Acne Vulgaris (Common)
Definition
Acne refers to any skin blemish or condition which results largely from the plugging of hair follicles and skin glands with secondary bacterial infection. Distribution favors the face, chest, back, and shoulders, due to overactive oil-secreting (sebaceous) glands. Hormone changes during puberty activate the oil-secreting glands. Diet may be a factor in the development of acne. Fatty foods and sweets are best avoided by most individuals with this condition.
Symptoms
- Blackheads or whiteheads on face, neck, shoulders, or back
- Pimples (zits)
- Cysts
Acne occurs when the hair follicles of your skin become plugged. Each follicle contains sebaceous glands that secrete a fatty oil (sebum) to lubricate your hair and skin. When your body produces sebum and dead cells faster than they can exit from the pore, the two solidify as a white, cheesy plug. This plug may close the pore, causing the follicle wall to bulge, thus creating a whitehead. If the pore stays open, the top surface of the plug may darken, causing a blackhead. Blackheads are neither caused nor colored by dirt.
Pimples are infections that develop when whiteheads rupture the follicle wall. After the rupture, solidified sebum, dead cells, and bacteria invade your skin. Ruptures deep within your skin form boil-like infections called cystic acne.
In some situations, the sebaceous gland continues to secrete material that does not rupture through the skin. Instead, a flattened, pliable lump forms under the skin. This is called a sebaceous cyst or wen. Sometimes the lumps can be an inch or more in diameter. Generally, there is no discoloration or pain unless the cyst becomes infected.
Three out of four teenagers have some acne. It is most prevalent in adolescence, because hormonal changes stimulate the sebaceous glands during these years, increasing sebum production and the chances of acne. Menstrual periods, the use of birth control pills or cortisone medications, and stress may aggravate acne in later life. Sudden onset of severe acne in a mature woman may be caused by a tumor that affects hormone production. This requires prompt medical attention.
Application of oil or grease to your skin can aggravate acne. This includes use of oil-based makeup, suntan oil, or hairdressing solutions, as well as oils from machinery or cooking.
Acne usually is easy to diagnose. Pimple-like pustules alone, with no blackheads or whiteheads, may be another skin disease (see: Rosacea) or a reaction to medications such as corticosteroids.
For many people, acne is a chronic problem from puberty through early adulthood. It eventually clears up in most cases, but permanent scars may remain. Medical treatment usually provides visible improvement within a few months, but the condition can affect self-esteem, confidence, personality, and social life.
Conventional Treatment
Your acne may require a lengthy, consistent treatment involving four basic steps. First, identify everything that aggravates your acne and avoid these things. Second, follow your physician's advice about removing blackheads and mature pimples, or have this done by a professional. Third, use a cleansing agent or soap that dries out your skin enough to cause minor shedding of skin so that the follicular plugs flake. Finally, promote skin peeling within your follicles, either by using one of the medications described below or by using a sunlamp (with proper caution).
Two types of medication can help acne. The first is topical, that is, you apply it directly to your skin. This lotion dries up the oil and promotes the skin's peeling. Over-the-counter lotions are mild and contain benzoyl peroxide, sulfur, resorcinol, or salicylic acid as the active ingredient. Stronger lotions containing these ingredients or a vitamin A acid (tretinoin or retinoic acid) require a prescription and supervision by your dermatologist.
The second type of medication is taken orally. For severe acne, your dermatologist may prescribe either an antibiotic (tetracycline) or-if your acne is severe-a new form of vitamin A acid (isotretinoin). Both can cause side effects, and neither should be used during pregnancy. The vitamin A preparation, in particular, may cause birth defects. Because such harmful effects are likely to occur during the very early stages of pregnancy, even before you are certain you are pregnant, do not use this drug if you are not using birth control measures.
Cystic acne and sebaceous cysts may require minor surgery (under local anesthesia) for drainage and removal. Doctors may use cosmetic surgery to diminish scars left by acne. The main procedures are dermabrasion or peeling by freezing or chemicals. However, if your skin tends to form scar tissue, these procedures can make your complexion much worse.
Peeling procedures eliminate superficial scars. Dermabrasion, usually reserved for more severe scarring, consists of abrading the skin with a rapidly rotating wire brush. Your doctor will use a local anesthetic or topical freezing of your skin during the procedure. General anesthesia ordinarily is not required. Generally, dermabrasion is done as an outpatient procedure.
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