Acne
Overview
Acne is a skin condition that occurs when your
hair follicles become plugged with oil and dead skin cells. It causes
whiteheads, blackheads or pimples. Acne is most common among teenagers, though
it affects people of all ages.
Effective acne treatments are available, but
acne can be persistent. The pimples and bumps heal slowly, and when one begins
to go away, others seem to crop up.
Depending on its severity, acne can cause
emotional distress and scar the skin. The earlier you start treatment, the
lower your risk of such problems.
Symptoms
Acne signs vary depending on the severity of
your condition:
·
Whiteheads (closed
plugged pores)
·
Blackheads (open
plugged pores)
·
Small red, tender
bumps (papules)
·
Pimples (pustules),
which are papules with pus at their tips
·
Large, solid, painful
lumps under the skin (nodules)
·
Painful, pus-filled
lumps under the skin (cystic lesions)
Acne usually appears on the face, forehead,
chest, upper back and shoulders.
When to see a doctor
If self-care remedies don't clear your acne,
see your primary care doctor. He or she can prescribe stronger medications. If
acne persists or is severe, you may want to seek medical treatment from a
doctor who specializes in the skin (dermatologist or pediatric dermatologist).
For many women, acne can persist for decades,
with flares common a week before menstruation. This type of acne tends to clear
up without treatment in women who use contraceptives.
In older adults, a sudden onset of severe acne
may signal an underlying disease requiring medical attention.
The Food and Drug Administration (FDA) warns
that some popular nonprescription acne lotions, cleansers and other skin
products can cause a serious reaction. This type of reaction is quite rare, so
don't confuse it with any redness, irritation or itchiness that occurs in areas
where you've applied medications or products.
Seek emergency medical help if after using a skin product you
experience:
·
Faintness
·
Difficulty breathing
·
Swelling of the eyes,
face, lips or tongue
·
Tightness of the throat
Causes
Four main factors cause acne:
·
Excess oil (sebum)
production
·
Hair follicles clogged
by oil and dead skin cells
·
Bacteria
·
Inflammation
Acne typically appears on your face, forehead,
chest, upper back and shoulders because these areas of skin have the most oil
(sebaceous) glands. Hair follicles are connected to oil glands.
The follicle wall may bulge and produce a
whitehead. Or the plug may be open to the surface and darken, causing a
blackhead. A blackhead may look like dirt stuck in pores. But actually the pore
is congested with bacteria and oil, which turns brown when it's exposed to the
air.
Pimples are raised red spots with a white
center that develop when blocked hair follicles become inflamed or infected
with bacteria. Blockages and inflammation deep inside hair follicles produce
cystlike lumps beneath the surface of your skin. Other pores in your skin,
which are the openings of the sweat glands, aren't usually involved in acne.
Certain things may trigger or worsen acne:
·
Hormonal
changes. Androgens are
hormones that increase in boys and girls during puberty and cause the sebaceous
glands to enlarge and make more sebum. Hormone changes during midlife,
particularly in women, can lead to breakouts too.
·
Certain
medications. Examples include
drugs containing corticosteroids, testosterone or lithium.
·
Diet. Studies indicate that consuming certain
foods — including carbohydrate-rich foods, such as bread, bagels and chips —
may worsen acne. Further study is needed to examine whether people with acne
would benefit from following specific dietary restrictions.
·
Stress. Stress doesn't cause acne, but if you
have acne already, stress may make it worse.
Acne myths
These factors have little effect on acne:
·
Chocolate
and greasy foods. Eating chocolate
or greasy food has little to no effect on acne.
·
Hygiene. Acne isn't caused by dirty skin. In
fact, scrubbing the skin too hard or cleansing with harsh soaps or chemicals
irritates the skin and can make acne worse.
·
Cosmetics. Cosmetics don't necessarily worsen acne,
especially if you use oil-free makeup that doesn't clog pores (noncomedogenics)
and remove makeup regularly. Nonoily cosmetics don't interfere with the
effectiveness of acne drugs.
Complications
People with darker skin types are more likely
than are people with lighter skin to experience these acne complications:
·
Scars. Pitted skin (acne scars) and thick scars
(keloids) can remain long-term after acne has healed.
