Acne

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Acne (AK-nee) is a condition in which there are pimples, blackheads, whiteheads, and sometimes deeper lumps on the skin.

Johnny’s Story
Until he turned 13, Johnny’s skin had always been clear. Soon after the start of eighth grade, though, Johnny noticed the first few pimples on his face. Before long, the problem had gotten much worse. Johnny’s face was always broken out, and the pimples had spread to his neck, back, and chest.

Johnny was willing to try almost anything to get rid of the problem. He had heard that acne was caused by dirt or by eating certain foods, so he washed his face several times a day and gave up chocolate, nuts, and french fries. He also tried several acne medicines sold without a prescription. Nothing did the trick. Finally, Johnny went to see the doctor, who prescribed a medicine. Within a few weeks, the acne started to go away. Although Johnny had to keep using medicine and seeing the doctor for a while, he felt that his new and improved appearance was well worth the trouble.

What Is Acne?

Acne is the name for pimples or comedones*: blackheads, whiteheads, and sometimes deeper lumps that occur on the skin, especially on the face, neck, chest, back, shoulders, and upper arms and legs. Almost all teenagers have at least a little acne, and some adults have the problem as well. Although acne is not a serious health threat, it can affect how people look, which in turn can affect how they feel about themselves. When the acne is severe, it can leave permanent scars on the skin.

Acne occurs when hair follicles (FOL-li-culs) become plugged. A follicle is a tiny shaft in the skin through which a hair grows. The follicles are connected to sebaceous (se-BAY-shus) glands, which are small structures in the skin that make an oily substance called sebum (SEE-bum). This oil helps keep the skin and hair healthy. To reach the surface of the skin, the oil drains from the glands into the follicles, then leaves the follicles through tiny openings in the top. As it leaves the follicles, the oil carries away dead skin cells shed by the follicle linings.

What Kinds of Acne Are There?

Sometimes the cells inside the follicles shed too fast and stick together, forming a white, cheesy plug at the surface of the skin. If the opening to the surface stays partly open, the top of the plug may darken, causing a blackhead. If the opening to the surface closes, the follicle may fill up and its wall may start to bulge, causing a whitehead. The mixture of oil and cells inside the follicle also aids the growth of bacteria. If the follicle wall bursts, the oil, cells, and bacteria spill into the skin. The result is redness, swelling, and pus, in other words, a pimple. Ordinary acne is made up of blackheads, whiteheads, and pimples.

At times, large, pus-filled lumps called cysts (pronounced SISTS) form deeper in the skin. This is a more severe form of acne. The lumps may be painful, and if they are not treated by a doctor, they may lead to permanent scars.

Who Gets Acne?

Nearly all teenagers have at least an occasional pimple. The problem usually starts between the ages of 10 and 13, and it typically lasts for 5 to 10 years. Acne usually goes away on its own by the early twenties. However, it can last into the twenties, thirties, and beyond. A few people get acne for the first time as adults. Acne strikes boys and girls about equally. However, boys are more likely than girls to have more severe, longer-lasting forms of the problem.

*comedo (KOM-e-do) is an acne pimple. A blackhead is an open comedo. A whitehead is a closed comedo. Cosmetics that are labeled “non-comedogenic” (non-kom-e-do-JEN-ik) are less likely to cause pimples.

*hormones are chemicals that are produced by different glands in the body. Hormones are like the body’s ambassadors: they are created in one place but are sent through the body to have specific regulatory effects in different places.

During the teen years, both boys and girls go through changes in their hormones*. One group of hormones, called androgens (AN-drojens), seem to play a role in acne. Among other things, androgens make the sebaceous glands work harder. The more oil the glands make, the greater the chance that the follicles will become clogged. Teenage boys make ten times as much androgen as teenage girls, so it is not surprising that boys are more likely to get more severe cases of acne.

What Else Causes Acne?

Certain oily kinds of makeup and face cream can clog the openings of the skin and cause mild acne. That may mean that people who try to cover their pimples with makeup actually make the problem worse by causing new pimples. Oil-free products are labeled “non-comedogenic” (non-kom-ee-do-JEN-ik), meaning they should not cause blackheads or whiteheads, or “non-acnegenic” (non-ak-nee-JEN-ik), meaning they should not cause acne.

Several other things can cause acne or make it worse. These include certain medicines. People who work in fast food restaurants or garages may find that their acne is made worse by the constant contact with grease, motor oil, or chemical irritants. Many girls also find that their pimples get worse around the time of their periods.

