Acne Overview
Acne is a skin condition that causes spots and pimples, especially on the face, shoulders, back, neck, chest, and upper arms. It occurs when oil and dead skin block hair follicles, causing inflammation.
Whiteheads, blackheads, pimples, cysts, and nodules are all types of acne.
Acne is the most common skin condition in the United States, affecting up to 50 million Americans yearly.
It commonly occurs during puberty, when the sebaceous glands activate, but it can occur at any age. It is not dangerous, but it can leave skin scars.
The glands produce oil and are stimulated by male hormones produced by the adrenal glands in both males and females.
At least 85 percent of people in the U.S. experience acne between the ages of 12 and 24 years.
Facts on Acne
- Acne is a skin disease involving the oil glands at the base of hair follicles.
- It affects 3 in every 4 people aged 11 to 30 years.
- Risk factors include genetics, the menstrual cycle,
- Anxiety and stress, hot and humid climates, using oil-based makeup, and squeezing pimples.
- Treatment depends on how severe and persistent it is.
- It is not dangerous, but it can leave skin scars.
Types of Acne
Acne pimples vary in size, color, and level of pain.
The following types are possible:
- Blackheads: Clearly visible, they are black and appear on the surface of the skin
- Cysts: Clearly visible on the surface of the skin. They are painful and filled with pus.
- Papules: Small, usually pink bumps, these are visible on the surface of the skin
- Nodules: Clearly visible on the surface of the skin. They are large, solid, painful pimples that are embedded deep in the skin
- Pustules: Clearly visible on the surface of the skin. They are red at their base and have pus at the top
- Whiteheads: These remain under the skin and are small
Causes of Acne
Human skin has pores that connect to oil glands under the skin. Follicles connect the glands to the pores. Follicles are small sacs that produce and secrete liquid.
The glands produce an oily liquid called sebum. Sebum carries dead skin cells through the follicles to the surface of the skin. A small hair grows through the follicle out of the skin.
Propionibacterium acnes (P. acnes) is the name of the bacteria that live on the skin and contributes to the infection of pimples.
Research suggests that the severity and frequency of acne depend on the strain of bacteria. Not all acne bacteria trigger pimples. One strain helps to keep the skin pimple-free.
Hormonal Factors
A range of factors triggers acne, but the main cause is thought to be a rise in androgen levels.
Androgen is a type of hormone, the levels of which rise when adolescence begins. In women, it gets converted into estrogen.
Rising androgen levels cause the oil glands under the skin to grow. The enlarged gland produces more sebum. Excessive sebum can break down cellular walls in the pores, causing bacteria to grow.
Other Possible Triggers
Some studies suggest that genetic factors may increase the risk.
Other causes include the following:
- Certain medications that contain androgen and lithium
- Emotional stress
- Greasy cosmetics
- Hormonal changes
- Menstruation
Treatment for Acne
Mild acne can be treated with over-the-counter (OTC) medications, such as gels, soaps, pads, creams, and lotions, that are applied to the skin.
Creams and lotions are best for sensitive skin. Alcohol-based gels dry the skin and are better for oily skin.
OTC acne remedies may contain the following active ingredients:
- Azelaic acid: strengthens cells that line the follicles, stops sebum eruptions, and reduces bacterial growth. There is cream for acne, but other forms are used for rosacea.
- Benzoyl peroxide: kills bacteria, accelerates the replacement of skin, and slows the production of sebum
- Retin-A: helps unblock pores through cell turnover
- Salicylic acid: assists the breakdown of blackheads and whiteheads and helps reduce inflammation and swelling
- Resorcinol: helps break down blackheads and whiteheads
- Sulfur: exactly how this works is unknown
Treating Moderate to Severe Acne
A skin specialist, or dermatologist, can treat more severe cases.
They may prescribe a gel or cream similar to OTC medications but stronger, or an oral or topical antibiotics.
Corticosteroid Injection
If an acne cyst becomes severely inflamed, it may rupture. This can lead to scarring.
A specialist may treat an inflamed cyst by injecting a diluted corticosteroid.
This can help prevent scarring, reduce inflammation, and speed up healing. The cyst will break down within a few days.
Oral Antibiotics
Oral antibiotics may be prescribed for up to 6 months for patients with moderate to severe acne.
These aim to lower the population of P. Acnes. The dosage will start high and reduce as the acne clears.
Acne is more likely to become resistant to topical rather than oral antibiotics.
Antibiotics can combat the growth of bacteria and reduce inflammation.
Oral Contraceptives
Oral contraceptives can help control acne in women by suppressing the overactive gland. They are commonly used as long-term acne treatments.
Contraceptives may not be suitable for women who:
- Are over the age of 35
- Have a blood-clotting disorder
- Smoke
- Have a history of migraines
It is important to check with a gynecologist first.
Topical Antimicrobials
Topical antimicrobials also aim to reduce P. acnes in patients with moderate to severe acne. Examples are clindamycin and sodium sulfacetamide.
The dermatologist may prescribe a topical retinoid.
Topical retinoids are a derivative of vitamin A. They unclog the pores and prevent whiteheads and blackheads from developing.
Examples of topical retinoids prescribed in the U.S. are adapalene, tazarotene, and tretinoin.
Isotretinoin
This is a strong, oral retinoid, used for the treatment of severe cystic acne and severe acne that has not responded to other medications and treatments.
The patient must sign a consent form to say that they understand the risks, since it is a strictly controlled medication with potentially serious side effects.
Adverse effects include dry skin, dry lips, nosebleeds, fetal abnormalities if used during pregnancy, and mood swings.
Patients who take isotretinoin must avoid vitamin A supplements, as these could lead to vitamin A toxicity.
Home Remedies for Acne
Following are some of the suggested home remedies for acne:
Diet
Diet: It is unclear what role diet plays in worsening acne. Scientists have found that people who consume a diet that offers a good supply of vitamins A and E and of zinc may have a lower risk of severe acne.
One review describes the link between acne and diet as “controversial,” but suggests that a diet with a low glycemic load may help.
Tea-Tree Oil
Tea-tree oil: Results of a study of 60 patients published in the Indian Journal of Dermatology, Venereology, and Leprology suggested that 5-percent tea-tree oil may help trea mild to moderate acne.
Tea
Tea: There is some evidence that polyphenols from tea, including green tea , applied in a topical preparation, may be beneficial in reducing sebum production and treating acne. However, the compounds in this case were extracted from tea, rather than using tea directly.
Moisturizers
Moisturizers: These can soothe the skin, especially in people who are using acne treatment such as isotretinoin, say researchers. Lotions containing aloe vera at a concentration of at least 10 percent or witch hazel can have a soothing and possibly anti-inflammatory effect.
Summary
Cleaning the skin regularly and gently, selecting skin care products carefully and avoiding contact with oil can help reduce acne.
If none of these methods show improvement in 6 to 8 weeks, see a dermatologist for further recommendations.
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