Acne Prone
What is acne?
Acne is a broad term that describes a range of different skin irregularities including plugged pores (blackheads and whiteheads), pimples and even deeper lumps (cysts or nodules) that appear on the face, neck, chest, back, shoulders and the upper arms.
The most common of all dermatological diseases, acne affects almost all adolescents to some extent (80-100%) irrespective of race or ethnicity. Many of those affected are able to control their acne with over-the-counter (non-prescription) treatments. For some 40% of these teenagers, however, their acne is more advanced, requiring treatment by a physician. Despite their heightened susceptibility to it, the disease is by no means strictly the domain of teenagers. Rather, people of all ages are susceptible to it. Some people are affected by acne as adults despite having had an acne-free youth.
Men and women are affected about equally, albeit in different ways. Young men are more prone to more severe, enduring forms of acne yet are less likely than young women to see a dermatologist for acne treatment. On the other hand, all women are more prone to intermittent acne associated both with the use of cosmetics and with hormonal changes that are linked to their menstrual cycle.
Even though acne is not a life-threatening condition in itself, it is cosmetically unpleasant and potentially disfiguring. Given that it is most commonly situated on the face during adolescence - a key time of personality development - it can be psychologically devastating. It's been said that "there is no single disease which causes more psychic trauma, more maladjustment between parent and children, more general insecurity and feelings of inferiority and greater sums of psychic suffering than does acne vulgaris."[1]
In both moderate and severe cases, acne can lead to permanent scarring. The best way to avoid such scarring is to ensure that early treatment is undergone.
What are the causes of acne?
Acne is caused by the interplay of two factors: the skin's production of large amounts of oil, and an inability to bring this oil to the surface effectively. The skin becomes its oiliest during puberty - a time of heightened physical transformation. The hormones that cause physical maturation also cause the sebaceous (oil) glands of the skin to produce more sebum (oil). The hormones with the greatest effect on sebaceous glands are androgens (male hormones), which are present in females as well as males, but in higher amounts in males.
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The following factors are causes of acne: |
The following factors may exacerbate acne: |
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Acne myths
The most important aspect of treatment in the early stages is that of re-education. Myths abound as to what the causes and appropriate treatment methods are in regards to acne. Many who have the best intentions of resolving their acne problem may in fact be worsening it.
Myth #1: Acne is caused by diet.
Extensive scientific studies have found there is little connection between diet and acne. In other words, food does not cause acne - neither chocolate nor pizza nor hot chips. Chocolate may in fact be beneficial to one's skin condition given that cocoa is a rich source of antioxidants.
Nevertheless, some people insist that certain foods affect their acne. If you find this to be the case, avoid those particular foods. Regardless, eating a balanced diet always makes sense in terms of overall health. However, according to the scientific evidence, if acne is being treated properly, there's no need to worry about food aggravating your acne.
On the other hand, recent studies have suggested that foods with a high glycemic index, such as processed breads, may contribute to acne. The Kitivan islanders of Papua New Guinea and the Ache hunter-gathers of Paraguay have recently been subjects of a dermatological study. They live on a diet with a low glycemic index and of 1,300, none was found to have had acne. This indicates that acne is caused by environmental factors. However, precisely what those environmental factors is is yet to be fully determined.
Myth #2: Acne is caused by poor hygiene.
Those who believe this and respond by washing their skin roughly and compulsively often actually contribute to their acne. This myth is not true simply because acne is not caused by dirt or surface skin oils; rather, oil generated beneath the surface of the skin is what causes acne. The best approach is to maintain a normal approach to hygiene - wash your face twice a day with a mild soap then pat the skin dry. This helps to temporarily remove the dead skin, dirt and excess surface oil. An additional acne treatment should be sought; cleaning is not in itself a sufficient means of treating acne.
Myth #3: Acne is caused by stress.
The type of stress that is encountered in the course of day-to-day living is not a major contributing factor in the onset of acne, though it can worsen pre-existing acne. Occasionally, drugs that are prescribed to treat extreme cases of stress can cause acne as a side effect. In such cases, it is advised that you consult with your doctor to discuss the possibility of an alternative treatment.
Myth #4: You just have to let acne run its course.
Acne can virtually always be resolved by intervention. Often, those affected become disheartened when the over-the-counter products they've tried haven't been successful. If this is the case, consider seeing your dermatologist. There is such a diverse range of effective treatments today that there is no reason to endure acne - particularly when it may lead to acne scarring.
Myth #5: Acne is just a cosmetic disease.
True, acne is a cosmetic disease and, in itself, doesn't pose a serious threat to a person's physical health. However, physical disfiguration can result - particularly if it is left untreated - and this can be very damaging to a person's self-esteem and ability to form meaningful relationships. Acne has been linked to depression and suicidal tendencies, particularly among adolescents.
Myth #6: Acne can be treated by exposure to sunshine, solariums or sun lamps.