·
Skin
changes. After acne has
cleared, the affected skin may be darker (hyperpigmented) or lighter
(hypopigmented) than before the condition occurred.
Risk factors
Risk factors for acne include:
·
Age. People of all ages can get acne, but
it's most common in teenagers.
·
Hormonal
changes. Such changes are
common during puberty or pregnancy.
·
Family
history. Genetics plays a
role in acne. If both of your parents had acne, you're likely to develop it
too.
·
Greasy
or oily substances. You may develop
acne where your skin comes into contact with oil or oily lotions and creams.
·
Friction
or pressure on your skin. This
can be caused by items such as telephones, cellphones, helmets, tight collars
and backpacks.
Treatment
If you've tried over-the-counter
(nonprescription) acne products for several weeks and they haven't helped, ask
your doctor about prescription-strength medications. A dermatologist can help
you:
·
Control your acne
·
Avoid scarring or
other damage to your skin
·
Make scars less
noticeable
Acne medications work by reducing oil
production and swelling or by treating bacterial infection. With most prescription
acne drugs, you may not see results for four to eight weeks. It can take many
months or years for your acne to clear up completely.
The treatment regimen your doctor recommends
depends on your age, the type and severity of your acne, and what you are
willing to commit to. For example, you may need to wash and apply medications
to the affected skin twice a day for several weeks. Topical medications and
drugs you take by mouth (oral medication) are often used in combination.
Treatment options for pregnant women are limited due to the risk of side
effects.
Talk with your doctor about the risks and
benefits of medications and other treatments you are considering. And make
follow-up appointments with your doctor every three to six months until your skin
improves.
Topical medications
The most common topical prescription
medications for acne are:
·
Retinoids
and retinoid-like drugs. Drugs
that contain retinoic acids or tretinoin are often useful for moderate acne.
These come as creams, gels and lotions. Examples include tretinoin (Avita,
Retin-A, others), adapalene (Differin) and tazarotene (Tazorac, Avage, others).
You apply this medication in the evening, beginning with three times a week,
then daily as your skin becomes used to it. It prevents plugging of hair
follicles. Do not apply tretinoin at the same time as benzoyl peroxide.
Topical retinoids increase your skin's sun sensitivity. They can
also cause dry skin and redness, especially in people with brown or Black skin.
Adapalene may be tolerated best.
·
Antibiotics. These work by killing excess skin
bacteria and reducing redness and inflammation. For the first few months of
treatment, you may use both a retinoid and an antibiotic, with the antibiotic
applied in the morning and the retinoid in the evening. The antibiotics are
often combined with benzoyl peroxide to reduce the likelihood of developing
antibiotic resistance. Examples include clindamycin with benzoyl peroxide (Benzaclin,
Duac, others) and erythromycin with benzoyl peroxide (Benzamycin). Topical
antibiotics alone aren't recommended.
·
Azelaic
acid and salicylic acid. Azelaic
acid is a naturally occurring acid produced by a yeast. It has antibacterial
properties. A 20% azelaic acid cream or gel seems to be as effective as many
conventional acne treatments when used twice a day. Prescription azelaic acid
(Azelex, Finacea) is an option during pregnancy and while breast-feeding. It
can also be used to manage discoloration that occurs with some types of acne.
Side effects include skin redness and minor skin irritation.
Salicylic acid may help prevent plugged hair follicles and is
available as both wash-off and leave-on products. Studies showing its
effectiveness are limited. Side effects include skin discoloration and minor
skin irritation.
·
Dapsone. Dapsone (Aczone) 5% gel twice daily is
recommended for inflammatory acne, especially in women with acne. Side effects
include redness and dryness.
Evidence is not strong in support of using
zinc, sulfur, nicotinamide, resorcinol, sulfacetamide sodium or aluminum
chloride in topical treatments for acne.
Oral medications
·
Antibiotics. For moderate to severe acne, you may
need oral antibiotics to reduce bacteria. Usually the first choice for treating
acne is a tetracycline (minocycline, doxycycline) or a macrolide (erythromycin,
azithromycin). A macrolide might be an option for people who can't take
tetracyclines, including pregnant women and children under 8 years old.
