Disease and Condition

What is acne? What are the different types of acne?

Acne (acne vulgaris, common acne) is not just a problem for teenagers; it can affect people from ages 10 through 40. It is not unusual for women, in particular, to develop acne in their mid- to late-20s, even if they have not had breakouts in years (or ever). On the positive side, those few individuals who have acne into their 40s may well grow out of it. Acne can appear on the skin as any of the following:

* congested pores ("comedones"),


* whiteheads,


* blackheads,


* pimples ("zits"),


* pustules, or


* cysts (deep pimples, boils). The pus in pustules and cysts is sterile and does not actually contain infectious bacteria.

These blemishes occur wherever there are many oil (sebaceous) glands, mainly on the face, chest, and back.

You can do a lot to treat your acne using products available at a drugstore or cosmetic counter that do not require a prescription. However, for tougher cases of acne, you should consult a physician for treatment options.

What causes acne?

No one factor causes acne. Acne happens when oil (sebaceous) glands come to life around puberty, stimulated by male hormones from the adrenal glands of both boys and girls. Sebum (oil) is a natural substance which lubricates and protects the skin, and under certain circumstances, cells that are close to the surface block the openings of sebaceous glands and cause a buildup of oil underneath. This oil stimulates bacteria (which live on everyone's skin and generally cause no problems) to multiply and cause surrounding tissues to become inflamed.

Inflammation near the skin's surface produces a pustule; deeper inflammation results in a papule (pimple); deeper still and it's a cyst. If the oil breaks though to the surface, the result is a "whitehead." If the oil accumulates melanin pigment or becomes oxidized, the oil changes from white to black, and the result is a "blackhead." Blackheads are therefore not dirt, and do not reflect poor hygiene.

Here are some factors that don't usually cause acne, at least by themselves:

* Heredity: With the exception of very severe acne, most people do not have the problem exactly as their parents did. Almost everyone has some acne at some point in their life.


* Food: Parents often tell teens to avoid pizza, chocolate, greasy and fried foods, and junk food. While these foods may not be good for overall health, they don't cause acne or make it worse. Although some recent studies have implicated milk and dairy products in aggravating acne, these findings are far from established.


* Dirt: As mentioned above, "blackheads" are oxidized oil, not dirt. Sweat does not cause acne, therefore, it is not necessary to shower instantly after exercise for fear that sweat will clog pores. On the other hand, excessive washing can dry and irritate the skin.


* Stress: Some people get so upset by their pimples that they pick at them and make them last longer. Stress, however, does not play much of a direct role in causing acne.


* Hormones: Some women break out cyclically, but most women (and men) don't. Some oral contraceptive pills may help relieve acne, but unless a woman has abnormal menstrual periods and excessive hair growth, it's unlikely that hormones play much of a role in causing acne. Pregnancy has a variable effect on acne; some women report that they clear up completely, and others get worse, while many others see no overall change.


* Cosmetics: Most cosmetic and skin-care products are not pore-clogging ("comedogenic"). Of the many available brands, those which are listed as "water-based" or "oil-free" are generally a better choice.

In occasional patients, the following may be contributing factors:

* Pressure: In some patients, pressure from helmets, chinstraps, collars, suspenders, and the like can aggravate acne.


* Drugs: Some medications may cause or worsen acne, such as those containing iodides, bromides, or oral or injected steroids (either the medically prescribed prednisone or the steroids that bodybuilders or athletes take). Other drugs that can cause or aggravate acne are anticonvulsant medications and lithium, which is used to treat bipolar disorder. Most cases of acne, however, are not drug-related.


* Occupations: In some jobs, exposure to industrial products like cutting oils may produce acne.

When should you start to treat acne?

Since everyone gets acne at some time, the right time to treat it is when it bothers you. This can be when severe acne flares suddenly, mild acne that just won't go away, or even when a single pimple decides to show up the week before your prom or wedding. The decision is yours.

What can you do about acne on your own?

Think back to the three basic causes of acne and you can understand why the focus of both home treatment and prescription therapy is to (1) unclog pores, (2) kill bacteria, and (3) minimize oil. But first a word about...

Lifestyle: Moderation and regularity are good things, but not everyone can sleep eight hours, eat three good meals, and drink eight glasses of water a day. You can, however, still control your acne even if your routine is frantic and unpredictable. Probably the most useful lifestyle changes you can make are to apply hot compresses to pustules and cysts, to get facials (see below), and never to pick or squeeze pimples. Playing with or popping pimples, no matter how careful and clean you are, nearly always makes bumps stay redder and bumpier longer. People often refer to redness as "scarring," but fortunately it usually isn't in the permanent sense. It's just a mark that takes months to fade if left entirely alone.

Open the pores

Cleansing and skin care: Despite what you read in popular style and fashion magazines, there is no magic product or regimen that is right for every person and situation.

* Mild cleansers: Washing once or twice a day with a mild cleansing bar or liquid (for example, Dove, Neutrogena, Basis, Purpose, and Cetaphil are all inexpensive and popular) will keep the skin clean and minimize sensitivity and irritation.


* Exfoliating cleansers and masques: A variety of mild scrubs, exfoliants, and masques can be used. These products contain either fine granules or salicylic acid in a concentration that makes it a very mild peeling agent. These products remove the outer layer of the skin and thus open pores. Products containing glycolic or alpha hydroxy acids are also gentle skin exfoliants.


* Retinol: Not to be confused with the prescription medication Retin-A, this derivative of vitamin A can help promote skin peeling.

Kill the bacteria

* Antibacterial cleansers: The most popular ingredient in over-the-counter antibacterial cleansers is benzoyl peroxide.


* Topical (external) applications: These products come in the form of gels, creams, and lotions, which are applied to the affected area. The active ingredients that kill surface bacteria include benzoyl peroxide, sulfur, and resorcinol. Some brands promoted on the Internet and cable TV (such as ProActiv) are more costly but not really any better than ones you can buy in the drugstore.

Benzoyl peroxide causes red and scaly allergic skin in a small number of people, which goes away as soon as you stop using the product. Keep in mind that benzoyl peroxide is a bleach, so do not let products containing benzoyl peroxide leave unsightly blotching on colored clothes, shirts, towels, and carpets.

Reduce the oil

You cannot stop your oil glands from producing oil (unless you mess with your hormones or metabolism in ways you shouldn't). Even isotretinoin (Accutane, see below) only slows down oil glands for a while; they come back to life later. What you can do is to get rid of oil on the surface of the skin and reduce the embarrassing shine.

* Use a gentle astringent/toner to wipe away oil. (There are many brands available in pharmacies, as well as from manufacturers of cosmetic lines.)


* Products containing glycolic acid or one of the other alpha hydroxy acids are also mildly helpful in clearing the skin by causing the superficial layer of the skin to peel (exfoliate).


* Masques containing sulfur and other ingredients draw out facial oil.


* Antibacterial pads containing benzoyl peroxide have the additional benefit of helping you wipe away oil.


How would you sum up current-day treatment of acne?

Treating acne requires patience and perseverance. Any of the treatments listed above may take two or three months to start working (even isotretinoin). Unless there are side effects such as dryness or allergy, it is important to give each regimen or drug enough time to work before giving up on it and moving on to other methods. Using modern methods, doctors can help clear up just about everyone.

Just hang in there. And don't pick. Please.

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