Acne
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What is acne?
Acne is a common skin condition that occurs when oil and dead skin
cells clog the skin's pores. Acne primarily affects teens; more than
85% experience at least a mild form of this condition. It most commonly
occurs on the face, chest, back, shoulders, and neck. Acne affects young
men and young women about equally, but there are differences. Men are
more likely than women to have more severe, longer lasting forms of
acne. In contrast, women are more likely to have intermittent acne due
to hormonal changes associated with their menstrual cycle and acne caused
by cosmetics. While most people outgrow their acne by their 20's, some,
especially women, have acne well into adulthood.
What causes acne?
| During puberty, elevated hormone levels
stimulate sebaceous glands to produce more oil, also called sebum,
which is normally released through the hair shaft to lubricate and
protect the skin. Sebum combines with dead cells, forming a plug
in the skin pore called a comedone. These comedones or plugged follicles
may eventually rupture and sebum may seep into the surrounding skin
causing inflammation. There are harmless bacteria present in |
 |
| Normal Hair Follicle |
| the sebaceous glands. These bacteria can break down
the fatty parts of the sebum into fatty acid substances which leak
into the surrounding skin and may also cause inflammation. The result
can be a small or large solid bump or a pustule on the surface of
the skin or cysts underneath the surface of the skin. Normal Hair
Follicle |
What makes acne worse?
Stress or illness may aggravate acne. Women may also have flares prior
to their menstrual periods. Oily cosmetics may alter the opening of
the sebaceous gland making the cells more likely to stick together and
form comedones.
What doesn't make acne worse?
Food seems to have little effect on the severity of acne in most individuals.
However, if you find that certain foods such as chocolate, fatty foods,
and excessive amounts of milk or sweets make your acne worse, it is
best to avoid them. In general, a balanced, healthful diet is recommended.
How is acne treated?
Treatment for acne depends upon its severity. The goal of treatment
is to reduce or eliminate outbreaks and to prevent scarring. Gently
cleanse your skin with soap such as Dove® or Neutrogena®. Facial
scrubs, toners, or masks may dry your skin.
Topical medications are applied to the skin and are often used
to treat mild to moderate acne. Some common topicals are:
- Benzoyl peroxide, available by prescription and in lesser
strengths over the counter. It is usually applied once or twice a
day to work best against pustules. It can be irritating if used around
the eyes and mouth. It should be used carefully since it can bleach
skin and clothing. If used excessively, benzoyl peroxide can cause
drying and redness.
- Salicylic acid is effective in treating non-inflammatory
acne lesions. Salicylic acid helps correct the abnormal shedding of
skin cells and unclogs pores to resolve and prevent lesions. It has
no effect on oil production or bacteria. Like benzoyl peroxide, salicylic
acid must be used continuously. Salicylic acid is found in many over-the-counter
acne products, including lotions, creams and pads. It may be irritating
to the skin.
- Retinoids are derivatives of vitamin A and have been a mainstay
in acne treatment for 25 years. They decrease the stickiness of plugged
sebaceous glands. They work best against blackheads and reduce papules
and non-inflamed pimples. They are to be used once per day at bedtime.
If overused, they can cause drying. Retinoids can make skin more sun
sensitive. Using sunscreen is recommended. Common names are Retin
A®, Differin®, or Tazorac®.
- Topical antibiotics come in solution, gel, or cream form.
They help reduce the amount of bacteria on the surface of the skin,
thereby preventing inflammation and the formation of new pimples.
They are to be applied to the skin twice a day.
- Azelaic acid is used to treat mild to moderate acne. It is
believed that azelaic acid clears acne by reducing the populations
of bacteria, decreasing the abnormal shedding of skin cells and reducing
inflammation. Side effects may include skin dryness and lightening
of the skin where applied.
How to use topical medicines: To decrease the chance of skin
irritation, apply to dry skin 20 minutes after washing your face, and
apply every other day for the first 2 weeks. Apply medicine to all areas
of your face which are acne prone. It's fine to apply multiple topical
medicines at the same time.
Systemic medications are swallowed and work internally to control
moderate to severe acne. Systemic medications are prescribed by clinicians
and may include the following:
- Antibiotics are used for mild-to-moderate and moderate-to-severe
acne. They work to reduce bacteria, thereby reducing inflammation.
A typical course of treatment can be six months or longer. Tetracycline,
doxycycline, erythromycin and minocycline are commonly used antibiotics.
Tetracycline should not be taken with milk, milk products, or antacids
because these products decrease its absorption. For the same reason,
it should also be taken at least one hour before or two hours after
meals. As tetracycline, doxycycline, and minocycline can also cause
sun sensitivity, it is recommended that you wear sun screen and avoid
overexposure to the sun.
- Oral contraceptives have been shown to effectively clear
acne in women by decreasing circulating male hormones called androgens,
thereby decreasing sebum (oil) production.
- Accutane® (isotretinoin) is a potent oral medication
that is used for cystic, refractory acne that does not respond to
any of the other medication. Used over about a six month period, it
works to decrease inflammation as well as formation of comedones.
Because of some potentially serious side effects, Accutane® is
usually prescribed and monitored by a dermatologist.
Will acne go away?
Yes, eventually. However, while the condition is still active, there
may be episodic flares and improvements. There is no cure for acne,
but there are treatments and medications that help keep acne under control
until it clears with time. These medications can be used alone or in
combinations. Sometimes acne worsens for the first several weeks
after treatment is initiated and then gradually improves. Often improvement
will not be noted for six to eight weeks. Once acne significantly
improves or clears, continued treatment is needed to keep acne from
reappearing. The care of your skin may require teamwork between you
and your clinician. Be prepared to see your clinician several times,
as medications may be added or deleted based on how your skin responds
to treatment.
Related services at the Tang Center
- Drop by the Self-Care Resource Center
to learn more about this medical concern or others.
- Call (510) 642-2000 for an appointment
- Call the Clinic Nurse (510) 643-7197 for advice
Note: Tang Center services are for eligible patients only
Additional online resources
Disclaimer: The information provided here is not intended to diagnose,
treat or provide a second opinion on any health problem or disease.
It is meant to support, not replace, the relationship that exists between
an individual and his/her clinician.
Last revised: January 2008
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