Oral antibiotics should be used for the shortest time possible
to prevent antibiotic resistance. And they should be combined with other drugs,
such as benzoyl peroxide, to reduce the risk of developing antibiotic
resistance.
Severe side effects from the use of antibiotics to treat acne
are uncommon. These drugs do increase your skin's sun sensitivity.
·
Combined
oral contraceptives. Four combined
oral contraceptives are approved by the FDA for acne therapy in women
who also wish to use them for contraception. They are products that combine
progestin and estrogen (Ortho Tri-Cyclen 21, Yaz, others). You may not see the
benefit of this treatment for a few months, so using other acne medications
with it for the first few weeks may help.
Common side effects of combined oral contraceptives are weight
gain, breast tenderness and nausea. These drugs are also associated with
increased risk of cardiovascular problems, breast cancer and cervical cancer.
·
Anti-androgen
agents. The drug
spironolactone (Aldactone) may be considered for women and adolescent girls if
oral antibiotics aren't helping. It works by blocking the effect of androgen
hormones on the oil-producing glands. Possible side effects include breast
tenderness and painful periods.
·
Isotretinoin. Isotretinoin (Amnesteem, Claravis,
others) is a derivative of vitamin A. It may be prescribed for people whose
moderate or severe acne hasn't responded to other treatments.
Potential side effects of oral isotretinoin include inflammatory
bowel disease, depression and severe birth defects. All people receiving
isotretinoin must participate in an FDA-approved risk management program.
And they'll need to see their doctors regularly to monitor for side effects.
Therapies
For some people, the following therapies might
be helpful, either alone or in combination with medications.
·
Light
therapy. A variety of
light-based therapies have been tried with some success. Most will require
multiple visits to your doctor's office. Further study is needed to determine
the ideal method, light source and dose.
·
Chemical
peel. This procedure
uses repeated applications of a chemical solution, such as salicylic acid,
glycolic acid or retinoic acid. This treatment is for mild acne. It might
improve the appearance of the skin, though the change is not long lasting and
repeat treatments are usually needed.
·
Drainage
and extraction. Your doctor may
use special tools to gently remove whiteheads and blackheads (comedos) or cysts
that haven't cleared up with topical medications. This technique temporarily
improves the appearance of your skin, but it might also cause scarring.
·
Steroid
injection. Nodular and
cystic lesions can be treated by injecting a steroid drug into them. This
therapy has resulted in rapid improvement and decreased pain. Side effects may
include skin thinning and discoloration in the treated area.
Treating children
Most studies of acne drugs have involved
people 12 years of age or older. Increasingly, younger children are getting
acne as well. The FDA has expanded the number of topical products
approved for use in children. And guidelines from the American Academy of
Dermatology indicate that topical benzoyl peroxide, adapalene and tretinoin in
preadolescent children are effective and don't cause increased risk of side
effects.
If your child has acne, consider consulting a
pediatric dermatologist. Ask about drugs to avoid in children, appropriate
doses, drug interactions, side effects, and how treatment may affect a child's
growth and development.
Alternative medicine
Some alternative and integrative medicine
approaches might be helpful in reducing acne:
·
Tea
tree oil. Gels containing
at least 5% tea tree oil may be as effective as lotions containing 5% benzoyl
peroxide, although tea tree oil might work more slowly. Possible side effects
include minor itching, burning, redness and dryness, which make it a poor
choice for people with rosacea.
·
Brewer's
yeast. A strain of
brewer's yeast called Hansen CBS seems to help decrease acne when taken orally.
It may cause gas (flatulence).
More research is needed to establish the
potential effectiveness and long-term safety of these and other integrative
approaches, such as biofeedback and ayurvedic compounds. Talk with your doctor
about the pros and cons of specific treatments before you try them.
Lifestyle and home
remedies
You can try to avoid or control mild or
moderate acne with nonprescription products, good basic skin care and other
self-care techniques:
·
Wash
problem areas with a gentle cleanser. Twice a day, use your hands to wash your face with mild
soap or a gentle cleanser (Cetaphil, Vanicream, others) and warm water. And be
gentle if you're shaving affected skin.
