Why Acne Develops
Treatment Can Improve
Poor Hygiene Is Not a Cause
Acne develops in skin follicles, each of which contains sebaceous glands and a tiny hair. An oily substance known as sebum is constantly produced in the sebaceous glands and normally travels up the hair follicle to the skin surface. Acne often occurs in early teenage years with the production of androgen, a hormone. Androgens make the sebaceous glands larger, in turn causing them to produce more sebum. Sebum mixes with the dead cells inside the lining of the follicle and plugs the follicle. This is a perfect place for bacteria to grow quickly, producing substances that inflame the follicle and surrounding skin. If the swollen follicle breaks open, the contents of sebum, dead skin cells and bacteria move into surrounding tissue, causing redness and inflammation. Although many people believe otherwise, acne is not caused by poor hygiene, fried foods, shrimp, chocolate, or stress. However, these factors may aggravate the condition. Acne may also be triggered by exposure to oils, or some cosmetics and medications.
Types of Acne: Acne is classified into noninflammatory and inflammatory lesions. Noninflammatory acne lesions, or comedones, are open (“blackheads”) or closed (“whiteheads”). This type of acne does not exhibit redness or swelling. Blackheads are clogged hair follicles that are open on the top, revealing packed dead cells and sebum. This gives them a dark appearance. They are not filled with dirt, and cannot be washed away. They can be removed safely by a clinician using a blackhead extractor, but should never be squeezed since this can cause inflammation and eventual scarring. Whiteheads are closed at the skin’s surface, so they look like small skin-colored or white bumps. Inflammatory acne causes redness and swelling of the hair follicle and the area around it. The redness is a result of inflammation, which occurs when the swollen hair follicle breaks open and its contents are released. There are three types of inflammatory acne lesions. Papules are small, red bups usually referred to as “pimples.” Pustules are similar to papules but they have pus underneath the skin surface, giving them a white appearance. The most severe inflammatory acne lesion is hte nodule or cyst. This is a large area of pus and inflammation deep under the skin. Nodules can be painful and lead to scarring.
Treatment: Treatment is aimed at slowing sebum production, speeding removal of dead skin cells, and fighting bacterial infection. First, the skin must be washed twice daily with a mild soap or cleanser and patted dry. Scrubbing or washing more than twice a day can aggravate the acne by irritating the skin. Moisturizers and makeup should be water-based and “non-comedogenic,” that is, they do not cause comedones. In mild acne, over-the-counter acne agents, such as salicylic acid, benzoyl peroxide, and resorcinol, dry the oil, remove dead skin, and fight bacteria. These preparations must be used every day, and often take 6 or 8 weeks to be effective. Stronger prescription medications, such as vitamin A acid (isotretinoin or retinoic acid) and azelaic acid, are used in uncontrolled acne. These drugs must be used daily, and results may take several weeks. Isotretinoin must not be used by women who are pregnant or sexually active unless they are using two methods of birth control. Your pharmacist can answer questions about over-the-counter agents or the stronger prescription medications.