Nearly everyone suffers from acne at some point in life. One fifth of all patient visits to dermatologists are acne-related.
Acne is a skin condition that affects the hair follicles (pores) of the face, chest, and back. In mild cases of acne, there are a few blackheads (open comedones) or whiteheads (closed comedones) with a few red or inflamed bumps (papules) and red or inflamed bumps with pus on the surface (pustules). In moderate acne, there are more blackheads and whiteheads and increasing numbers of papules and pustules. Severe acne can be associated with tender red cysts and nodules that can often be accompanied by scarring. The whiteheads, blackheads, papules, pustules, cysts, and nodules are medically referred to as “acne lesions”.
Acne Photo and Condition Information – Skinsight.com
How do acne lesions develop?
Acne starts out underneath the skin where the cells that line the pore become sticky and do not move out of the pore onto the skin surface like normal cells. This results in a microscopic acne lesion called the “microcomedo” that cannot be seen with the naked eye. This microcomedo can turn into any one of the types of acne lesions noted above (whiteheads, blackheads, papules, pustules, cysts).
The process of a microcomedo turning into a visible acne lesion can take several weeks. Most acne treatments are designed to prevent microcomedoes from forming and developing into other acne lesions. That is why it is important to apply acne medications to all areas of the skin where acne can develop and not just on the acne lesion itself. Unlike treatments for other conditions, acne treatment can sometimes take several weeks to see improvement, because it is preventing the formation of microcomedoes beneath the skin and their further progression into a visible acne lesion. One of the forward goals in controlling acne early is the prevention of Acne Scarring.
Will I Outgrow my Acne?
Acne, a chronic disease, affects a majority of those 12 to 24 years of age and may continue to afflict some patients well into adulthood. The physiological, psychological, and quality-of-life impacts associated with acne are significant and well studied. The effective treatment of acne in sufferers of all ages and types is critical and the acne patient or parents of a child with acne should not “wait it out”.
Patient Education Lesson Slides
Three Stages of the Acne Life Cycle
The first stage is clogged pores. Just as skin cells on the skin’s surface are constantly being sloughed off and renewed, dead skin cells are sloughed off the skin inside the pore as well. When oil and dead skin cells get trapped in the narrow opening of the pore, this can cause cells to clump and form a plug.
The second stage in the acne life cycle involves the infiltration of bacteria. Normally found on the skin, the P. acnes bacteria can feed and breed inside clogged hair follicles where sebum is trapped. Your body responds by sending white blood cells to fight these bacterial invaders.
This leads to the next stage in the acne life cycle-inflammation. As the body fights the bacteria, your skin becomes inflamed and small pink bumps, pimples, nodules, or cysts appear.
How Acne Develops
Acne develops when sebum (an oily substance that lubricates your hair and skin) and dead skin cells plug the hair follicles. Bacteria can trigger inflammation and infection resulting in complications of acne – MayoClinic
How is acne treated?
a. Treatment applied to the skin
Patients with mild acne usually respond well to topical treatments. There are several OTC topical medicines used for mild acne. Each works a little differently. Following are the most common ones:
- Benzoyl peroxide – destroys P. acnes, and may also reduce oil production
- Resorcinol – can help break down blackheads and whiteheads
- Salicylic acid – helps break down blackheads and whiteheads. Also helps cut down the shedding of cells lining the hair follicles
- Sulfur – helps break down blackheads and whiteheads.
b. Oral RX treatment
If your acne becomes worse and you have a lot of inflamed spots, topical treatment alone may not be adequate. Several types of prescription topical medicines are used to treat acne. They include:
- Antibiotics – help stop or slow the growth of bacteria and reduce inflammation
- Vitamin A derivatives (retinoids) – unplug existing comedones (plural of comedo), allowing other topical medicines, such as antibiotics, to enter the follicles. Some may also help decrease the formation of comedones. These drugs contain an altered form of vitamin A. Some examples are tretinoin (Retin-A2), adapalene (Differin), and tazarotene (Tazorac)
- Others – may destroy P. acnes and reduce oil production or help stop or slow the growth of bacteria and reduce inflammation. Some examples are prescription strength Benzoyl peroxide, sodium sulfacetamide/sulfur-containing products, or Azelaic acid (Azelex).
