Acne: Causes and cure
October 01 2013 08:16 PM

Dr Fuad Usman; Acne typically appears on areas of your skin with the largest number of functional oil glands.

By Dr Fuad Usman

Acne is a skin condition that occurs when your hair follicles become plugged with oil and dead skin cells. Acne most commonly appears on your face, neck, chest, back and shoulders. Acne can be distressing and annoyingly persistent. Acne lesions heal slowly, and when one begins to resolve, others seem to crop up.
Depending on its severity, acne can cause emotional distress and lead to scarring of the skin.
The good news is that effective treatments are available and the earlier the treatment is taken, the lower your risk of lasting physical and emotional damage.


Acne typically appears on your face, neck, chest, back and shoulders, which are the areas of your skin with the largest number of functional oil glands.
Acne can take the following forms:
Non inflammatory lesions:
Comedones (whiteheads and blackheads) are created when the openings of hair follicles become clogged and blocked with oil secretions, dead skin cells and sometimes bacteria. When comedones are open at the skin surface, they’re called blackheads because of the dark appearance of the plugs in the hair follicles. When comedones are closed, they’re called whiteheads, slightly raised, skin-coloured bumps.
Inflammatory lesions
Papules are small raised bumps that signal inflammation or infection in the hair follicles. Papules may be red and tender.
Pustules (pimples) are red, tender bumps with white pus at their tips.
Nodules are large, solid, painful lumps beneath the surface of the skin. They’re formed by the buildup of secretions deep within hair follicles.
Cysts are painful, pus-filled lumps beneath the surface of the skin. These boil like infections can cause scars.

When to see a doctor
Usually acne isn’t a serious medical condition. If you have acne that’s not responding to home 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 social relationships or self esteem. After an initial examination, your doctor may refer you to a specialist in the diagnosis and treatment of skin conditions (dermatologist). You may also want to ask a dermatologist if your acne can be controlled or if your scars can be diminished.
Acne treatments work by reducing oil production, speeding up skin cell turnover, fighting bacterial infection, reducing the inflammation or doing all four. With most prescription acne treatments, you may not see results for four to eight weeks, and your skin may get worse before it gets better.
Your doctor or dermatologist may recommend a prescription medication you apply to your skin (topical medication) or take by mouth (oral medication). Oral prescription medications for acne should not be used during pregnancy, especially during the first trimester.

* Three factors contribute to the formation of acne:
* Overproduction of oil (sebum)
* Irregular shedding of dead skin cells resulting in irritation of the hair follicles of your skin
* Buildup of bacteria

Factors that may worsen acne
The factors that can trigger or aggravate an existing case of acne are hormones, certain medications, diet, acne myths, greasy foods and chocolate and dirty skin.

Risk factors
Hormonal changes in your body can provoke or aggravate acne. Such changes are common in:
* Teenagers
* Women and girls, two to seven days before their periods
* Pregnant women
* People using certain medications, including those containing corticosteroids, androgens or lithium
* Other risk factors include
* Direct skin contact with greasy or oily substances, or to certain cosmetics applied directly to the skin
* A family history of acne, if your parents had acne, you’re likely to develop it, too
* Friction or pressure on your skin caused by various items, such as telephones or cellphones, helmets, tight collars and backpacks
* Stress doesn’t cause acne, but if you have acne already, stress may make it worse  

