Acne vulgaris, what to do?

Acne is a skin condition that occurs when your hair follicles become plugged with oil and dead skin cells. It usually appears on your face, neck, chest, back and shoulders. The pimples and bumps heal slowly, and when one begins to go away, others seem to crop up.

Acne is most common among teenagers, with a reported prevalence of 70 to 87 percent. Increasingly, younger children are getting acne as well.

But not only the children,the number of women taht have acne in their 30s, 40s, 50s is growing. Dermatologists don’t have clear answer why this is happening but they do understand that adult acne can be particularly frustrating.

Depending on its severity, acne can cause emotional distress, depresseion and low selfesteem and scar the skin. The earlier the treatment begins, the lower your risk of lasting physical and emotional damage.

Acne is not just pimples

A person who has acne can have any of these:

  • Whiteheads (closed plugged pores)
  • Blackheads (open plugged pores — the oil turns brown when it is exposed to air)
  • Small red, tender bumps (papules)
  • Pimples (pustules), which are papules with pus at their tips
  • Large, solid, painful lumps beneath the surface of the skin (nodules)
  • Painful, pus-filled lumps beneath the surface of the skin (cystic lesions)

What is going on beneath the surface?

As explained, acne occurs when hair follicles become plugged with oil and dead skin cells. But hair follicles are connected to oil glands. These glands secrete an oily substance (sebum) to lubricate your hair and skin. Sebum normally travels along the hair shafts and through the openings of the hair follicles onto the surface of your skin.

When body produces an large amount of sebum and dead skin cells, the two can build up in the hair follicles. They form a soft plug, creating an environment where bacteria can thrive. If the clogged pore becomes infected with bacteria, inflammation results.

The plugged pore may cause the follicle wall to bulge and produce a whitehead. Or the plug may be open to the surface and may darken, causing a blackhead. A blackhead may look like dirt stuck in pores. But actually the pore is congested with bacteria and oil, which turns brown when it’s exposed to the air.

Pimples are raised red spots with a white center that develop when blocked hair follicles become inflamed or infected. Blockages and inflammation that develop deep inside hair follicles produce cyst-like lumps beneath the surface of your skin. Other pores in your skin, which are the openings of the sweat glands, aren’t usually involved in acne.

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What causes acne?

There are four important factors:

  • Oil production (of you have oily skin, or apply a face cream that doesn’t suit your skin type)
  • Dead skin cells (overproduction of dead cells or not using suitable pilling gel)
  • Clogged pores (because of allpied cream or other cosmetic products)
  • Bacteria (touching your face too often, or exposed to dirt too often)

Acne typically appears on your face, neck, chest, back and shoulders. These areas of skin have the most oil (sebaceous) glands.

Factors that may worsen acne

These factors can trigger or aggravate an existing case of acne:

  • Hormonal changes. Androgens are hormones that increase in boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy and the use of oral contraceptives also can affect sebum production. And low amounts of androgens circulate in the blood of women and can worsen acne.
  • Family history. Genetics plays a role in acne. If both parents had acne, you’re likely to develop it, too.
  • Diet. Studies indicate that certain dietary factors, including dairy products and carbohydrate-rich foods — such as bread, bagels and chips — may trigger acne. Chocolate has long been suspected of making acne worse. A recent study of 14 men with acne showed that eating chocolate was related to an increase in acne. Further study is needed to examine why this happens or whether acne patients need to follow specific dietary restrictions.
  • Greasy or oily substances. You may develop acne where your skin comes into contact with oily lotions and creams or with grease in a work area, such as a kitchen with fry vats.
  • Friction or pressure on your skin. This can be caused by items such as telephones, cellphones, helmets, tight collars and backpacks.
  • Stress. This doesn’t cause acne, but if you have acne already, stress may make it worse.
  • Certain medications. Drugs containing corticosteroids, androgens or lithium can worsen acne.

If you have acne that’s not responding to self-care and over-the-counter treatments, make an appointment with your doctor. Early, effective treatment of acne reduces the risk of scarring and of lasting damage to your self-esteem. After an initial examination, your doctor may refer you to a specialist in the diagnosis and treatment of skin conditions (dermatologist).

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Have you tried everything?

