Acne
What is it?
Acne is an inflammatory disease of the skin. It is a
disorder of the skin’s pilosebaceous unit, which consists
of an oil gland (sebaceous gland) and a canal (pore) that
contains a hair called a follicle. The pore becomes
blocked and causes lesions commonly known as pimples.
Who gets it?
Acne affects young people as well as adults. It can
occur at anytime during the lifespan including the newborn
period, but it is not until puberty that it becomes a
common problem. In general, the condition is a bit more
common in males than in females and is usually more severe
in males than in females. It is also more common in
Caucasions.
What causes it?
The actual cause of acne is unknown. One important
factor does seem to be rising levels of the hormones
called androgens (male sex hormones) that are found in
both boys and girls at the time of puberty. Another factor
is heredity or genetics. Acne does seem to run in
families. Girls or women may find their acne flares 2 to 7
days before the onset of their menstrual period.
Pregnancy, coming on or off birth control pills, and
stress can make acne worse. Certain drugs (androgens,
lithium, and barbiturates) can cause acne. Physical trauma
(squeezing, picking, rubbing, hard scrubbing or pressure
from helmets, tight collars, or backpacks), greasy
cosmetics, and high humidity can make acne worse.
What are the symptoms?
Acne lesions usually occur on the face, neck, back,
shoulders and chest. The basic lesion in acne is called a
comedo and is an enlarged hair follicle plugged with oil
and bacteria. When the comedo stays below the skin it is
called a whitehead. When it reaches the surface of the
skin and opens up it is called a blackhead. Papules (small
inflamed lesions that look like pink bumps on the skin),
pustules (pimples), nodules (large, sore, solid lesions
deep in the skin) and cysts (deep, inflamed, pus-filled
lesions) are other types of acne lesions. Cysts can cause
serious scaring and deformity.
How is it diagnosed?
Diagnosis is primarily based on the appearance of the
skin. No testing is usually required.
What is the treatment?
Treatment is designed to prevent formation of new
lesions and aid the healing of old lesions. Treatment may
consist of topical creams or gels, with or without oral
medications, depending on the severity of the acne. At a
follow-up visit, a skin specialist called a dermatologist
would re-evaluate the patient's acne, get feedback
concerning the treatment, and make any necessary
adjustments in the treatment plan. Topical medications
that can normalize the shedding of skin cells may contain
benzoyl peroxide, sulfur, resorcinol, salicylic acid or
tretinoin, or retinoic acid. Oral antibiotics (such as
tetracycline, doxycycline, minocycline, or erythromycin)
may be prescribed if there are numerous inflammatory
lesions. Topical antibiotics (applied to a localized area
of the skin), such as clindamycin or erythromycin, are
also for milder forms of inflammatory acne. Oral
tetracyclines are usually not prescribed for children
until after they have all their permanent teeth, because
it can permanently discolor teeth that are still forming.
Severe acne may benefit from a synthetic vitamin A
analogue. However, this treatment requires careful
consideration of potential side effects. Surgical
intervention may include professional chemical skin
peeling, removal of eruptions or scars through
dermabrasion, or removal and/or drainage of cysts.
Self-care tips
If you have acne, clean your skin gently but thoroughly
with soap and water, removing all dirt or make-up. Wash as
often as needed to control oil, at least daily and after
exercising. Use a clean washcloth every day to prevent
bacterial infection. Shampoo hair daily when possible,
using a dandruff shampoo if necessary. Comb or pull hair
back to keep hair out of the face. Don't squeeze, scratch,
pick, or rub lesions because these activities can increase
skin damage. Don't rest your face on your hands. This
irritates the skin of the face. Unlike other conditions,
acne treatment usually requires 6 to 8 weeks before
improvement is noted. Be patient!
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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