What Is Acne?
There's a reason it's called "common acne" -- nearly everyone suffers from a pimple outbreak at some point in life.
It starts when greasy secretions from the skin's sebaceous glands (oil glands) plug the tiny openings for hair follicles (plugged pores). If the openings remain open, the clogs take the form of blackheads: small, flat spots with dark centers. If the openings are closed, the clogs take the form of whiteheads: small, flesh-colored bumps. Both types of plugged pores can develop into swollen, tender inflammations or pimples or deeper lumps or nodules. Nodules associated with severe cases of acne (cystic acne) are firm swellings below the skin's surface that become inflamed, tender, and sometimes infected.
Although acne remains largely a curse of adolescence, about 20% of all cases occur in adults. Acne commonly starts during puberty between the ages of 10 and 13 and tends to be worse in people with oily skin. Teenage acne usually lasts for five to 10 years, normally going away during the early 20s. It occurs in both sexes, although teenage boys tend to have the most severe cases. Women are more likely than men to have mild to moderate forms into their 30s and beyond.
Acne lesions are most common on the face, but they can also occur on the neck, chest, back, shoulders, and upper arms.Contrary to popular belief, acne isn't caused by a harmful diet, poor hygiene, or an uncontrolled sex drive. The simple truth is that heredity and hormones are behind most forms of acne. Swearing off chocolate or scrubbing your face 10 times a day won't change your predisposition to this unsightly, sometimes painful, and often embarrassing skin problem.
What Are the Treatments for Acne?
The occasional pimple can be concealed. If used at all, over-the-counter cover-up creams and cosmetics should be water-based. Even if outbreaks of acne cannot be eliminated, conventional treatment can provide relief.
The best treatments inhibit sebum production, limit bacterial growth, encourage shedding of skin cells to unclog pores, or a newer treatment that blocks male hormones in the skin. Because many therapies can have side effects, any patient with acne should proceed with caution when trying a new treatment. People with any type of acne that lowers their self-esteem or makes them unhappy, those with acne that is leaving scars or people with severe, persistent cases of acne, need the care of a dermatologist.
Nonprescription Treatment for Acne
Soap and water. Gentle cleansing of the face with soap and water no more than two times a day can help with acne. However, this does not clear up acne that is already present. Aggressive scrubbing can injure the skin and cause other skin problems.
Cleansers. There are many cleansers and soaps advertised for treating acne. They often contain benzoyl peroxide, glycolic acid, salicylic acid, or sulfur.
Benzoyl peroxide. For mild acne, you may try, or your doctor may recommend, treatment with a nonprescription drug that contains benzoyl peroxide. It's believed that this compound works by destroying the bacteria associated with acne. It usually takes at least four weeks to work and it must be used continuously to keep acne at bay. Like many over-the-counter and prescription products, it does not affect sebum production or the way the skin follicle cells are shed, and when you stop using it, the acne comes back. It is available in many forms: creams, lotions, washes, foams,cleansing pads and gels. Benzoyl peroxide can cause dry skin and can bleach fabrics, so take care when applying it. Consider wearing an old T-shirt to bed if you are applying it to your back or chest overnight.Salicylic acid. On the skin, salicylic acid helps to correct the abnormal shedding of cells. For milder acne, salicylic acid helps unclog pores to resolve and prevent lesions. It does not have any effect on sebum production and does not kill bacteria. It must be used continuously, just like benzoyl peroxide, because its effects stop when you stop using it -- pores clog up again and the acne returns. Salicylic acid is available in many acne products, including lotions, creams, and pads.
Sulfur. In combination with other substances such as alcohol, sodium sulfacetamide (a prescription medication) and salicylic acid, sulfur is a component of many over-the-counter acne medications. It usually isn't used by itself because of its unpleasant odor and temporary skin discoloration.Sulfur helps to prevent pores from being clogged and inhibits growth of bacteria. but it has only a marginal benefit in most cases.
Topical retinol gel or creams. Retinol works to keep pimples from being able to form. It affects the growth of cells, causing increased cell turnover to unblock pores. Your acne may appear to get worse before it gets better because it will work on the pimples that have already started forming beneath your skin. It must be used continuously and may take 8-12 weeks to get results. Retinoids used to be available in only a prescription strength. Differin Gel is the only topical retinoid approved as an over-the-counter treatment for acne.
Alcohol and acetone. Alcohol is a mild anti-bacterial agent, and acetone can remove oils from the surface of the skin. These substances are combined in some over-the-counter acne drugs. These agents dry out the skin, have little or no effect on acne, and are generally not recommended by dermatologists.
Herbal, organic, and "natural" medications. There are many herbal, organic, and natural products marketed to treat or prevent acne. The effectiveness of these agents isn't proven and they are unlikely to have much benefit.
Note: When pus-filled pimples are ready to break, apply a hot towel for a few minutes to encourage the natural bursting process. Inflamed pimples should be opened only by a nurse or doctor using surgical instruments and following antiseptic practices. Squeezing pimples yourself may lead to further inflammation and perhaps permanent scars.
Prescription Treatments for Acne
Antibiotics.Antibiotics may be used on top of the skin (topical) or taken orally (systemic). Antibiotics work by clearing the skin of acne-causing bacteria and reducing inflammation. There are several topical products available in creams, gels, solutions, pads, foams, and lotions. Topical antibiotics are limited in their ability to penetrate the skin and clear more deep-seated acne, whereas systemic antibiotics circulate throughout the body and into sebaceous glands. However, systemic antibiotics often cause more side effects than topicals, but they can be used for more severe kinds of acne. Usually, topical antibiotics aren't recommended alone as an acne treatment, as they can increase the risk for antibiotic resistance in skin bacteria. However, using benzoyl peroxide with a topical antibiotic may reduce the chances of developing
Topical clindamycin (Cleocin T, Clinda-Derm) and erythromycin (Akne-Mycin, ATS, Erycette, Erygel, Ilotycin) are antibiotics that are also anti-inflammatory drugs and are effective against a number of bacteria. They should always be combined with benzoyl peroxide or a topical retinoid and applied directly to the skin. Oral erythromycin is also available, but you may become resistant to its effects, limiting its usefulness.
Other oral antiinflammatory antibiotics often used are doxycycline, minocycline, and tetracycline, all of which are quite effective in many cases of acne.
Antibiotics do not address the other causative factors in acne and may take several weeks or months to clear it up. Antibiotics are often used in combination with other drugs that "unclog" follicles. Many oral antibiotics for acne should not be used during pregnancy.
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