Alternative medicine

There are studies that suggest that using the following supplements may help treat acne.
  • Tea tree oil. Gels containing 5 percent tea tree oil may be as effective as are lotions containing 5 percent benzoyl peroxide, although tea tree oil might work more slowly.
  • Alpha hydroxy acid. This natural acid is found in citrus fruit and other foods. When applied to your skin, it helps remove dead skin cells and unclog pores. It may also improve the appearance of acne scars. Side effects include increased sensitivity to the sun, redness, mild stinging and skin irritation.
  • Azelaic acid. This natural acid is found in whole-grain cereals and animal products. It has antibacterial properties. A 20 percent azelaic acid cream seems to be as effective as many other conventional acne treatments when used twice a day for at least four weeks.
  • Bovine cartilage. Creams containing 5 percent bovine cartilage, applied to the affected skin twice a day, may be effective in reducing acne.
  • Zinc. Zinc in lotions and creams may reduce acne breakouts.
  • Green tea extract. A lotion of 2 percent green tea extract helped reduce acne in two studies of adolescents and young adults with mild to moderate acne.
  • Aloe vera. A study shows that 50 percent aloe vera gel combined with a conventional acne drug (tretinoin) is significantly more effective than tretinoin alone.
  • Brewer’s yeast. A specific strain of brewer’s yeast, called CBS 5926, seems to help decrease acne. Brewer’s yeast is the only item in this list that’s taken orally. It may cause flatulence.

If home care remedies don’t work to clear up your acne, see your primary care doctor. He or she can prescribe stronger medications. If acne persists or is severe, you may want to seek medical treatment from a doctor who specializes in the skin (dermatologist).

A dermatologist can help you:
  • Control your acne
  • Avoid scarring or other damage to your skin
  • Make scars less noticeable
Acne medications work by reducing oil production, speeding up skin cell turnover, fighting bacterial infection or reducing inflammation — which helps prevent scarring. With most prescription acne drugs, you may not see results for four to eight weeks, and your skin may get worse before it gets better. It can take many months or years for your acne to clear up completely.

Topical medications

These products work best when applied to clean, dry skin about 15 minutes after washing. You may not see the benefit of this treatment for a few weeks. And you may notice skin irritation at first, such as redness, dryness and peeling.

Your doctor may recommend steps to minimize these side effects, including using a gradually increased dose, washing off the medication after a short application or switching to another medication.

The most common topical prescription medications for acne are:

  • Retinoids. These come as creams, gels and lotions. Retinoid drugs are derived from vitamin A and include tretinoin (Avita, Retin-A, others), adapalene (Differin) and tazarotene (Tazorac, Avage). It works by preventing plugging of the hair follicles.
  • Antibiotics. These work by killing excess skin bacteria and reducing redness. For the first few months of treatment, you may use both a retinoid and an antibiotic, with the antibiotic applied in the morning and the retinoid in the evening. The antibiotics are often combined with benzoyl peroxide to reduce the likelihood of developing antibiotic resistance.
  • Dapsone (Aczone). This gel is most effective when combined with a topical retinoid. Skin side effects include redness and dryness.

Oral medications

  • Antibiotics. For moderate to severe acne, you may need oral antibiotics to reduce bacteria and fight inflammation. You will likely use topical medications and oral antibiotics together. Studies have found that using topical benzoyl peroxide along with oral antibiotics may reduce the risk of developing antibiotic resistance.
  • Combined oral contraceptives. Combined oral contraceptives are useful in treating acne in women and adolescent girls. The most common side effects of these drugs are headache, breast tenderness, nausea, weight gain and breakthrough bleeding. A serious potential complication is a slightly increased risk of blood clots.
  • Anti-androgen agent. The drug spironolactone (Aldactone) may be considered for women and adolescent girls if oral antibiotics aren’t helping. It works by blocking the effect of androgen hormones on the sebaceous glands. Possible side effects include breast tenderness, painful periods and the retention of potassium.
  • Isotretinoin. This medicine is reserved for people with the most severe acne. Isotretinoin (Amnesteem, Claravis, Sotret) is a powerful drug for people whose acne doesn’t respond to other treatments.Oral isotretinoin is very effective. But because of its potential side effects, doctors need to closely monitor anyone they treat with this drug. The most serious potential side effects include ulcerative colitis, an increased risk of depression and suicide, and severe birth defects.In fact, isotretinoin carries such serious risk of side effects that women of reproductive age must participate in a Food and Drug Administration-approved monitoring program to receive a prescription for the drug.

Therapies

These therapies may be suggested in select cases, either alone or in combination with medications.

  • Light therapy. Light therapy targets the bacteria that cause acne inflammation. Some types of light therapy are done in a doctor’s office. Blue-light therapy can be done at home with a hand-held device.
  • Chemical peel. This procedure uses repeated applications of a chemical solution, such as salicylic acid. It is most effective when combined with other acne treatments, except oral retinoids. Chemical peels aren’t recommended for people taking oral retinoids because together these treatments can significantly irritate the skin.
  • Extraction of whiteheads and blackheads. Your dermatologist uses special tools to gently remove whiteheads and blackheads (comedos) that haven’t cleared up with topical medications. This technique may cause scarring.
  • Steroid injection. Nodular and cystic lesions can be treated by injecting a steroid drug directly into them. This improves their appearance without the need for extraction. The side effects of this technique include thinning of the skin, lighter skin and the appearance of small blood vessels on the treated area.

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