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Acne(Pimples)

What is acne?

Acne (acne vulgaris, common acne) is a disease of the hair follicles of the face, chest, and back that affects almost all teenagers during puberty-the only exception being members of a few primitive Neolithic tribes living in isolation. It is not caused by bacteria, although bacteria play a role in its development. It is not unusual for some women to develop acne in their mid- to late-20s.

Acne appears on the skin as

  • occluded pores ("comedones"), also known as blackheads or whiteheads,
  • tender red bumps also known as pimples or zits,
  • pustules (bumps containing pus), and occasionally as
  • cysts (deep pimples, boils).
  • One can do a lot to treat acne using products available at a drugstore or cosmetic counter that do not require a prescription. However, for tougher cases of acne, one should consult a physician for treatment options.


    What causes acne?

    No one factor causes acne. Acne occurs when sebaceous (oil) glands attached to the hair follicles are stimulated at the time of puberty or due to other hormonal changes. Sebum (oil) is a natural substance that lubricates and protects the skin. Associated with increased oil production is a change in the manner in which the skin cells mature, predisposing them to plug the follicular pore. The plug can appear as a whitehead if it is covered by a thin layer of skin, or if exposed to the air, the darker exposed portion of the plug is called a "blackhead." The plugged hair follicle gradually enlarges, producing a bump. As the follicle enlarges, the wall may rupture, allowing irritating substances and normal skin bacteria access into the deeper layers of the skin, ultimately producing inflammation. Inflammation near the skin's surface produces a pustule; deeper inflammation results in a papule (pimple); if the inflammation is deeper still, it forms a cyst.

    Here are some factors that don't usually play a role in acne:

  • Food :
  • Parents often tell teens to avoid pizza, greasy and fried foods, and junk food. While these foods may not be good for overall health, they don't cause acne or make it worse. Although some recent studies have implicated a high-carbohydrate diet, milk, and pure chocolate in aggravating acne, these findings are very far from established.

  • Dirt :
  • Blackheads are oxidized oil, not dirt. Sweat does not cause acne and is produced by entirely separate glands in the skin. On the other hand, excessive washing can dry and irritate the skin.

  • Stress :
  • Some people get so upset by their pimples that they pick at them and make them last longer. Stress, however, does not play much of a direct role in causing acne.

    In occasional patients, the following may be contributing factors:

  • Heredity :
  • If one of your parents had severe acne, it is likely that your acne will be more difficult to control.

  • Pressure :
  • In some patients, pressure from helmets, chin straps, collars, suspenders, and the like can aggravate acne.

  • Drugs :
  • Some medications may cause or worsen acne, such as those containing iodides, bromides, or oral or injected steroids (either the medically prescribed prednisone [Deltasone, Orasone, Prednicen-M, Liquid Pred] or the steroids that bodybuilders or athletes sometimes take). Other drugs that can cause or aggravate acne are anticonvulsant medications and lithium (Eskalith, Lithobid). Most cases of acne, however, are not drug related.

  • Occupations :
  • In some jobs, exposure to industrial products like cutting oils may produce acne.

  • Cosmetics :
  • Some cosmetics and skin-care products are pore clogging ("comedogenic"). Of the many available brands of skin-care products, it is important to read the list of ingredients and choose those which have water listed first or second if one is concerned about acne. These "water-based" products are usually best for those with acne.

    When should someone start acne treatment?

    Since everyone gets acne at some time, the right time to treat it is when it becomes bothersome or when the potential for scarring develops. This can be when severe acne flares suddenly, for mild acne that just won't go away, or even when a single pimple decides to show up the week before one's prom or wedding.


    What can people do to get rid of their acne?

    Lifestyle

    Moderation and regularity are good things, but not everyone can sleep eight hours, eat three good meals, and drink plenty of water a day. One can, however, still control acne despite one's frantic and unpredictable routine. Probably the most useful lifestyle changes one can make is to never to pick or squeeze pimples. Playing with or popping pimples, no matter how careful and clean one is, nearly always makes bumps stay redder and bumpier longer. People often refer to redness as "scarring," but fortunately, it usually isn't permanent. It's just a mark that takes months to fade if left entirely alone.

    Open the pores

    Occasional visits to an esthetician who is an expert at safely removing blackheads during a facial can be beneficial.

    Cleansing and skin care

    Despite what one might read in popular style and fashion magazines, there is no magic product or regimen that is right for every person and situation.

  • Mild cleansers
  • Washing once or twice a day with a mild cleansing bar or liquid (for example, Dove, Neutrogena, Basis, Purpose, and Cetaphil are all inexpensive and popular) will keep the skin clean and minimize sensitivity and irritation.

