Acne

Causes and Risks:
Acne is most common in adolescent boys, but it can occur in both sexes and at all ages. There seems to be a familial tendency to develop acne. The condition usually begins at puberty and may continue for many years. Three out of four teenagers have acne to some extent, probably caused by hormonal changes that stimulate the sebaceous (oil producing) skin glands. Other hormonal changes, such as can occur with menstrual periods, pregnancy , use of birth control pills, or stress , also aggravate acne.

Acne is caused when sebaceous glands within the hair follicles (pores) of the skin become plugged, because secretion occurs faster than the oil and skin cells can exit the follicle. The plug causes the follicle to bulge (causing whiteheads ), and the top of the plug may darken (causing blackheads ). If the plug causes the wall of the follicle to rupture, the oil, dead skin cells, and bacteria found normally on the surface of the skin can enter the skin and form small infected areas called pustules (also known as pimples or "zits").

If these infected areas are deep in the skin, they may enlarge to form cysts . A sebaceous cyst forms when the sebaceous gland continues to produce oil. Instead of rupturing the follicle wall, the follicle continues to enlarge and form a soft, pliable lump (known as a cyst) under the skin. The cyst is usually not painful or discolored unless it becomes infected. Acne commonly appears on the face and shoulders, but may extend to the trunk, arms and legs.

Acne is not caused by dirt or by masturbation or other activities, but dirt and oil on the face can aggravate the condition. Other factors that increase the chances of acne are hormonal changes, exposure to weather extremes, stress, oily skin , endocrine disorders, certain tumors, and the use of certain drugs (such as cortisone, testosterone , estrogen, and others). Acne is not contagious. A tendency to have acne may persist through ages 30's to early 40's.

Prevention:
The tendency to develop acne is inherited. Although acne cannot be prevented, careful cleanliness can help to lessen the effects.

Symptoms:



Signs and Tests:
Diagnosis is primarily based on the appearance of the skin. No testing is usually required.

Treatment:
Treatment is designed to prevent formation of new lesions and aid the healing of old lesions.

Topical medications that dry up the oil and/or promote skin peeling may contain benzoyl peroxide, sulfur, resorcinol, salicylic acid or tretinoin, or retinoic acid (Retin-A).

Antibiotics (such as tetracycline or erythromycin) may be prescribed if the skin lesions appear infected. Topical antibiotics (applied to a localized area of the skin) such as clindamycin or erythromycin are also used to control infection. Note: oral tetracycline is usually not prescribed for children until after they have all their permanent teeth, because it can permanently discolor teeth that are still forming.

Synthetic vitamin A analogues (isotretinoin, Accutane) have been shown to be of benefit in the treatment of severe acne. However, pregnant women and sexually active adolescent females should not take this medication!

Other medications may include topical or injected forms of cortisone.

Surgical intervention may include professional (chemical) skin peeling, removal of eruptions or scars ( dermabrasion ), or removal and/or drainage of cysts .

A small amount of sun exposure may improve acne. However, excessive exposure to sunlight or ultraviolet rays is not recommended because prolonged exposure increases the risk of skin cancer .

Home treatment may lessen the effects of acne:

  • Clean the 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 reinfection.
  • Use steam or warm, moist compresses to open clogged pores.
  • Shampoo hair daily when possible. Use a dandruff shampoo if necessary.
  • Comb or pull hair back to keep hair out of the face.
  • Use topical astringents to remove excess oil.
  • Don't squeeze, scratch, pick, or rub lesions. These activities can increase skin damage. Wash your hands before and after caring for skin lesions to reduce the chance of infection.
  • Don't rest your face on your hands. This irritates the skin of the face.
  • Identify and avoid anything that aggravates acne. This may include foods, lotions, make-up, and so on. Avoid greasy cosmetics or creams, which can aggravate acne.
  • Acne often improves in the summer, so some foods that aggravate acne may be tolerated in the summer but not in the winter.



Prognosis:
Acne is usually chronic from puberty to adulthood, but eventually lessens. Acne generally responds well to treatment after a few weeks, but may flare up from time to time. Acne is not medically dangerous except for untreated, severe infection. Scarring may occur if severe acne is not treated.

Complications:

  • cyst
  • skin abscess
  • permanent facial scars
  • keloids
  • skin pigment changes
  • psychological damage to self-esteem, confidence, personality, social life
  • side effects of Accutane (including liver damage and damage to the fetus)
  • side effects of other medications



Call Your Healthcare Provider:
Apply home treatment and call your health care provider if there are signs of complications or if acne is severe and progressively worsening.

Call for an appointment with your health care provider if new symptoms develop, including large or painful cysts .


Blackheads are collections of oil and debris that clog pores. The material is normally whitish, but as it oxidizes, the surface turns black, producing this characteristic appearance.



Blackheads are collections of oil and debris that clog pores. The material is normally whitish, but if it's exposed to air, the surface turns black (oxidizes), producing this characteristic appearance.



This picture illustrates how acne can appear on the face of darker-complected individuals.



Cystic acne may occur across the upper chest as well as on the back.



The face is the most common location of acne. Here, there are 4 to 6 millimeter red (erythematous) pustules, some with bridging scars and fistulous tract formation (connecting passages). Severe acne may have a profound psychological impact and may cause scarring. Effective treatments are available for this type of acne.



Acne frequently occurs on the back. Here, there are 2 to 6 millimeter wide erythematous (red) pustules with large open and closed comedones. Permanent scarring may follow a severe case of acne. Men are more often affected on their shoulders and back than are women.



Cystic acne, or nodulocystic acne, is the most severe form of acne. Both pustules and hard red bumps are present in the skin. This form of acne is more difficult to treat and often requires taking an oral vitamin A derivative.



Cystic acne, or nodulocystic acne, is the most severe form of acne. Both pustules and red bumps are present in the skin and scarring can be seen. The back is a common site for acne.



Acne affects the areas of the skin that contain sebaceous glands, including the face, upper chest, and back. Acne occurs most commonly during adolescence. Many new treatment regimens are available for acne, especially for the most severe types.



Permanent scarring may follow a severe case of acne. Men are more often affected on their shoulders and back than are women.



Cystic acne is a severe form of acne that can cause pitting and scarring. There are several large cysts on the cheek and forehead, with many smaller pustules. Preventing new lesions and limiting the amount of scarring are the primary goals of treatment.



Cystic acne: In this more severe form of acne multiple deep "cysts" develop on the face, chest or back. Because of the deeper inflammation the tendency for scarring is increased.



Pustular acne: In this form of acne the inflammation is more superficial, producing pustules, or white heads, on the skin. It is more commonly seen in teenagers and is often associated with small, blocked pores (closed comedones) and black-heads (open comedones).



Acne lesions frequently contain pus. This close-up photograph shows small acne pustules with surrounding inflammation (erythema).



The second stage of acne rosacea produces characteristic redness (erythema) and telangiectasias (vascular lesions). Only some people in the second stage of rosacea develop raised bumps (papules) and pustules, as seen on the face of this individual. If the rosacea continues to the fourth stage, it is called rhinophyma.