Avoid certain products, such as facial scrubs, astringents and
masks. They tend to irritate the skin, which can worsen acne. Too much washing
and scrubbing also can irritate the skin.
·
Try
over-the-counter acne products to dry excess oil and promote peeling. Look for products containing benzoyl
peroxide and adapalene as the active ingredients. You might also try products
containing salicylic acid, glycolic acid or alpha hydroxy acids. It may take a
few weeks of using a product before you see any improvement.
Creams are less irritating than gels or ointments.
Nonprescription acne medications may cause initial side effects — such as
redness, dryness and scaling — that often improve after the first month of
using them.
·
Avoid
irritants. Oily or greasy
cosmetics, sunscreens, hairstyling products or acne concealers can worsen acne.
Instead, use products labeled water-based or noncomedogenic, which means they
are less likely to cause acne.
·
Protect
your skin from the sun. For
some people, the sun worsens the discoloration that sometimes lingers after the
acne has cleared. And some acne medications make you more susceptible to
sunburn. Check with your doctor to see if your medication is one of these. If
it is, stay out of the sun as much as possible. Regularly use a nonoily
(noncomedogenic) moisturizer that includes a sunscreen.
·
Avoid
friction or pressure on your skin. Protect your acne-prone skin from contact with items such
as phones, helmets, tight collars or straps, and backpacks.
·
Avoid
touching or picking acne-prone areas. Doing so can trigger more acne or lead to infection or
scarring.
·
Shower
after strenuous activities. Oil
and sweat on your skin can lead to breakouts.
Coping and support
Acne and acne scars can cause anxiety and may
affect your social relationships and self-image. Sometimes it can help to talk
with your family, a support group or a counselor.
Stress can worsen acne. Try to manage stress
by getting enough sleep and practicing relaxation techniques.
Preparing for your
appointment
If you have acne that's not responding to
self-care and over-the-counter treatments, make an appointment with your
doctor. Early, effective treatment of acne reduces the risk of scarring and of
lasting damage to your self-esteem. After an initial examination, your doctor
may refer you to a specialist in the diagnosis and treatment of skin conditions
(dermatologist).
Here's some information to help you get ready
for your appointment.
What you can do
·
List
your key medical information, such as other conditions you're dealing with and any
prescription or over-the-counter products you're using, including vitamins and
supplements.
·
List
key personal information, including
any major stresses or recent life changes.
·
List
questions to ask your doctor.
Creating your list of questions in advance can help you make the most of your
time with your doctor.
Below are some basic questions to ask your
doctor about acne. If any additional questions occur to you during your visit,
don't hesitate to ask.
·
What treatment
approach do you recommend for me?
·
If the first treatment
doesn't work, what will you recommend next?
·
What are the possible
side effects of the medications you're prescribing?
·
How long can I safely
use the medications you're prescribing?
·
How soon after
beginning treatment might my symptoms start to improve?
·
When will you see me
again to evaluate whether my treatment is working?
·
Is it safe to stop my
medications if they don't seem to be working?
·
What self-care steps
might improve my symptoms?
·
Do you recommend any
changes to my diet?
·
Do you recommend any
changes to the over-the-counter products I'm using on my skin, including soaps,
lotions, sunscreens and cosmetics?
What to expect from
your doctor
Your doctor is likely to ask you a number of
questions. Being ready to answer them may reserve time to go over any points
you want to talk about in-depth. Your doctor may ask:
·
When did you first
develop this problem?
·
Does anything in
particular seem to trigger an acne flare, such as stress or — in girls and
women — your menstrual cycle?
·
What medications are
you taking, including over-the-counter and prescription drugs as well as
vitamins and supplements?
·
In girls and women: Do
you use oral contraceptives?
·
In girls and women: Do
you have regular menstrual periods?
·
In girls and women:
Are you pregnant, or do you plan to become pregnant soon?
·
What types of soaps,
lotions, sunscreens, hair products or cosmetics do you use?
·
How is acne affecting
your self-esteem and your confidence in social situations?
·
Do you have a family
history of acne?
·
What treatments and
self-care steps have you tried so far? Have any been effective?
·
Have other family
members had isotretinoin treatment or hormone therapy to treat their acne? Has
it been effective?
0 Comments