Acne

What is acne?

Acne is a disorder of the hair follicles and sebaceous glands. The glands become clogged, leading to pimples and cysts.

Acne is very common - nearly 17 million people in the US are affected by this condition. Acne most often begins in puberty. During puberty, the male sex hormones (androgens) increase in both boys and girls, causing the sebaceous glands to become more active - resulting in increased production of oil (sebum).

How does acne develop?

The sebaceous glands produce sebum that normally travels via hair follicles to the skin surface. However, skin cells can plug the follicles, blocking the sebum coming from the sebaceous glands. When follicles become plugged, skin bacteria (called Propionibacterium acnes, or P. acnes) begin to grow inside the follicles, causing inflammation. Acne progresses in the following manner:

Incomplete blockage of the hair follicle results in blackheads (a semisolid, black plug).
Complete blockage of the hair follicle results in whiteheads (a semisolid, white plug). Infection and irritation cause whiteheads to form.

Eventually, the plugged follicle bursts, spilling oil, skin cells, and bacteria onto the skin surface. In turn, the skin becomes irritated and pimples or lesions begin to develop. The basic acne lesion is called a comedo.

Acne can be superficial (pimples without abscesses) or deep (when the inflamed pimples push down into the skin, causing pus-filled cysts that rupture and result in larger abscesses).

What causes acne?

Rising hormone levels during puberty may cause acne. In addition, acne is often inherited. Other causes of acne may include the following:

hormone level changes during the menstrual cycle in women
certain drugs (such as corticosteroids, lithium, and barbiturates)
oil and grease from the scalp, mineral or cooking oil, and certain cosmetics
bacteria inside pimples

Acne can be aggravated by squeezing the pimples or by scrubbing the skin too hard. Skin may also become irritated with friction or pressure from helmets, backpacks, or tight collars. Some environmental conditions such as pollution or humid conditions can also irritate the skin.

What are the symptoms of acne?

Acne can occur anywhere on the body. However, acne most often appears in areas where there is a high concentration of sebaceous glands, including the following:

face
chest
upper back
shoulders
neck

The following are the most common symptoms of acne. However, each individual may experience symptoms differently. Symptoms may include:

blackheads
whiteheads
pus-filled lesions that may be painful
nodules (solid, raised bumps)

The symptoms of acne may resemble other skin conditions. Always consult your physician for a diagnosis.

Treatment of acne:

Specific treatment for acne will be determined by your physician based on:

your age, overall health, and medical history
severity of the acne
your tolerance for specific medications, procedures, or therapies
expectations for the course of the condition
your opinion or preference

The goal of acne treatment is to minimize scarring and improve appearance. Treatment for acne will include topical or systemic drug therapy. Depending upon the severity of acne, topical medications (applied to the skin) or systemic medications (taken orally) may be prescribed by your physician. In some cases, a combination of both topical and systemic medications may be recommended.

Topical medications to treat acne:

Topical medications are often prescribed to treat acne. Topical medication can be in the form of a cream, gel, lotion, or solution. Examples include:

benzoyl peroxide	kills the bacteria (P. acnes)
antibiotics	helps stop or slow down the growth of P. acnes and reduces inflammation
tretinoin	stops the development of new acne lesions (comedones) and encourages cell turnover, unplugging pimples
adapalene	decreases comedo formation

Systemic medications to treat acne:

Systemic medications, or oral antibiotics, are often prescribed to treat moderate to severe acne, and may include the following:

doxycycline
erythromycin
tetracycline

Treatment for severe, cystic, or inflammatory acne:

Isotretinoin (Accutane®), an oral drug, may be prescribed for individuals with severe, cystic, or inflammatory acne to prevent extensive scarring. Isotretinoin reduces the size of the sebaceous glands that produce the skin oil, increases skin cell shedding, and affects the hair follicles, thereby reducing the development of acne lesions. Isotretinoin can clear acne in 90 percent of patients. However, the drug has major unwanted side effects, including psychiatric side effects. It is very important to discuss this medication with your physician.

Treatment for acne scars:

Specific dermatological procedures to minimize acne scars will be determined by your physician based on:

your age, overall health, and medical history
severity of the scar
type of scar
your tolerance for specific medications, procedures, or therapies
your opinion or preference

Although acne often is a chronic condition, even if it lasts only during adolescence, acne can leave life-long scars. Acne scars typically look like "icepick" pit scars or crater-like scars. Although proper treatment for acne may help minimize scarring, several dermatological procedures may help to further minimize any acne scars, including the following:

dermabrasion
Dermabrasion may be used to minimize small scars, minor skin surface irregularities, surgical scars, and acne scars. As the name implies, dermabrasion involves removing the top layers of skin with an electrical machine that "abrades" the skin. As the skin heals from the procedure, the surface appears smoother and fresher.
chemical peels
Chemical peels are often used to minimize sun-damaged skin, irregular pigment, and superficial scars. The top layer of skin is removed with a chemical application to the skin. By removing the top layer, the skin regenerates, often improving the skin's appearance.
collagen injections
One type of collagen, which is derived from purified bovine (cow) collagen, is injected beneath the skin to replace the body's natural collagen that has been lost. Injectable collagen is generally used to treat wrinkles, scars, and facial lines.
laser resurfacing
Laser resurfacing uses high-energy light to burn away damaged skin. Laser resurfacing may be used to minimize wrinkles and fine scars.
punch grafts
Punch grafts are small skin grafts used to replace scarred skin. A hole is punched in the skin to remove the scar, which is then replaced with unscarred skin (often from the back of the earlobe). Punch grafts can help treat deep acne scars.
autologous fat transfer
An autologous fat transfer uses fat taken from another site on your own body and it is injected into your skin. The fat is placed beneath the surface of the skin to elevate depressed scars. This method is used to correct deep contour defects caused by scarring from nodulocystic acne. Because the fat may be reabsorbed into the skin over a period of months, there may be a need for the procedure to be repeated.

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Online Resources of Dermatology

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