What Does Acne Look Like?

Acne is typically found where the sebaceous glands are most numerous: on the face, neck, chest, back, and shoulders. Blackheads are spots with a dark top, whereas whiteheads are spots with a white center. Pimples look like small, red bumps. Some of them have a white center with a ring of redness around it. When pimples occur with no blackheads or whiteheads, they may be a sign of another skin disease or a skin reaction to medication. Cysts are large, red bumps that are often painful. They may leave deep pits and scars after healing.

It is usually easy for a doctor to recognize acne by sight. It is smart to see a doctor whenever:

* acne interferes with a person’s life
* acne spots are large, red, and painful
* acne causes dark patches to appear on a dark-skinned person
* acne scars remain when the acne spots heal
* treatment with nonprescription medication does not work

How Is Acne Treated?

Acne treatments work by stopping new pimples from forming. They do this by cutting back on the amount of oil the sebaceous glands make, the number of bacteria that are present in the skin, or the rate at which dead skin cells are shed. It is important to give an acne treatment enough time to do its job. It may take weeks for the skin to clear up, even if a treatment is working.

Over-the-counter medications

Milder cases of acne are often helped by lotions, creams, pads, and gels sold without a prescription. Many will dry out the skin if used too frequently, however, and it is important to follow label instructions carefully.
Prescription medications

A doctor may prescribe stronger medicines than those sold over the counter. When put on the skin in creams or lotions, such medicines may cause dryness and peeling. The doctor can offer advice on how to deal with these side effects.

Other treatments

The doctor may open pimples or remove blackheads and whiteheads in the office. A skilled doctor is the best one to do this. People who try to do it themselves may wind up making the acne worse and increasing the risk of scarring.

Retin-A and Accutane

Two drugs used to clear up severe cases of acne are Retin-A and Accutane. Both of these drugs are derivatives of vitamin A.

Retin-A (tretinoin) comes in a cream, gel, or liquid and is applied to the skin daily. Exactly how it works is unknown but it is thought to loosen and expel existing acne plugs in the skin glands and prevent new lesions from forming. Results are seen in about 2 or 3 weeks but treatment should be continued for at least 6 weeks. The most common side effect is skin irritation.

Accutane (isotretinoin) is taken orally. Accutane must be taken daily for 4 or 5 months, and results last for about one year. Accutane has some serious side effects such as chapped lips, dry, itchy skin, nosebleeds, irritation of the eyelids, joint and muscle pain, temporary hair loss, and rash. It is particularly important that Accutane not be taken by women who are pregnantorwho may become pregnant during treatment as the drug can severely damage the developing fetus.

What Doesn’t Cause Acne?

Acne is not caused by being dirty. Even the black in a blackhead is dried oil and dead skin cells, not dirt. Washing too often may actually irritate the skin and make the acne worse. In general, the following guidelines may help to prevent acne or to reduce its symptoms:

* not popping, squeezing, or picking at acne pimples, as this can just lead to more redness, swelling, and scars.
* Choosing oil-free makeup and face creams labeled “non-comedogenic” or “non-acnegenic.”
* Avoiding things that can irritate the skin, such as grease, oil, and rubbing from clothes and sports equipment.
* Washing the face gently twice a day with a mild soap, then patting it dry.
* Shampooing hair regularly.
* For men who shave, shaving as lightly as possible to avoid nicking any pimples.

Acne also is not caused by the foods a person eats. Studies have shown that a strict diet alone will not clear up the skin. On the other hand, some people are still convinced that certain foods such as chocolate or french fries make their acne worse. It certainly could not hurt to cut back on junk food. A healthier diet is always a plus, whether or not it has an effect on acne.

Resources

Book

Silverstein, Alvin, Virginia Silverstein, and Robert Silverstein. Overcoming Acne: The How and Why of Healthy Skin Care. New York: William Morrow, 1990.

Organizations

The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases posts a fact sheet about acne at its website.

http://www.nih.gov/niams/healthinfo/acne/acne.htm

American Academy of Dermatology, P.O. Box 681069, Schaumburg, IL 60168-1069. The AAD publishes a brochure called Acne.
Telephone 888-462-DERM

http://www.aad.org

AcneNet is the website created by Roche Laboratories, a drug company, and the American Academy of Dermatology.

http://lwww.derm-infonet.com/acnenet

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