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ACNE: Frequently Asked
Questions About Acne
Acne is a very common disease. People who have it
tend to have similar kinds of questions about it and its
treatment. This section addresses some of the common
questions asked by people with acne. Please remember
that your dermatologist is always the best source of
specific information about your individual health
issues, including acne.
What causes acne?
The causes of acne are linked to the changes that take
place as young people mature from childhood to
adolescence. 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.
Sebaceous glands are found together with a hair shaft in
a unit called a sebaceous follicle. During maturation, the
cells of the skin that line the follicle begin to shed
more rapidly. In people who develop acne, cells shed and
stick together more so than in people who do not develop
acne. When cells mix with the increased amount of sebum
being produced, they can plug the opening of the
follicle. Meanwhile, the sebaceous glands continue to
produce sebum, and the follicle swells up with sebum.
In addition, a normal skin bacteria called P. acnes,
begins to multiply rapidly in the clogged hair follicle.
In the process, these bacteria produce irritating
substances that can cause inflammation. Sometimes, the
wall of the follicle bursts, spreading inflammation to
the surrounding skin. This is the process by which acne
lesions, from blackheads to pimples to nodules, are
formed.
I wash my face several times a day. Why do I still
get acne?
Many people still believe that acne is caused by dirty
skin. The truth is, washing alone will not clear up or
prevent acne. Washing does, however, help remove excess
surface oils and dead skin cells. Many people use all
kinds of products, including alcohol-based cleansers,
and scrub vigorously, only to irritate the skin further
and worsen their acne. Washing the skin twice a day
gently with water and a mild soap is usually all that is
required. However, acne is actually caused by a variety
of biologic factors that are beyond the control of
washing. For that reason, you should use appropriate
acne treatments for the acne.
Does stress cause acne?
Stress is commonly blamed for the development of acne.
Stress can have many physiologic effects on the body,
including changes in hormones that may theoretically
lead to acne. In some cases the stress may actually be
caused by the acne lesions, not the other way around! If
the acne is being treated effectively, stress is not
likely to have much impact on the majority of people.
I never had acne as a teenager. Why am I now getting
acne as an adult?
Usually, acne begins at puberty and is gone by the early
20s. In some cases, acne may persist into adulthood.
Such types of acne include severe forms that affect the
body as well as the face (which afflict males more than
females) and acne associated with the menstrual cycle in
women. In other cases, acne may not present itself until
adulthood. Such acne is more likely to affect females
than males.
There are several reasons for this. As females get
older, the pattern of changes in hormones may itself
change, disposing sebaceous glands to develop acne.
Pregnancy may also cause hormonal
changes that lead to acne. Some women get acne when they
discontinue birth control pills that have been keeping
acne at bay. Sometimes young women may wear cosmetics
that are comedogenic-that is, they can set up conditions
that cause comedones to form.
What role does diet play in acne?
Acne is not caused by food. Following a strict diet will
not, clear your skin. While some people feel that their
acne is aggravated by certain foods, particularly
chocolate, colas, peanuts, shellfish and some fatty
foods, there is no scientific evidence that suggests
food causes or influences acne. Avoid any foods which
seem to worsen your acne and, for your overall health,
eat a balanced diet--but diet shouldn't really matter if
the acne is being appropriately treated.
Does the sun help acne?
Many patients feel that sunlight improves their acne
lesions and go to great lengths to find sources of
ultraviolet light. There is no proven effect of sunlight
on acne. In addition, ultraviolet light in sunlight
increases the risk of skin cancer and early aging of the
skin. It is, therefore, not a recommended technique of
acne management, especially since there are many other
proven forms of treatment for acne. Moreover, many acne
treatments increase the skin's sensitivity to
ultraviolet light, making the risk of ultraviolet light
exposure all the worse.
What is the best way to treat acne?
Everyone's acne must be treated individually. If you have not gotten good
results from the acne products you have tried, consider seeing a dermatologist.
Your dermatologist will decide which treatments are best for you.
What kind of cosmetics and cleansers can an acne
patient use?
Look for "noncomedogenic" cosmetics and toiletries.
These products have been formulated so that they will
not cause acne.
Some acne medications cause irritation or pronounced
dryness particularly during the early weeks of therapy,
and some cosmetics and cleansers can actually worsen
this effect. The choice of cosmetics and cleansers
should be made with your dermatologist or pharmacist.
Heavy foundation makeup should be avoided. Most acne
patients should select powder blushes and eye shadow
over cream products because they are less irritating and
noncomedogenic. Camouflaging techniques can be used
effectively by applying a green undercover cosmetic over
red acne lesions to promote color blending.
Is it harmful to squeeze my blemishes?
Yes. In general, acne lesions should not be picked or
squeezed by the patient. In particular, inflammatory
acne lesions should never be squeezed. Squeezing forces
infected material deeper into the skin, causing
additional inflammation and possible scarring.
Can anything be done about scarring caused by acne?
Scarring is best prevented by getting rid of the acne.
Dermatologists can use various methods to improve the
scarring caused by acne. The treatment must always be
individualized for the specific patient. Chemical peels
may be used in some patients, while dermabrasion or
laser abrasion may benefit others. It is important that
the acne be well controlled before any procedure is used
to alleviate scarring.
