ACNE
(adolescent / teen age) home
Cause: There are a series on interrelated factors that cause acne. Acne is actually an infection or inflammation of a sweat gland. The sweat gland produces natural oils that moisten and protect the skin. Androgens (male hormones) cause an increase in the size of the gland and the amount of oil and other materials during the changes that occur just before and during puberty. Both men and women produce androgens, but men produce more, resulting in more acne. Being overweight also causes more androgen production and thus more acne in some people. When the gland opening is large and gets blocked by the oil that dries out, you get a black head or comedo. This comedo is actually a sack of material produced by the gland. When the contents of that sack leak out and contact the normal tissue surrounding it, the body reacts with an inflammatory process that results in acne. The comedos are more likely to rupture and get infected when the opening to the gland is small; therefore a lot of the acne you get is not from the large black heads on your face. The bacterium that causes the infection is called Proprionibacterium acnes, but it is deep in the skin, not on the surface
Misconceptions: There are many rumors or wive's tales commonly thought of as facts that are incorrect about acne. Having a misconception is not bad unless it causes you to do something that either does not help your acne or even worsens it. First, greasy foods DO NOT cause acne. This misconception has been studied extensively and there is no evidence that foods are associated with acne. This misconception actually starts with the misconception that a greasy face causes acne and that grease in your food increases the grease on your face. Neither of these are true. Some foods, such as chocolate and tomatoes, cause an allergic type reaction that looks like tiny acne under the chin, but this is not acne. If you believe that a certain food is exacerbating your acne, then avoid it anyway. Second, black heads are NOT dirt that should be scrubbed out. As you read above, black heads are sacks of dried out oil, not dirt, that is blocking a pore. When you scrub your face, you are actually damaging the skin allowing the bacteria that cause acne to enter the gland. Therefore, scrubbing your skin will not get rid of the black head and will actually increase the amount of acne. You should still wash your face, but gently. Third, you should NOT squeeze black heads out to prevent acne. When you squeeze or pinch your skin to remove a black head, you are damaging your skin allowing bacteria to get to the pore, and you actually are causing acne. Also, rupturing the black head sack spills the contents into the normal surrounding skin, and this causes an inflammatory reaction, or acne. Keep track of those black heads you squeeze, and you will see that this is true. See below for the treatment of black heads. Fourth, touching your face frequently can cause acne. This one is probably true, in that pressure on your face will block the pores, and the dirt on your fingers will inflame the pore or gland causing acne. Fifth, the bacteria on your skin are NOT what causes acne and this should be sterilized. The bacteria on your skin are actually normal and are not the ones that cause the acne. Therefore, even if you could sterilize your skin, it would do no good. Further, the strong cleansers actually do remove some of the outer layer of skin and this prevents some large black head formation, but it does not prevent the small black heads that cause most of the acne. Sixth, surface oil on your face causes acne and should be removed. The oil on the surface of your skin has nothing to do with acne and actually protects your skin, therefore the efforts to remove the oil will not prevent acne and in some cases actually worsens it.
Prevention: First, wash you’re face gently with a moisturizing soap three times a day. Remember: scrubbing you’re face or over drying it will damage it, allowing bacteria to get to the glands. Some soaps and acne preventative medications that claim to clean you face are called astringents. These actually will kill some surface bacteria, but they cannot kill the bacteria that cause most of the acne. The astringents will dry out your skin, thus damaging it and allowing bacteria to enter the glands, and thereby causing acne. Some cleansers, such as Stridex, claim to be keratinolytics. The theory behind a keratinolytic is that the increases in material produced in the gland and on the skin are what cause acne and therefore removing this extra skin and material will reduce acne. As you read above, removing the extra material might give a minor improvement in large black heads, but will not affect the small black heads that cause most of the acne. Further, if the keratinolytic dries out your skin too much, then that damages your skin and actually increases the acne. Good moisturizing soaps are: Dove, Cerise PM cleanser, Tone, and Oil of Olay. Second, keep you fingers off your face. Dirty fingers will simply put more bacteria on your skin and pressure from your fingers will block the pores. Third, don’t damage your skin when trying to remove black heads. The proper way to get rid of black heads is as follows; Use the black head removing strips where possible. Make sure to use as directed. Your skin might be sensitive to the glue used to remove the black head, so be careful. The strips can only be used on the nose and forehead. For the areas which you can’t use the strips, soften the black head with regular use of benzoyl peroxide (Clearasil). Then use a comedo or black head remover. There are two types of black head removers. The first is a syringe-type device that vacuums out the black head. These can be ordered on the internet. These do work, but don’t put too much pressure on the syringe, or you may damage the skin. The second type looks like a tiny spoon