Acne & Treatment

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Acne (acne vulgaris, common acne) is a disease of the hair follicles of the face, chest, and back that affects almost all males and females during puberty; the only exception being teenage members of a few primitive isolated tribes living in Neolithic societies. It is not caused by bacteria, although bacteria play a role in its development. Acne appears on the skin as...

• congested pores ("comedones"), also known as blackheads or whiteheads,
• tender red bumps also known as pimples or zits,
• pustules, and occasionally as
• cysts (deep pimples, boils).

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

• Heredity: With the exception of very severe acne, most people do not have the problem exactly as their parents did. Almost everyone has some acne at some point in their life.
• Food: Parents often tell teens to avoid pizza, chocolate, greasy and fried foods, and junk food.
• Dirt: As mentioned above, "blackheads" are oxidized oil, not dirt. Sweat does not cause acne, therefore, it is not necessary to shower instantly after exercise for fear that sweat will clog pores. On the other hand, excessive washing can dry and irritate the skin.
• Stress: Stress, however, does not play much of a direct role in causing acne.

What can you do about acne on your own?

Think back to the three basic causes of acne and you can understand why the focus of both home treatment and prescription therapy is to (1) unclog pores, (2) kill bacteria, and (3) minimize oil


Lifestyle: Moderation and regularity are good things, but not everyone can sleep eight hours, eat three good meals, and drink eight glasses of water a day. You can, however, still control your acne even if your routine is frantic and unpredictable. Playing with or popping pimples, no matter how careful and clean you are, nearly always makes bumps stay redder and bumpier longer. People often refer to redness as "scarring," but fortunately it usually isn't in the permanent sense. It's just a mark that takes months to fade if left entirely alone.
Open the pores
Cleansing and skin care: Despite what you 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 masques: A variety of mild scrubs, exfoliants, and masks can be used. These products contain either fine granules or 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.

Kill the bacteria

• Antibacterial cleansers: The most popular ingredient in over-the-counter antibacterial cleansers is benzoyl peroxide.
• Topical (external) applications: These products come in the form of gels, creams, and lotions, which 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 products you 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 you stop using the product. Keep in mind that benzoyl peroxide is a bleach, so do not let products containing benzoyl peroxide leave unsightly blotching on colored clothes, shirts, towels, and carpets.
Reduce the oil
You cannot stop your oil glands from producing oil (unless you mess with your hormones or metabolism in ways you shouldn't). Even isotretinoin (Accutane, see below) only slows down oil glands for a while; they come back to life later. What you can do is to get rid of oil on the surface of the skin and reduce the embarrassing 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 mildly 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 you wipe away oil.

What are other things you can do for acne?

• Cosmetics: Don't be afraid to hide blemishes with flesh-tinted coverups or even foundation, as long at 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 yourself.
• Pore strips: Pharmacies now carry, under a variety of brand names, strips which you put on your nose, forehead, chin, etc., to "pull out" oil from your 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. Ditto for vinegar.

What is a good basic skin regimen?

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

1. Cleanse twice daily with a 5% benzoyl peroxide wash. An alternative for those who are allergic to benzoyl peroxide is 2% salicylic acid.
2. Apply a gel or cream containing 5% benzoyl peroxide; an alternative is sulfur or resorcinol.
3. At night, apply a spot cream containing sulfur to the affected areas.
4. Use a light skin moisturizer and water-based oil-free makeup.

What can the doctor do for acne?

If you haven't been able to control your acne adequately, you may want to consult a primary-care physician or dermatologist. 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:

• Topical (externally applied) antibiotics and antibacterials: These include erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone), clindamycin (BenzaClin, Duac), sulfacetamide (Klaron), and azelaic acid (Azelex or Finacea).
• Retinoids: Retin-A (tretinoin) has been around for years, and preparations have become milder and gentler while still maintaining its effectiveness. Newer retinoids include adapalene (Differin) and tazarotene (Tazorac). These medications are especially helpful for unclogging pores. Side effects may include irritation and a mild increase in sensitivity to the sun. With proper sun protection, however, they can be used even during sunny periods. In December 2008, the U.S. FDA approved the combination medication known as Epiduo gel, which contains the retinoid adapalene along with the antibacterial cleanser benzoyl peroxide. This once-daily prescription treatment was approved for use in patients 12 years of age and older.
• Oral antibiotics: Doctors may start treatment with tetracycline (Sumycin) or one of the related "cyclines," such as doxycycline (Vibramycin, Oracea, Adoxa, Atridox and others) and minocycline (Dynacin, Minocin). Other oral antibiotics that are useful for treating acne are cefadroxil (Duricef), amoxicillin (Amoxil, DisperMox, Trimox), and the sulfa drugs
• Oral contraceptives: Oral contraceptives, which are low in estrogen to promote safety, have little Those FDA approved for treating acne are Estrostep, Ortho Tri-Cyclen, and Yaz. Most dermatologists work together with primary physicians or gynecologists when recommending these medications.
• Spironolactone (Aldactone): This drug blocks androgen (hormone) receptors. It can cause breast tenderness, menstrual irregularities, and increased potassium levels in the bloodstream. It can help some women with resistant acne, however, and is generally well-tolerated in the young women who need it.
• Cortisone injections: To make large pimples and cysts flatten out fast, doctors inject them with a form of cortisone.
• Isotretinoin:
• Laser treatments: Recent years have brought reports of success in treating acne using lasers 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.
• 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 they may need to be repeated three or more times. These treatments can help, but they are never completely successful at eliminating acne scars.

How would you sum up current-day acne treatment?

Treating acne requires patience and perseverance. Any of the treatments listed above may take two or three months to start working (even isotretinoin). Unless there are side effects such as dryness or allergy, it is important to give each regimen or drug enough time to work before giving up on it and moving on to other methods. Using modern methods, doctors can help clear up the skin of just about everyone.
Just hang in there. And don't pick. Please.

REFERENCE:

Kurokawa, Ichiro, et al. "New Developments in Our Understanding of Acne Pathogenesis and Treatment." Experimental Dermatology 18 (2009): 821-832.

Last Editorial Review: 2/22/2011