Acne consists of blackheads, whiteheads, and pimples and, sometimes, deeper boil-like lesions called nodules or "cysts. " It most often appears on the face, but can also be present on the back, chest, shoulders and neck. although acne is not a threat to life and limb, it can be an upsetting problem, depending on severity. When acne is severe, the lesions can lead to serious and permanent scarring. Scarring can follow even less severe cases.

The why of acne
top of page

Basic research on the causes of acne links its occurrence to the biological changes that take place as young people mature from childhood to adolescence. Rising hormone levels during puberty result in the enlargement of the of sebaceous (oil) glands of the skin. This is brought about by increased activity of the endocrine glands, which secrete hormones that influence various parts of the body, including the sebaceous glands. The skin of the acne-prone person may react to the hormones in such a way as to produce changes that lead to the development of the blackheads and pimples. The oily product of the sebaceous glands - sebum - may be altered by bacteria, causing the irritation characteristic of acne.

Let's look a little further into these changes. The growth of the sebaceous glands in areas where acne is most common (the face, upper back and chest) is activated by the male hormone called testosterone. Both males and females have this hormone, but the amount produced in the female is far less than that in the male. Nevertheless, enough testosterone is present to activate the sebaceous glands in both sexes.

Most of the oil formed by the large oil glands reaches the surface of the skin. Blackheads form because small kernels of sebum, skin cells and bacteria fill up the follicles and are retained. Sebum may break through the walls of the ducts and cause pimples and boil-like lesions. In addition, this oily material may be altered by bacteria, causing a greater amount of irritation to the surrounding skin.

Some comedones, however, do not have as wide an opening. These are the whiteheads, which may rupture and cause the development of inflamed lesions such as pustules and nodules (inflames lumps or cysts) Sebum probably goes though the ruptured wall first, but the horny material also contributes to the inflammation.

Wash your face with soap and warm water at least twice a day. It is important to wash thoroughly enough to clean the skin, yet gently enough to avoid irritating it. Shampooing is also in order; the oilier your hair is, the more often you should shampoo it. Also, it is best to keep hair off your face as much as possible and to avoid using hair oils. Follow the instructions your doctor gives you.

Males with acne who shave should try both an electric and a safety razor to see which is more comfortable. If you use a safety razor, soften your beard thoroughly with soap and warm water. To avoid nicking pimples, shave as lightly as possible. Also shave as seldom as possible and always use a sharp blade.

Frequently the person with acne also has dandruff, a flaking condition of the scalp that appears two-to-four days after each shampooing. Although some flaking occurs on almost every scalp, there is a point at which it becomes annoying. Any good shampoo will provide some control over the flaking. Some people find that using a shampoo or rinse for dandruff will provide better control for a longer time. If symptoms of dandruff persist or if they are bothersome, consult a doctor.

Diet
top of page
Acne is not primarily a dietary disease and authorities vary on the importance they attach to diets in the control of acne. One thing is certain: following the strictest diet will not by itself clear your skin. On the other hand, a few people find that their acne seems to become worse when they eat certain foods, particularly chocolate and fats. These people should avoid the foods that clearly worsen their acne.

If your acne persists even though you have been following a routine of good cleansing, see a doctor. The earlier the disorder is properly diagnosed and treated, the less likelihood there is of permanent skin damage. A doctor who has an opportunity to examine you can best determine the important aspects of your treatment. Do not assume that medicines and methods prescribed for a friend will be good for you.
When your doctor talks with you, he or she may - or may not - make specific dietary suggestions. A preparation will probably be prescribed for application to your skin to help reduce oiliness and produce mild peeling. Medicated preparations, that are tinted to match your natural skin color, may also be prescribed. These preparations can mask the blemishes while they help to control the acne. Your physician may open the inflamed lesions, since some skin specialists consider this very important, especially for severe acne. He or she may remove blackheads and may show you the proper method of extracting them yourself. But your doctor will almost certainly warn you against picking, scratching, popping and squeezing the lesions. This is important because the cells of the skin tend to wall off the lesions of acne. When the patient removes the lesions improperly, for example by squeezing, these natural barriers may break down; and more inflammation and scarring may result.

Antibiotics taken by mouth are often prescribed for moderate or severe cases of inflammatory acne, especially when there is significant involvement of the back or chest. They are used to reduce the bacteria in the follicle that act on sebum. There are also forms of antibiotics prepared for direct application to the skin. These are used instead of oral antibiotics in milder cases, particularly on the face. When cysts are a prominent aspect of the disease, direct injection of a long-acting corticosteroid preparation into the lesions can be very beneficial. Female sex hormones (estrogens) are sometimes used in female patients who have not responded well to other treatments. They decrease the size of the sebaceous glands. Since the amount of sebum that is produced is decreased when the glands are smaller, there is less "fuel" for the acne lesions. Therefore, fewer lesions will develop.

Estrogens may also have undesirable side effects, and their usage and dosage must be properly determined by your dermatologist While the results of therapy with estrogens are slow, they are often quite good but are only maintained for as long as the treatment is given. Acne often improves when patients are out in the sun; therefore, ultraviolet light treatment is often recommended by dermatologists. Sunlamp therapy, as used for acne, is given for a relatively limited time span. Special precautions must be taken to avoid burning. It is important to realize that excessive exposure to sunlight over many years may result in premature aging of the skin and in skin cancer. In 1982 a new oral medication isotretinoin (Accutane) became available for the treatment of patients with severe cystic acne which has not responded to conventional treatments. Use of the medication requires a thorough understanding of its side effects and precautions (e.g., the prevention of pregnancy) which must be taken. The duration of treatment is usually three to five months, and one such course is often all that is needed. Exfoliation of the outer layers of the skin (stratum comeum) using either chemicals like alpha hydroxy acids (glycolic acid) or mechanical dermabrasion helps with the unclogging of the pores there by preventing the formation of acne.

Niacin (vitamin B2), this has been known to reduce the fatty acids in the secretions of the sebaceous (oily) glands, this helps reduce the viscosity of the secretions so it does not clog the pores.

Proper care is necessary
No matter what special treatments your physician may use, remember some patients take a longer time than others to respond and some do not respond. You must continue proper skin care until the tendency to have acne has passed.
top of page