c. For severe acne
In very serious cases who do not respond to the above treatment, or in cases of severe nodulocystic acne, a medication called isotretinoin (Accutane) may be prescribed by Dr. Blumenstrauch. People with nodules or cysts should be treated by a dermatologist. For patients with severe inflammatory acne that does not improve with medicines such as those described above, we may prescribe isotretinoin (Accutane), a retinoid (vitamin A derivative). Isotretinoin is an oral drug that is usually taken once or twice a day with food for 15 to 20 weeks. It markedly reduces the size of the oil glands so that much less oil is produced. As a result, the growth of bacteria is decreased. Accutane usage is government monitored. Patients who desire to enter into an Accutane program must be willing to follow all the guidelines within the iPLEDGE Program
A powerful system of light activated topical medication called Photo Dynamic Therapy is a two-part program that is often effective for severe acne in cases where oral medications are either undesirable or not possible. There is no systemic medication involved though the treatment may be used in conjunction with RX antibiotics and/or other topical acne control products.
Advantages of Isotretinoin (Accutane)
Isotretinoin is a very effective medicine that can help prevent scarring. After 15 to 20 weeks of treatment with isotretinoin, acne completely or almost completely goes away in most patients. In those patients where acne recurs after a course of isotretinoin, the doctor may institute another course of the same treatment or prescribe other medicines.
Disadvantages of Isotretinoin (Accutane)
Isotretinoin can cause birth defects in the developing fetus of a pregnant woman. It is important that women of childbearing age are not pregnant and do not get pregnant while taking this medicine. Women must use two separate effective forms of birth control at the same time for 1 month before treatment begins, during the entire course of treatment, and for 1 full month after stopping the drug. You should ask your doctor when it is safe to get pregnant after you have stopped taking isotretinoin.
Some people with acne become depressed by the changes in the appearance of their skin. Changes in mood may be intensified during treatment or soon after completing a course of medicines like isotretinoin. There have been a number of reported suicides and suicide attempts in people taking isotretinoin; however, the connection between isotretinoin and suicide or depression is not known. Nevertheless, if you or someone you know feels unusually sad or has other symptoms of depression, such as loss of appetite, loss of interest in once-loved activities, or trouble concentrating, it’s important to consult your doctor.
Other possible side effects of isotretinoin include:
- dry eyes, mouth, lips, nose, or skin (very common)
- muscle aches
- sensitivity to the sun
- poor night vision
- changes in the blood, such as an increase in fats in the blood (triglycerides and cholesterol)
- change in liver function.
To be able to determine if isotretinoin should be stopped if side effects occur, your doctor may test your blood before you start treatment and periodically during treatment. Side effects usually go away after the medicine is stopped.
Can hormones help my acne?
In some women, acne is caused by an excess of androgen (male) hormones. Clues that this may be the case include hirsutism (excessive growth of hair on the face or body), premenstrual acne flares, irregular menstrual cycles, and elevated blood levels of certain androgens.
The doctor may prescribe one of several drugs to treat women with this type of acne:
* Birth control pills – to help suppress the androgen produced by the ovaries
* Low-dose corticosteroid drugs, such as prednisone (Deltasone) or dexamethasone (Decadron, Hexadrol) – to help suppress the androgen produced by the adrenal glands
* Antiandrogen drugs such as spironolactone (Aldactone) – to reduce the excessive oil production.
Side effects of antiandrogen drugs may include irregular menstruation, tender breasts, headaches, and fatigue.
“Acne Therapies should be initiated early to minimize or prevent the post-effects of acne, which include scarring and psychological effects”.
What causes my skin to develop acne and what does not?
Many people have various beliefs and perceptions regarding the cause of acne . It is only natural for people to think that their acne results from something they did or didn’t do, something they ate or didn’t eat, or something that they came in contact with, etc.
In reality, acne happens for reasons that for the most part are out of our control. We can’t control changes in the cells of our pores, the fact that P. acnes lives on the skin, or the fact that our oil glands produce oil. As young people become teenagers, normal hormones in the body cause the oil glands to grow and secrete more oil on the face, chest, back, and scalp. The P. acnes bacteria live on the skin of teenagers and adults who have acne, and also on the skin of those not affected by acne.
- Dermatology Foundation – www.dermatologyfoundation.org
- American Acne and Rosacea Society – www.acnesociety.org
- The American Academy of Dermatology – www.aad.org
- National Institute of Arthritis, Musculoskeletal and Skin Diseases
- (English) – www.niams.nih.gov/Health_info/acne
- (Spanish) – www.niams.nih.gov/Portal_en_espanol/informacion_de_salud/acne
- Medline Plus (National Library of Medicine) – www.nlm.nih.gov/medlineplus/acne.html
- Acne.Org – http://www.acne.org.au/different_types.php