some factors that don't usually play a role in acne:
- Food: Parents often tell teens to avoid pizza, greasy and fried foods, and junk food. While these foods may not be good for overall health, they don't play an important causal role in acne. Although some recent studies have implicated a high-carbohydrate diet, milk, and pure chocolate in aggravating acne, these findings are far from established.
- Dirt: Blackheads are oxidized oil, not dirt. Sweat does not cause acne and is produced by entirely separate glands in the skin. On the other hand, excessive washing can dry and irritate the skin.
- Stress: Some people get so upset by their pimples that they pick at them and make them last longer. Stress, however, does not play much of a direct role in causing acne.
In occasional patients, the following may be contributing factors:
- Heredity: If one of your parents had severe acne, it is likely that your acne will be more difficult to control.
- Pressure: In some patients, pressure from helmets, chin straps, collars, suspenders, and the like can aggravate acne.
- Drugs: Some medications may cause or worsen acne, such as those containing iodides, bromides, or oral or injected steroids (either the medically prescribed prednisone [Deltasone, Orasone, Prednicen-M, Liquid Pred] or the steroids that bodybuilders or athletes sometimes take). Other drugs that can cause or aggravate acne are anticonvulsant medications and lithium (Eskalith, Lithobid). Most cases of acne, however, are not drug-related.
- Occupations: In some jobs, exposure to industrial products like cutting oils may produce acne.
- Cosmetics: Some cosmetics and skincare products are pore-clogging ('comedogenic'). Of the many available brands of skincare products, it is important to read the list of ingredients and choose those which have water listed first or second if one is concerned about acne. These 'water-based' products are usually best for those with acne.
When should someone start acne treatment?
Since everyone gets acne at some time, the right time to treat it is when it becomes bothersome or when the potential for scarring develops. This can be when severe acne flares suddenly, for mild acne that just won't go away, or even when a single pimple decides to show up the week before one's prom or wedding.
How to get rid of acne (pimples)
Moderation and regularity are good things, but not everyone can sleep eight hours, eat three healthy meals per day, and drink plenty of water a day. Probably the most useful lifestyle changes one can make is to never to pick or squeeze pimples. Playing with or popping pimples, no matter how careful and clean one is, nearly always makes bumps stay redder and bumpier longer. People often refer to redness as 'scarring', but fortunately, it usually isn't permanent. It's just a mark that takes months to fade if left entirely alone.
Open the pores
Occasional visits to an esthetician who is an expert at safely removing blackheads during a facial can be beneficial.
Cleansing and skin care
Despite what one might read in popular style and fashion magazines, there is no magic product or regimen that is right for every person and situation.
- Mild cleansers: Washing once or twice a day with a mild cleansing bar or liquid (for example, Dove, Neutrogena, Basis, Purpose, and Cetaphil are all inexpensive and popular) will keep the skin clean and minimize sensitivity and irritation.
- Exfoliating cleansers and masks: A variety of mild scrubs, exfoliants, and masks can be used. These products may contain salicylic acid in a concentration that makes it a very mild peeling agent. These products remove the outer layer of the skin and thus open pores. Products containing glycolic or alpha hydroxy acids are also gentle skin exfoliants.
- Retinol: Not to be confused with the prescription medication Retin-A, this derivative of vitamin A can help promote skin peeling.
Benzoyl peroxide causes red and scaly skin irritation in a small number of people, which goes away as soon as one stops using the product. Keep in mind that benzoyl peroxide is a bleach, so do not let products containing benzoyl peroxide come into contact with fabrics, leaving unsightly white spots on colored clothes, shirts, towels, and carpets.
Reduce excess oil
One cannot stop oil glands from producing oil. Even isotretinoin (Accutane, see below) only slows down oil glands for a while; they resume normal activity later. It is possible to get rid of oil on the surface of the skin and reduce the appearance of shine.
- Use a gentle astringent/toner to wipe away oil. (There are many brands available in pharmacies, as well as from manufacturers of cosmetic lines.)
- Products containing glycolic acid or one of the other alpha hydroxy acids are also helpful in clearing the skin by causing the superficial layer of the skin to peel (exfoliate).
- Masks containing sulfur and other ingredients draw out facial oil.
- Antibacterial pads containing benzoyl peroxide have the additional benefit of helping to wipe away oil.
How does a doctor treat acne?