with a hole in the center. To use this one, place the hole in the center of the spoon over the black head, and push gently on the black head. This evenly distributes the pressure and expresses the black head. This differs from squeezing with your fingernails, in that there is no tearing of the skin and the black head sack is unlikely to rupture. Fourth, use an over-the-counter preventative medication. Benzoyl peroxide prevents acne in a number of ways. The medicine is actually an antibiotic that kills the bacteria that cause acne; it is a keratinolytic that reduces the amount of material produced that causes black heads, and there are other boring scientific ways it works. Benzoyl peroxide prevents acne rather than getting rid of the acne that is currently present; therefore you must use this medication regularly. Place the medication on your face in the areas prone to acne in a thin layer two to three times a day. The medicine comes in a gel and in an alcohol base. The alcohol base does dry out your skin and removes more of the oil, but some people react to this and get irritated skin. Use whichever type works best for you. The other over-the-counter medications, such as sulfur, resorcinol and salicylic acid, claim to work under the keratinolytic theory. In theory, they reduce large black head formation, but in reality, they do little to prevent acne. One common brand name is Stridex, which contains salicylic, and this is the same medication in wart removers like Compound W, but in less strength (2% versus 17%). Fifth, use a retinoid. Differin is a brand of adapaline. It has been the first line prescription for acne for decades. It went over the counter several years ago. This is a anti-inflammatory medication that is very effective for most acne. To use, apply at night after using a moisturizing soap, like Cereve PM Cleanser. Pat your skin dry, then apply a thin layer to the areas that you usually get acne. Wash off in the morning and apply benzoyl peroxide. This medicine works by changing how your skin reacts to inflammation and therefore takes several week to work. You will see significant improvement in 3-8 weeks. Some people get mild irritation when first using adapaline. You can build a tolerance to this medication. If you get irritation, start by applying this medication for 5 minutes and then wash off. After a few days, do 10 minutes, then 15, etc, until you can tolerate having the medication on overnight.
Treatment of current acne: For mild acne, there is no real treatment to get rid of it quicker. Benzoyl peroxide might make the acne resolve quicker. But in general, the best you can do is prevent further acne from forming and wait for the currently inflamed and infected glands to resolve on their own. For cystic acne (nodules like boils under the skin), a doctor could inject the cysts with anti-inflammatory medications to reduce the size. Otherwise, the more advanced treatment requires a prescription. There is a device for sale that claims to remove “blemishes” with a wand type electrical device, but there is no scientific evidence that this device does anything except make your wallet lighter.
Medical prescriptions and treatments: Prescription medicines include topical antibiotics, oral antibiotics and topical exfoliates, while treatments include black head removal surgery, dermabrasion and steroid injection of cysts. I will only cover these briefly since we will discuss these in detail should you need them. Topical antibiotics are actually absorbed into the skin and kill the bacteria that cause some of acne. The over-the-counter topical antibiotics are not strong enough to kill the deeper bacteria that cause some acne. The topical antibiotics generally take a week or two to work and can give anything from mild to dramatic reductions in the amount of new acne lesions. Generally, these medications will stop working in most people about 6 to 36 months after starting them, but if that happens, we simply switch to another brand and generally you will get a good response from the new medicine. Remember, these are preventions, not cures, and as such must be used regularly. Oral antibiotics work in the same manner as the topical ones, only they generally have more of an effect, have more side effects and must be used regularly. Topical keratinolytics, such as Retin-A, work by increasing the turnover of skin cells, reducing the ability of the cells to stick together, and thus reducing the formation of comedos. One major caution is that women of childbearing age whom get pregnant on this medicine can have a baby with a very severe birth defect. Some doctors will not prescribe this medication to women at all, while some will only prescribe it with a signed promise that the woman won’t get pregnant and understands the risks. Black head removal surgery is just that, surgery, except it is done by a physician, requires no anesthesia and gives less inflammatory reaction than you do it yourself. This is generally for severe cases. Dermabrasion is basically sanding off the outer layer of skin that has been scarred by severe acne. This does require anesthesia and must be done by a specialist. The skin that’s removed is replaced with skin that is generally smoother. Steroid injection of cysts is done by a plastic surgeon or a dermatologist to reduce the inflammatory reaction around a cyst under the skin. If you have acne bad enough to be thinking about these last few solutions, then you will definitely be referred to a specialist. Above all, remember that you can control acne, but only through prevention not wishing it away. Don’t hesitate to call your doctor if you need help. PARENTS: just because your child still has acne after claiming to wash their face, does not mean they are not doing everything you suggest. Every patient is different and some require more extensive treatment. It only takes a phone call and a brief office visit.