Treatments and drugs
Types of acne treatments include:
Over-the-counter topical treatments: Acne lotions may dry up the oil, kill bacteria and promote sloughing of dead skin cells. Over the counter (OTC) lotions are generally mild and contain benzoyl peroxide, sulfur, resorcinol, salicylic acid or sulfur as their active ingredient.
Topical treatments available by prescription: If your acne doesn’t respond to OTC treatments, consider seeing a doctor or dermatologist to get a stronger prescription lotion. Tretinoin (Avita, Retin-A, others), adapalene (Differin) and tazarotene (Tazorac, Avage) are examples of topical prescription products derived from vitamin A. A number of topical antibiotics also are available. Often, a combination of such products is required to achieve optimal results. Dapsone gel (Aczone) is a newer acne treatment that’s particularly effective in treating inflammatory acne.
Antibiotics: For moderate to severe acne, you may need a short course of prescription oral antibiotics to reduce bacteria and fight inflammation. Since oral antibiotics were first used to treat acne, antibiotic resistance has increased significantly in people with acne. For this reason, your doctor likely will recommend tapering off these medications as soon as your symptoms begin to improve, or as soon as it becomes clear the drugs aren’t helping.
Isotretinoin: Isotretinoin (Amnesteem, Claravis, Sotret) is a powerful medication available for scarring cystic acne or acne that doesn’t respond to other treatments. This medicine is reserved for the most severe forms of acne. It’s very effective, but people who take it need close monitoring by a dermatologist because of the possibility of severe side effects. In fact, the drug carries such serious potential side effects that women of reproductive age must participate in a Food and Drug Administration approved monitoring programme to receive a prescription for the drug.
Oral contraceptives: Oral contraceptives, including a combination of norgestimate and ethinyl estradiol (Ortho Tri-Cyclen, Previfem, others), can improve acne in women.
Laser and light therapy: Laser and light based therapies reach the deeper layers of skin without harming the skin’s surface. Laser treatment is thought to damage the oil (sebaceous) glands, causing them to produce less oil. Light therapy targets the bacteria that cause acne inflammation. These therapies can also improve skin texture and lessen the appearance of scars.
Cosmetic procedures: Chemical peels and microdermabrasion may be helpful in controlling acne. These cosmetic procedures which have traditionally been used to lessen the appearance of fine lines, sun damage and minor facial scars are most effective when used in combination with other acne treatments.
Acne scar treatment: Doctors may be able to use certain procedures to diminish scars left by acne. These include soft tissue fillers, dermabrasion, microdermabrasion, intense light therapy (light source and radio frequency treatments), skin surgery and laser resurfacing.
Lifestyle & home remedies: You can avoid or control most acne with good basic skin care and the following self-care techniques:
Wash problem areas with a gentle cleanser: Products such as facial scrubs, astringents and masks generally aren’t recommended because they tend to irritate skin, which can worsen acne. Excessive washing and scrubbing also can irritate skin. If you tend to develop acne around your hairline, shampoo your hair frequently.
Try over-the-counter acne lotion to dry excess oil and promote peeling: Look for products containing benzoyl peroxide or salicylic acid as the active ingredient.
Avoid irritants: You may want to avoid oily or greasy cosmetics, sunscreens, hairstyling products or acne concealers. Use products labelled ‘water-based’ or ‘noncomedogenic’.  For some people, the sun worsens acne. Additionally, some acne medications can make you more susceptible to the sun’s rays. Check with your doctor to see if your medication is one of these, and if so, stay out of the sun as much as possible and anytime you have to be in the sun, use sunscreen that doesn’t clog your pores.
Watch what touches your face: Keep your hair clean and off your face. Also avoid resting your hands or objects, such as telephone receivers, on your face. Tight clothing or hats also can pose a problem, especially if you’ll be sweating. Sweat, dirt and oils can contribute to acne.
Don’t pick or squeeze blemishes: Picking or squeezing can cause infection or scarring. If you need aggressive treatment, see your doctor or dermatologist.

Once your acne improves or clears, you may need to continue your acne medication or other treatment to prevent new acne breakouts. In some cases, you might need to use a topical medication on acne-prone areas, continue taking oral contraceptives or attend ongoing light therapy sessions to keep your skin clear. Talk to your doctor about how you can prevent new eruptions. You can also prevent new acne breakouts with self-care measures, such as washing your skin with a gentle cleanser and avoiding touching or picking at the problem areas.
Other acne prevention tips include:
* Wash acne prone areas only twice a day
* Use an over the counter acne cream or gel to help dry excess oil
* Avoid heavy foundation makeup
* Remove makeup before going to bed
* Wear loose fitting clothing
* Shower after exercising or doing strenuous work

Dr Fuad Usman
MBBS, MD (DVL), Dermatology
Aster Medical Centre, Industrial Area
* For questions and clarifications please contact: [email protected]

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