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!