It's best to consult a primary care physician or dermatologist if an individual is unable to adequately control his or her acne. The goal of treatment should be the prevention of scarring (not a flawless complexion) so that after the condition spontaneously resolves there is no lasting sign of the affliction. Here are some of the options available:Problems with these drugs can include
Allergicreactions (especially sulfa), gastrointestinal upset, and increased sun sensitivity. Doxycycline, in particular, is generally safe but can sometime cause
esophagitis(irritation of the
esophagus, producing discomfort when swallowing) and an increased tendency to
sunburn.Despite the concern that the long-term use of tetracycline antibiotics for acne might 'weaken the immune system' or induce bacterial resistance, these concerns seem to be unwarranted.
birth control pills), which are low in estrogen to promote safety, have little effect on acne one way or the other. Some contraceptive pills have been shown to have modest effectiveness in treating acne. Those that have been U.S. FDA approved for treating acne are Estrostep, Ortho Tri-Cyclen, and Yaz. Most dermatologists work together with primary care physicians or gynecologists when recommending these medications.
Aldactone): This drug blocks
androgen(hormone) receptors. It can cause breast tenderness, menstrual irregularities, and increased potassium levels in the bloodstream. It can help some women with resistant acne, however, and is generally well-tolerated in the young women who need it.
- Cortisone injections: To make large pimples and cysts flatten out fast, doctors inject them with a form of cortisone.
Isotretinoin: Accutane was the original brand name; there are now several generic versions in common use, including Sotret,
Amnesteem. Isotretinoin is an excellent treatment for severe, scarring, persistent acne and has been used on millions of patients since it was introduced in Europe in 1971 and the U.S. in 1982. It should be used for people with severe acne, chiefly of the cystic variety, that has been unresponsive to conventional therapies like those listed above. If taken in sufficient dosage, it should eliminate the need to continue the use of prescription drugs in most patients. The drug has many potential serious side effects and requires several unique controls before it is prescribed. This means that isotretinoin is not a good choice for people whose acne is not that severe but who are frustrated and want 'something that will knock acne out once and for all.' Used properly, isotretinoin is safe and produces few side effects beyond dry lips and occasional muscle aches. This drug is prescribed for five to six months at a dosage that has a high likelihood of preventing the return of acne. Fasting blood tests are monitored monthly to check
liver functionand the level of
triglycerides, substances related to
cholesterol, which often rise a bit during treatment but rarely to the point at which treatment has to be modified or stopped. Even though isotretinoin does not remain in the body after therapy is stopped, improvement is often long-lasting. It is safe to take two or three courses of the drug if unresponsive acne makes a comeback. It is, however, best to wait at least several months and to try other methods before using isotretinoin again.Isotretinoin has a high risk of inducing
birth defectsif taken by
pregnantwomen. Women of childbearing age who take isotretinoin need two negative
pregnancy tests(blood or urine) before starting the drug, monthly tests while they take it, and another after they are done. Those who are sexually active must use two forms of
contraception, one of which is usually the oral contraceptive pill. Isotretinoin leaves the body completely when treatment is done; women must be sure to avoid pregnancy for one month after therapy is stopped. There is, however, no risk of childbearing after that time.
- Other concerns include
inflammatory bowel diseaseand the risk of
suicidein patients taking isotretinoin. Recent evidence seems to indicate that these problems are exceedingly rare. Government oversight has resulted in a highly publicized and very burdensome national registration system for those taking the drug. This has reinforced concerns in many patients and their families have that isotretinoin is dangerous. Large-scale studies so far have shown no convincing evidence of increased risk for those taking isotretinoin compared with the general population. It is important for those taking this drug to report changes in mood or bowel habits (or any other symptoms) to their doctors. Even patients who are being treated for
depressionare not barred from taking isotretinoin, whose striking success often improves the mood and outlook of patients with severe disease.
What is the best skin care routine for acne?
These are all good basic skin regimens that may help with the acne battle:
- Cleanse gently twice daily.
- Apply a gel or cream containing 5% benzoyl peroxide; an alternative is sulfur or resorcinol. Use a pad containing 2% salicylic acid to help exfoliation each morning.
- At night, apply a spot cream containing sulfur to the affected areas.
- Use a light skin moisturizer and water-based makeup.
How would you summarize current-day acne treatment?
Treating acne requires patience and perseverance. Any of the treatments listed above may take two or three months to start working (even isotretinoin). Unless there are side effects such as excessive dryness or allergy, it is important to give each regimen or drug enough time to work before giving up on it and moving on to other methods. Using modern methods, doctors can help clear up the skin of just about everyone.
Just hang in there. And don't pick. Please.
Cupping is a type of traditional Chinese medicine that stimulates the flow of chi (qi, or energy) within the body. There are a few different types of cupping: air, fire, wet, and the sliding cups technique. Cupping purports to bring impurities to the skin's surface and remove toxins. Oftentimes, cupping leaves marks, or bruises, on the skin.
Keratosis Pilaris (KP)
Keratosis pilaris (KP) is a common skin disorder in which small white or red bumps appear around hair follicles on the upper arms, thighs, buttocks, and cheeks. The cause of KP is unknown. There is no cure for keratosis pilaris, and the condition may resolve on its own. Gentle exfoliation, professional manual extraction, chemical peels, and microdermabrasion, along with topical products, are the best treatments for this condition.