Acne

What is Acne?

Acne, also known as zits, pimples, blackheads or whiteheads, is a skin disorder caused by the clogging of the pores by dead cells and oil.

It is most commonly seen among teenagers, but it may develop in younger and older people as well.

Acne ranges from mild to severe, and may develop on the face, neck, chest, shoulders, and back. Severe forms of acne may lead to scars, and many sufferers, especially teenagers, may feel embarrassed by it.

Early treatment of acne helps to control it, but in some cases, pimples may be difficult to remove and prevent from reoccurring. Mild forms of acne can be removed using over-the-counter prescriptions, while tougher areas may need further medical consultation.

Acne symptoms appear in different forms and in different areas on the skin. Symptoms include:

• Blackheads: The pore is plugged with dead cells and oil, but remains open and exposed.

• Whiteheads: The pore is plugged with dead cells and oil, but is closed

• Pimples: When sebum collects under the pores.

• Pustules: A severe form of acne, resulting from bacterial infection of clogged pores leading to inflammation. They are small, red-colored bumps filled with pus.

• Nodules: In some cases, solid bumps may develop under the skin surface. When these sub-surface lumps are filled with pus, they are known as cystic lesions. 

The most common cause of acne is the plugging of pores by dead cells and oil. Increased production of hormones during puberty and pregnancy stimulate sebaceous glands on the skin to produce more oil, which mixes with the dead cells and clog the pores.

Certain medications like corticosteroids and androgens are known to increase the production of sebum, and thus cause acne. Some dietary habits and stress also trigger pimples. 

Acne myths:

There are many misconceptions about the causes of acne.

Most people consider dirty skin as the major source of acne, and scrub their skin hard to keep it clean. Too much scrubbing can worsen acne, particularly when one is using harsh soaps or chemicals. Further, many people avoid cosmetics thinking that these will trigger acne. However, oil-free makeup may not affect acne.

Another common myth is that fatty foods cause and worsen acne, but this dietary factor actually does not affect the development of pimples. 

No specific tests are usually required for making a diagnosis of acne.

When to see a Doctor about acne

You can see your primary care physician if home care does not help in clearing your acne.

Your doctor will prescribe medications that can help reduce your acne. In conditions where your acne is persistent or more severe, you may seek treatment from a dermatologist, a doctor who specializes in the treatment of skin disorders.

Early treatment always decreases the risk of permanent scarring.

Preparing for your visit

There are a few things you can do to help your doctor reach a diagnosis. Be ready for any possible questions he or she may ask.

Make a list of key information, such as other conditions you've been diagnosed with, and any prescription or over-the-counter products you are currently using, including vitamins and supplements.

List key personal information, including any life changes, and also list any other questions you can think to ask your doctor.

Your doctor may ask you when you first developed the problem, and he or she will ask about potential triggers.

Mild acne may go without any specific treatment or with over-the-counter medications. Common medications help to dry up the oil and peel off the skin. Moderate and severe forms of acne may need treatment which depends on the severity and type of acne. These medications help to control acne and avoid scarring of the skin.

Acne medications help to reduce oil production by sebaceous glands and speed up the production of new skin cells, preventing clogging of pores by dead cells. They may also help to reduce inflammation. It may take months for severe acne to clear. Treatment of acne includes topical applications, oral medications, and/or therapies. 

Common treatment methods

• Retinoids – retinoid creams and gels are usually applied in the evening and help to prevent clogging of skin pores. Dapsone gel is often used along with a retinoid for improved effect. 

• Antibiotics – antibiotics help to prevent bacterial infection and is usually used in combination with retinoids. Oral antibiotics are used in moderate to severe form of acne. A combination of antibiotics and benzoyl peroxide helps to prevent development of antibiotic resistance. 

• Hormonal therapy – Combined oral contraceptives with estrogen and progestin are used for controlling acne in teenage girls and women. Acne caused by sensitivity to the androgen hormone is treated with anti-androgen medications. 

