Acne

DEFINITION
Acne is a complex disease in which the oil glands become highly sensitive to the levels of hormones released during the biological change from childhood to adolescence. The disease is most common among teenagers, but can continue into adulthood. It can usually be controlled and scarring can be prevented with the proper treatment.

CAUSES
In your teen-age years, the sebaceous glands (oil glands) tend to enlarge as your hormone levels rise. These glands, which are numerous on the face, back and chest are very sensitive to testosterone, a male hormone found in both males and females during and following puberty. When these glands enlarge, they produce large amounts of sebum, the oil that lubricates the skin. This enlargement also causes the cells lining the sebaceous duct to loosen and fall off, blocking the exit of the oil duct through the follicle onto the skin’s surface.

Hair follicles have visible openings that you know as the “pores” in your skin. The oil glands empty into the follicles, and the follicles empty out onto the skin. When these pores are blocked near the surface and the oil oxidizes, turning dark, they are called blackheads. Blackheads are made up of sebum (oil), bacteria and skin cells built up in the follicle and usually do not become inflamed. When blockages are deeper in the follicles and have smaller openings, they are called whiteheads. Whiteheads prevent oil from exiting to the surface, which may cause the follicle to rupture beneath the skin. The resulting skin inflammation may take the form of pimples (red papules), pustules or cysts.

PREVENTIVE MEASURES

Wash your face with a mild soap twice a day

Avoid moisturizers

Use only oil-free or water-based cosmetics

Do not pick, scratch or squeeze your pimples because this can lead to scarring.

PRECAUTIONS
Women should know that certain kinds of oral contraceptives could cause or worsen acne due to hormonal changes. Acne can also worsen shortly before menstruation. Men should know that the use of certain hormones to enhance bodybuilding could cause or worsen acne. Also, excessive heat and sweating under occlusive clothing (such as a football uniform) may worsen acne.

MEDICATION
Several things can be done to help control your acne.

If your acne is relatively mild, you may want to try some of the nonprescription lotions and creams containing salicylic acid or benzoyl peroxide that are available at the pharmacy.

If your acne is more severe, your physician may prescribe one or more of the following treatments.

Benzoyl peroxide applied to the skin to reduce skin bacteria and oil by creating a mild peeling action

Antibiotics applied to the skin to reduce inflammation and bacteria

Retinoic acid products (Retin-A®) that are available as gel, cream and liquid forms that are applied to the skin’s surface. These products reduce blackheads and whiteheads, but may cause some irritation at first. Your health care professional can explain ways to minimize the irritation.

Antibiotics taken by mouth may be prescribed to reduce the inflammation and the bacteria

Isotretinoin (Accutane®) is taken by mouth and may be considered for people with severe cystic scarring forms of acne. Because it has significant side effects, this drug must be taken under close medical supervision.

SUMMARY
Even untreated acne clears up after several years; however, treatment may prevent permanent scarring. For more information on acne, please check with your health care provider.