  • Exfoliating cleansers and masks
  • A variety of mild scrubs, exfoliants, and masks can be used. These products may contain salicylic acid in a concentration that makes it a very mild peeling agent. These products remove the outer layer of the skin and thus open pores. Products containing glycolic or alpha hydroxy acids are also gentle skin exfoliants.

  • Retinol
  • Not to be confused with the prescription medication Retin-A, this derivative of vitamin A can help promote skin peeling.

    Reducing bacteria

  • Antibacterial cleansers
  • The most popular ingredient in over-the-counter antibacterial cleansers is benzoyl peroxide.

  • Topical (external) applications
  • Antibacterial cleansers come in the form of gels, creams, and lotions that are applied to the affected area. The active ingredients that kill surface bacteria include benzoyl peroxide, sulfur, and resorcinol. Some brands promoted on the Internet and cable TV (such as ProActiv) are much more costly than identical and sometimes more potent products one can buy in the drugstore.

    Benzoyl peroxide causes red and scaly skin irritation in a small number of people, which goes away as soon as one stops using the product. Keep in mind that benzoyl peroxide is a bleach, so do not let products containing benzoyl peroxide come into contact with fabrics, leaving unsightly white spots on colored clothes, shirts, towels, and carpets.

    Reduce the oil

    One cannot stop oil glands from producing oil. Even isotretinoin (Accutane, see below) only slows down oil glands for a while; they resume normal activity later. It is possible to get rid of oil on the surface of the skin and reduce the appearance of shine.

  • Use a gentle astringent/toner to wipe away oil. (There are many brands available in pharmacies, as well as from manufacturers of cosmetic lines.)
  • Products containing glycolic acid or one of the other alpha hydroxy acids are also helpful in clearing the skin by causing the superficial layer of the skin to peel (exfoliate).
  • Masks containing sulfur and other ingredients draw out facial oil.
  • Antibacterial pads containing benzoyl peroxide have the additional benefit of helping to wipe away oil.

  • What are other things you can do for acne? Are there any home remedies for acne?


  • Cosmetics :
  • Don't be afraid to hide blemishes with flesh-tinted cover-ups or even foundation, as long as it is water-based (which makes it noncomedogenic). There are many quality products available.

  • Facials :
  • While not absolutely essential, steaming and "deep-cleaning" pores is useful, both alone and in addition to medical treatment, especially for people with "whiteheads" or "blackheads." Having these pores unclogged by a professional also reduces the temptation to do it oneself.

  • Pore strips:
  • Pharmacies now carry, under a variety of brand names, strips which one applies to the nose, forehead, chin, etc., to "pull out" oil from pores. These are, in effect, a do-it-yourself facial. They are inexpensive, safe, and work reasonably well if used properly.

  • Toothpaste
  • One popular home remedy is to put toothpaste on zits. There is no medical basis for this. The same applies to vinegar.


    What is a good basic skin regimen?

    These are all good basic skin regimens that may help with the acne battle:

    1. Cleanse gently twice daily.
    2. Apply a gel or cream containing 5% benzoyl peroxide; an alternative is sulfur or resorcinol. Use a pad containing 2% salicylic acid to help exfoliation each morning.
    3. At night, apply a spot cream containing sulfur to the affected areas.
    4. Use a light skin moisturizer and water-based makeup.

    How does treat acne? Is it possible to remove acne scars?

    It's best to consult a primary-care physician or dermatologist if an individual is unable to adequately control his or her acne. The goal of treatment should be the prevention of scarring (not a flawless complexion) so that after the condition spontaneously resolves there is no lasting sign of the affliction. Here are some of the options available:

  • Light treatments :
  • Recent years have brought reports of success in treating acne using special lights and similar devices, alone or in conjunction with photosensitizing dyes. It appears that these treatments are safe and can be effective, but it is not clear that their success is lasting. At this point, laser treatment of acne is best thought of as an adjunct to conventional therapy, rather than as a substitute.

  • Chemical peels :
  • Whether the superficial peels (like glycolic acid) performed by estheticians or deeper ones performed in the doctor's office, chemical peels are of modest, supportive benefit only, and in general, they do not substitute for regular therapy.

  • Treatment of acne scars :
  • For those patients whose acne has gone away but left them with permanent scarring, several options are available. These include surgical procedures to elevate deep, depressed acne scars and laser resurfacing to smooth out shallow acne scars. Newer forms of laser resurfacing ("fractional resurfacing") are less invasive and heal faster than older methods, although results are less complete and the procedures may need to be repeated three or more times. These treatments can help, but they are never completely successful at eliminating acne SCARS