• Isotretinoin – this medication is prescribed for severe forms of acne, particularly in those who do not respond to other forms of treatment. 

• Chemical peel – this procedure is used in combination with other acne treatments, and is done with salicylic acid. This method cannot be used as an alternative for a regular therapy. 

• Extraction – whiteheads and blackheads may be removed using a special tool. It should be performed with utmost care as it may lead to scarring.

• Injections – steroids are injected directly into nodular lesions and cystic lesions to clear them off completely. 

Scar removal

Removal of scars is the next step in the treatment of acne. Different procedures help in reducing the scars. Chemical peels using acids help in making scars less obvious. Repeated fillings with collagen are also used to remove scars.

Shallow scars can be removed by dermabrasion, a procedure in which upper layers of skin are removed. This triggers healing by the formation of new skin cells in the region.

Upper layers of the skin in the scar can also be removed with the help of laser and light sources, and this will be gradually replaced by a new layer of skin.

Surgery is used to remove deep depressions in scars and to replace them with graft.

You may need to continue your acne medication or treatment even if your acne has improved in order to prevent new lesions.

You should continue use of topical creams on acne prone areas, continue taking oral medication, and attending ongoing light therapy sessions. Your doctor will provide advice on the ways to keep your skin clear.

You can also follow these skin care tips to prevent acne:

• Wash the acne-prone areas only twice a day. Washing removes excess oil and dead skin cells, but excessive washing may irritate the skin.

• Wash affected areas with a gentle cleansing lotion and use oil-free, water-based skin care products.

• Use an over-the-counter acne cream or gel to help remove excess oil.

• Use products containing benzoyl peroxide or salicylic acid as the active ingredient.

• Use non-greasy makeup and choose oil-free cosmetics that do not clog pores (noncomedogenic).

• Cleanse your makeup before going to bed in the night. Going to sleep with cosmetics on your skin can cause plugged pores.

• Dispose old makeup and regularly clean your cosmetic brushes and applicators using soap water.

• Wear loosely fitting clothes. Tight fitting clothes trap heat and moisture and can irritate your skin.

• When possible, avoid tight fitting straps, backpacks, helmets, hats and sports equipment to prevent friction against your skin.

• Take a shower after strenuous activities. Leaving oil and sweat on your skin can lead to breakouts.

• Avoid touching or picking at the whiteheads/blackheads. Doing this can trigger more acne.

Several alternative and homeopathic remedies are used for Acne.

A number of supplements can be used for controlling acne, the efficacy of which are yet to be scientifically proven.

Gel containing 5% tea tree oil is one such supplement used topically for treating pimples.

Alpha hydroxy acids contained in citrus fruits are used to remove dead cells and open up the pores of the skin.

Anti-bacterial properties of azelaic acid are also useful in treating acne, particularly when used in combination with erythromycin.

Creams and lotions containing zinc are used to control outbreaks of pimples.

In mild to moderate forms of acne, green tree extract is used. An oral form of brewer’s yeast is also considered to be useful in acne treatment.

Make sure to consult with your primary physician when considering any homeopathic or alternative remedies for acne.

There are different ways to adapt your lifestyle in coping with acne.

Practicing basic skin care

Wash the affected area with a mild soap and warm water. Avoid using scrubs and other soaps to avoid irritating the skin.

Use only oil-free cosmetics and make it a habit to remove applied make-up before sleeping.

Avoid picking, touching and squeezing pimples with hands. This will prevent formation of scars. 

Many people, particularly teenagers, find it especially embarrassing to have pimples and scars. Early treatment reduces the damage caused by persistent acne.

Support groups and counselling may also be helpful to cope with this condition.

There are several common factors that increase the risk and affect complications of acne.

Some of the most common risk factors for the development of acne include:

• Hormonal changes

• Family history

• Stress

• Pressure on the skin

• Use of oily cosmetics

Complications

Scarring is the most common complication of acne and is caused by the bursting of cysts and nodules.

Many teenagers may develop depression and become socially withdrawn.