What is acne?

Acne is a skin condition when your hair follicles become plugged with oil and dead skin cells.  It causes the formation of whiteheads, blackheads, or pimples that appear on the surface of your skin. Acne most commonly appears on your face, forehead, chest, upper back and shoulders.

 

Four main factors cause acne:

• Excess oil production

• Hair follicles clogged by oil and dead skin cells

• Bacteria

• Excess activity of a type of hormone (androgens)

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Symptoms of acne:

Symptoms of acne include:

• Whiteheads (closed plugged pores)

• Blackheads (open plugged pores)

• 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)

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Factors that may worsen your acne:

These factors can trigger or aggravate acne:

• Hormones. Androgens are hormones that increase in boys and girls during puberty that cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy may also worsen acne. 

• Certain medications. Examples: corticosteroids, testosterone or lithium.

• Diet. Studies indicate certain foods may worsen acne including skim milk and carbohydrate-rich foods (such as bread, bagels and chips). Chocolate has long been suspected of making acne worse. A small study of 14 men with acne showed that eating chocolate was related to a worsening of symptoms. Further study is needed to examine why this happens and whether people with acne would benefit from following specific dietary restrictions.

• Stress. Stress can make acne worse.

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Treatment:

Acne treatment depends on each individual’s case. You can speak to a doctor to understand what treatment options are right for you. Your doctor may recommend over the counter treatment or may prescribe medication that can control your acne and limit scarring.

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Topical medications:

The most common topical prescription medications for acne are as follows:

• Retinoids and retinoid-like drugs. 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). You apply this medication in the evening, beginning with three times a week, then daily as your skin becomes used to it. 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. Examples include clindamycin with benzoyl peroxide (Benzaclin, Duac, Acanya) and erythromycin with benzoyl peroxide (Benzamycin). Topical antibiotics alone aren't recommended.

• Salicylic acid may help prevent plugged hair follicles and is available as both wash-off and leave-on products. Studies showing its effectiveness are limited.

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Oral Medications:

• Antibiotics. For moderate to severe acne, you may need oral antibiotics to reduce bacteria and fight inflammation. Usually the first choice for treating acne is tetracycline — such as minocycline or doxycycline — or a macrolide.

  Oral antibiotics should be used for the shortest time possible to prevent antibiotic resistance.

  Oral antibiotics are best used with topical retinoids and benzoyl peroxide. Studies have found that using topical benzoyl peroxide along with oral antibiotics may reduce the risk of developing antibiotic resistance.

  Antibiotics may cause side effects, such as an upset stomach and dizziness. These drugs also increase your skin's sun sensitivity.

• Combined oral contraceptives. Four combined oral contraceptives are approved by the FDA for acne therapy in women who also wish to use them for contraception. They are products that combine estrogen and progestin (Tri-Cyclen, Yaz and others). You may not see the benefit of this treatment for a few months, so using other acne medications with it the first few weeks may help.

  The most common side effects of these drugs are weight gain, breast tenderness and nausea. A serious potential complication is a slightly increased risk of blood clots.

• Anti-androgen agents. Spironolactone 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 and painful periods.

• Isotretinoin - is a powerful drug for people with severe acne that don'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. 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 all people receiving isotretinoin must participate in a Food and Drug Administration-approved risk management program.

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Other Therapies:

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

• Lasers and photodynamic therapy. A variety of light-based therapies have been tried with some success. But further study is needed to determine the ideal method, light source and dose.

• Chemical peel. This procedure uses repeated applications of a chemical solution, such as salicylic acid, glycolic acid or retinoic acid. Any improvement in acne is not long lasting, so repeat treatments are usually needed.

• Extraction of whiteheads and blackheads. Your doctor may use 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 therapy has resulted in rapid improvement and decreased pain. Side effects may include thinning in the treated area.

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​Lifestyle Management:

• Avoiding triggers (see above)

• Avoiding picking or touching the infected area

• Showering after exercise

• washing your face twice a day with a gentle face wash — try to avoid harsh facial scrubs

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