Would using my medication more frequently than
prescribed speed up the clearing of my acne?
No--always use your medication exactly as your
dermatologist instructed. Using topical medications more
often than prescribed may actually induce more
irritation of the skin, redness and follicular plugging,
which can delay clearing time. If oral medications are
taken more frequently than prescribed, they won't work
any better, but there is a greater chance of side
effects.
My topical treatment seems to work on the spots I
treat, but I keep getting new acne blemishes. What
should I do?
Topical acne medications are made to be used on all
acne-prone areas, not just individual lesions. Part of
the goal is to treat the skin before lesions can form
and to prevent formation, not just to treat existing
lesions. Patients are generally advised to treat all of
the areas (forehead, cheeks, chin and nose) that tend to
break out rather than just individual lesions.
My face is clear! Can I stop taking my medication
now?
If your dermatologist says you can stop, then stop--but
follow your dermatologist's instructions. Many times
patients will stop their medication suddenly only to
have their acne flare up several weeks later. If you are
using multiple products, it may be advisable to
discontinue one medication at a time and judge results
before discontinuing them all at once. Ask your
dermatologist before you stop using any of your
medications.
What is Acne?
Acne is a disease that affects the skin's oil
glands. The small holes in your skin (pores) connect to oil glands
under the skin. These glands make an oily substance called sebum.
The pores connect to the glands by a canal called a follicle. Inside
the follicles, oil carries dead skin cells to the surface of the
skin. A thin hair also grows through the follicle and out to the
skin. When the follicle of a skin gland clogs up, a pimple grows.
Most pimples are found on the face, neck, back,
chest, and shoulders. Acne is not a serious health threat but, it
can cause scars.
How Does Acne Develop?
Sometimes, the hair, sebum, and skin cells clump
together into a plug. The bacteria in the plug causes swelling. Then
when the plug starts to break down, a pimple grows.
There are many types of pimples. The most common
types are:
- Whiteheads. These are pimples that stay under
the surface of the skin.
- Blackheads. These pimples rise to the skin's
surface and look black. The black color is not from dirt.
- Papules. These are small pink bumps that can be
tender.
- Pustules. These pimples are red at the bottom
and have pus on top.
- Nodules. These are large, painful, solid
pimples that are deep in the skin.
- Cysts. These deep, painful, pus-filled pimples
can cause scars.
Who Gets Acne?
Acne is the most common skin disease. Nearly 17
million people in the United States have it. People of all races and
ages get acne. But it is most common in teenagers and young adults.
Nearly 85 percent of people between the ages of 12 and 24 get acne.
For most people, acne goes away by age 30. But some people in their
forties and fifties still get acne.
What Causes Acne?
The cause of acne is unknown. Doctors think certain
factors might cause it:
- The hormone increase in teenage years (this can
cause the oil glands to plug up more often)
- Hormone changes during pregnancy
- Starting or stopping pregnancy control pills
- Heredity (if your parents had acne, you might
get it, too)
- Some types of prescriptions
- Greasy makeup.
How is Acne Treated?
Acne is treated by doctors who work with skin
problems (dermatologists). Treatment tries to:
- Heal pimples
- Stop new pimples from forming
- Prevent scarring
- Help reduce the embarrassment of having acne.
Early treatment is the best way to prevent scars.
Your doctor may suggest over-the-counter (OTC) or prescriptions.
Some acne treatments are put right on the skin. Other remedies are
pills that you swallow. The doctor may tell you to use more than one
treatment.
How Should People With Acne Care for Their
Skin?
Here are some ways to care for skin if you have
acne:
- Clean skin gently. Use a mild cleanser in the
morning, evening, and after heavy workouts. Scrubbing the skin
does not stop acne. It can even make the problem worse.
- Try not to touch your skin. People who squeeze,
pinch, or pick their pimples can get scars or dark spots on
their skin.
- Shave carefully. If you shave, you can try both
electric and safety razors to see which works best. With safety
razors, use a sharp blade. Also, it helps to soften your beard
with soap and water before putting on shaving cream. Shave
lightly and only when you have to.
- Stay out of the sun. Many acne medicines can
make people more likely to sunburn. Being in the sun a lot can
also make skin wrinkle and raise the risk of skin cancer.
- Choose makeup carefully. All makeup should be
oil free. Look for the word "noncomedogenic" on the label. This
means that the makeup will not clog up your pores. But some
people still get acne even if they use these products.
What Things Can Make Acne Worse?
Some things can make acne worse:
- Changing hormone levels in teenage girls and
adult women 2 to 7 days before their monthly starts
- Pressure from bike helmets, backpacks, or tight
collars
- Pollution and high humidity
- Squeezing or picking at pimples
- Hard scrubbing of the skin.
What Are Some Myths About the Causes of Acne?
There are many myths about what causes acne. Dirty
skin and stress do not cause acne. Also, chocolate and greasy foods
do not cause acne in most people.
What Research is Being Done on Acne?
Scientists are looking at new ways to treat acne.
They are:
- Working on new drugs to treat acne
- Looking at ways to prevent plugs
- Looking at ways to stop the hormone
testosterone from causing acne.
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