It is a common misconception that tanning clears acne - it actually only hides it temporarily. The chance of developing melanoma and other skin cancers is heightened by excessive exposure to sunlight or tanning booths. Some acne treatments actually increase the skin's sensitivity to the ultraviolet light from sun lamps and tanning booths so combining these processes is fraught with danger. Protection from the sun is even more important if you have acne. This can be achieved by covering up with clothes or with a broad-spectrum sunscreen.
Specialised light treatments have proven to be effective in the treatment of acne but this is only with specified light wavelengths. Unlike natural sunshine and solariums, these treatments do not contain ultraviolet rays and therefore do not carry the threat of skin cancer.
Myth #7: It's best to pop, squeeze or pick at acne.
This myth is incorrect. One should never do this to their own acne as it drives germs deeper into the pores, potentially increasing the inflammation. Besides, without medical treatment, this will not solve the problem and is therefore rarely necessary. When blackhead or whitehead removal is needed, it should be performed by an experienced health care professional who has the appropriate tools at his/her disposal to avoid any bruising or rupturing of the skin.
Myth #8: Acne is caused by too much sex / too little sex.
This myth is also false. Sexual activity is not at all related to acne.
Myth #9: Acne is an infectious disease.
Acne is not infectious at all and, as such, cannot be transmitted from one person to another in any way.
What are the available treatments?
Today, virtually all cases of acne can be treated effectively. However, there is no single treatment that works for everyone. Many factors need to be considered including the person's age, skin type, motivation and lifestyle, as well as the kind of acne present, the causes of the acne and any co-existing conditions.
So, the WRONG approach is to:
- clean one's skin repeatedly throughout the day
- put oneself on a strict diet, such as a "liver-cleansing diet"
- squeeze one's pimples
- apply copious amounts of heavy "pancake" makeup
- use extra medication in the hope of improving results - this will not work and can actually make your acne worse by aggravating the skin.
The CORRECT approach is to:
- only use oil-free, non-pore-clogging (non-comedogenic) cosmetics and toiletries for your skin and hair.
- commence treatment early to avoid the possibility of acne scarring.
- be patient and give acne treatments sufficient time to take effect. Your doctor will advise you as to when you can expect to see results. Generally speaking, it takes at least six to eight weeks before you will begin to see any improvement.
- only use the treatment as directed by your doctor. One should be motivated when reminded of the fact that acne is virtually always treatable if one is disciplined and focused upon adhering to the correct mode of treatment laid out by the doctor. The mode of treatment itself is case-dependent.
Treatment options
Topical
- Over-the-counter (non-prescription) treatments
- Antibiotics
- Retinoids
- Others, such as azelaic acid and beta-hydroxy acids (salicylic acid)
- Combinations of over-the-counter medications shouldn't be used due to potential side effects, unless otherwise directed by a dermatologist or other medical practitioner.
Oral antibiotics
Since acne is not an infection, the focus is not upon completing a 'course' of antibiotics. Rather, the focus is more upon homeostasis: i.e. the antibiotics do what is often said of doctors: "occupy the patient while nature provides the cure."
Oral contraceptives
Moderate and severe acne in women can be treated by the use of oral contraceptives.
Hormonal therapies
Oral hormonal therapies are an effective option. Nortestosterone derivatives should be avoided at all times.
Isotretinoin
Isotretinoin is one of the most effective and potent remedies for severe acne. However, many adverse side effects accompany it so for some, such as those prone to depression, should not take it unless the benefits are seen to outweigh the risks.
Despite the effectiveness of these oral therapies, there has been a growing community resistance to many of them - particularly given that many of them are prescribed to teenagers who may become emotionally vulnerable. Recent developments in laser and non-UV light treatments have yielded excellent results with few discernable side effects.
Non-UV light treatments
Visible light treatments, especially blue light (but also green, yellow and red), are non-UV light therapy that has been found to be highly effective - much more so than topical treatments or oral antibiotics. In line with these developments, home therapies that provide such lamps are becoming very popular. They emit the exact wavelength required to clear most acne and being free of ultra-violet light, there is no risk of skin damage or any incidence of skin cancer.
Even though Isotretinoin often achieves better results, non-UV light treatments are a good alternative for patients who either can't or won't use Isotretinoin due to its potential side effects. Light treatments are also a viable alternative for those whose acne hasn't responded to Isotretinoin.
Light treatments are perfect for those with very long-term milder acne that is failing to respond to other remedies such as topical treatments.
Light treatment is also ideal for those who demand a "natural" treatment with a low incidence of adverse side effects.
Non-ablative resurfacing lasers (Smoothbeam, Cool Touch, Er Glass, RF)
These lasers apply a process of selective heating of the acne lesions. This process has also been found to be highly effective.
Very deep acne scars often need to be surgically removed and resurfaced either by laser, microdermabrasion or standard dermabrasion. Depending upon the nature of your acne scars, filling substances may also help.
Other options
Surgical excision and intralesional corticosteroid injections are other options for those with severe cases of acne.
Your medical practitioner will assist you to create your own customised plan to effectively combat your acne.
Links
AcneNet (AmericanAcademy of Dermatology), USA, www.skincarephysicians.com/acnenet/index.html