Acne

ACNE

What is acne?

Acne is the most common skin problem, affecting 70 to 90 percent of the population. It tends to be familial, meaning that you inherited the tendency to the disorder from your parents. The symptoms-pimples, soreness, burning, and itching of the skin-are usually worse in the teenage years, when there is a rapid growth of oil glands. Most people stop having acne flare-ups by their early or mid-twenties.

What causes acne?

Acne is caused by blocked oil ducts in the skin. During puberty the body starts to produce androgens, male sex hormones that are produced by both men and women. These in turn increase the production of an oily substance called sebum, which is secreted by sebaceous, or oil, glands located at the base of the hair follicles in the skin. The oil ducts enlarge and develop thicker walls during puberty.

When the increased amount of sebum can't pass through the thickened duct to be excreted, some of the oil becomes trapped and clogs the follicle, causing a backup of oil. This is how pimples are formed. The development from blocked duct to the final eruption on your forehead can take two months.

This entire process takes place in the dermis, which is below the epidermis, the outer layer of the skin. If the duct becomes completely blocked, a whitehead develops on the surface. Sometimes the duct becomes plugged with oxidized sebum and presents as a blackhead.

Does eating junk food or chocolate cause acne?

Food does not cause acne. Acne has its own cycle of worsening and improving. It may seem as though last night's candy bar caused this morning's pimple, but it was actually there for a long time as a blocked oil gland. More than likely, its appearance right after the candy bar was merely a coincidence.

In some persons a particular food may seem to make acne worse. The only way to verify this is to forgo the suspected food for several weeks and then eat a lot of it at one time. If you have a flare-up, avoid that food. The most common foods that may make acne worse are chocolate, nuts, cola drinks, and root beer.

Does dirt cause acne?

Surface dirt is not a cause of acne. The cause is a plugged oil gland just below the surface of the the skin. Too frequent cleaning and too vigorous scrubbing can make acne worse by irritating the skin and mechanically clogging or inflaming the oil ducts. Wash your face with a mild soap and water only as often as needed to keep it clean.

Special soaps, cleansers, abrasives, and astringents are a waste of money. Antibacterial over-the-counter preparations are also ineffective because the bacteria that cause acne reside be low the skin surface. These products affect only the surface of the skin.

A simple pimple now and then wouldn't be so bad, but acne seems to spread all over. Why is that?

When the oil inside the pimple builds up, it attracts certain bacteria that live on oil. The bacteria digest the oil and weaken the follicle walls. The sebum may break through the follicle wall, spilling into the surrounding tissue and spreading the infection. This type of pimple is called a pustule and is noted by a red, elevated area filled with pus. If the inflammation occurs deeper in the skin, a larger, more painful pimple called a cyst develops.

What sort of things make acne worse?

The first thing to keep in mind is that generally acne gets worse-and better-on its own. If it gets worse, it may be just a coincidence and not anything you have done. However, there are several things that may make your outbreak more severe. Most are mechanical-like substances that block the pores.

The oil-based moisturizers and makeup that many women use to cover pimples can block the pores and exacerbate the problem. Use a water-based moisturizer and cover-up instead. Any oil-based hairdressings for men or women can block the pores on the forehead, contributing to acne in this area. Vase-line, as well as oil-based suntan lotions and sunscreens, can also clog the pores.

What else can aggravate acne?

Habitually resting your chin on your hand while you are studying, and also rubbing your face, can make your acne worse, as can the friction from straps on sports equipment. Rubbing hard with towels or facial scrubbers can irritate and block the oil ducts.

Picking and squeezing a pimple can rupture a plugged duct, causing more inflammation and a possible scar. Keep your fingernails clipped short and avoid irritating an inflamed area. You could be blocking adjacent ducts that will erupt two months later.

You may be taking medications that make your acne worse. Some oral contraceptives (birth control pills) can aggravate it, particularly if they contain norgestrel. Some other types of oral contraceptives seem to improve it. Other prescription drugs that may make your acne worse are cortisone and other corticosteroids, bromides, and isoniazid (used to treat tuberculosis). If you think a drug you are taking may be the cause of your acne, discuss it with your physician.

Heat and humidity may cause you to break out more severely, and women may find their acne worse just before and during their menstrual cycles. The usual pimple lasts from 3 to 7 days no matter what you do. It will last longer if you irritate it.

The best practice for both men and womeil is to cover it with water-based makeup and be patient. A pimple is far more obvious to you in the bright glare of the bathroom mirror than it is to a friend who sees your face from 4 to 10 feet away. Don't let it ruin your self-image.

I seem to get more pimples during finals or when I'm going out on a big date. Does stress cause acne?

Worry and stress don't cause acne, but may make it worse.

Usually these flare-ups are mild and go away quickly. No one is quite sure what causes the outbreaks, but worrying about them certainly won't help. Try not to let anxiety or embarrassment about acne increase whatever stress you are under.

Does sexual activity make acne worse?

Sexual activity, including masturbation, does not affect outbreaks of acne.

How can I treat acne?

The treatment for acne is a control, not a cure. Treatment prevents or lessens future lesions but does not affect an existing outbreak. You must be patient because it will take 2 to 4 weeks to see results. The four ingredients in over-the-counter preparations that can help you control mild acne are benzoyl peroxide, sulfur, resorcinol, and salicylic acid. Avoid buying any acne product that does not list at least one of these as an active ingredient.

These ingredients work by inflaming the skin and causing it to peel, opening plugged glands that are on their way to becoming pimples, and thus preventing oil plugs. They do not affect existing pimples.

These products come in pads, lotions, creams, and sticks. Apply them 30 minutes after washing your face. They may dry your skin and cause increased redness the first 1 or 2 weeks. Use only a very small amount of one kind of medication. If your skin is very dry, apply the medication every other night.

These are preventive medications, so they will not do anything for a current outbreak. Because glands are located close together in the skin, an area with existing pimples is likely to be the site of future outbreak. Therefore, you need to treat areas that are prone to acne as well as those that are already active. The medications should be used regularly for 4 weeks to prevent future flare-ups and to see if they are effective.

There is a possibility that you may become allergic to these products. If there is increased swelling and redness, discontinue their use. They may also increase your sensitivity to sunlight, so be sure to use a water-based sunscreen.

My acne is severe, and the over-the-counter medications aren't helping. What can I do?

See a dermatologist. If you are getting cysts, pustules, or scarring, a dermatologist can help you get your acne under control and reduce the severity of the outbreaks. There are a number of prescription medications that can help considerably. Topical antibiotics, which have a deeper penetration than their over-the-counter counterparts, can be applied.

For moderate to severe acne, oral antibiotics can be effective. It may take 4 to 6 weeks to see results, and then you may need to stay on a lower, maintenance dose. If one particular antibiotic doesn't work, others can be tried. You need a doctor's prescription for these medications.

For the most unresponsive cases there is a medicine called accutane, which must only be taken under the very strict supervision of a dermatologist. It has very serious side effects, and certain blood tests must be closely monitored. Women should not become pregnant during this treatment because of the high incidence of birth defects associated with this drug. Never take this drug unless you are under the supervision of a physician.

My acne has left me with a lot of scars on my face and back. Is there anything I can do about it?

Yes. See your dermatologist or a plastic surgeon. There are a number of techniques that can reduce the unsightly appearance of scars. Dermabrasion, chemical peel, punch grafts, and collagen injections are some of them. Although there is no known medical cure, there are many treatments available to control and minimize the long-term effects of acne.