Acne is a common skin disorder that occurs when hair follicles become plugged by oil and dead skin cells. Hormones act on sebaceous glands and hair follicles leading to clogged pores and lesions which we commonly call pimples. Acne usually forms on the face, neck, back, chest, and shoulders. Depending on its severity, acne can cause emotional distress and leave behind permanent scars. The earlier you start treatment, the lower your risk of lasting physical and emotional damage.
The sebaceous glands secrete an oily substance called sebum that is normally carried out to the skin surface through the tiny opening of the hair follicle, called a pore. The hair, sebum, and dead skin cells in the follicle may form a plug that prevents sebum from reaching the skin surface. The bacteria Propionibacterium acnes (P. acnes) found normally on your skin start to grow in these follicles and cause inflammation. When this plug breaks down, it causes pimples.
There are many types of pimples. The most common types include:
Acne is common in teenagers because of excessive hormone production of androgens during puberty. These hormones make the oil glands produce more sebum and also clog the pores of your skin. It can also occur as a result of hormonal changes during pregnancy or when birth control pills are started or stopped. In addition, heredity may also play a role, where it runs in families. The use of certain drugs containing lithium and oily creams can also contribute to acne. In women, acne frequently worsens at the time of menstruation.
Acne is often treated by topical and oral medications.
There are several over–the–counter medications which can be helpful in controlling acne, including Benzoyl peroxide, Salicylic acid, and Sulfur. These medications are available in many forms, such as gels, lotions, creams and soaps.
Prescription medications can be used for moderate to severe acne.
These products work best when applied to clean, dry skin about 15 minutes after washing. You may not see the benefit of this treatment for a few weeks. And you may notice skin irritation at first, such as redness, dryness and peeling. Steps to minimize side effects include: using a gradually increased dose, washing off the medication after a short application, or switching to another medication.
Retinoids: Retinoid drugs are derived from vitamin A and include tretinoin (Retin-A, others), adapalene (Differin) and tazarotene (Tazorac). This medication is applied to affected areas in the evening, beginning with three times a week, then daily as your skin becomes used to it. It works by preventing plugging of the hair follicles.
Antibiotics: These work by killing excess skin bacteria and reducing redness. For the first few months of treatment, you may use both a retinoid and an antibiotic, with the antibiotic applied in the morning and the retinoid in the evening. The antibiotics are often combined with benzoyl peroxide to reduce the likelihood of developing antibiotic resistance. Examples include clindamycin with benzoyl peroxide (Benzaclin, Duac, Acanya) and erythromycin with benzoyl peroxide (Benzamycin).
Dapsone (Aczone): This gel is most effective when combined with a topical retinoid. Skin side effects include redness and dryness.
Antibiotics: For moderate to severe acne, you may need oral antibiotics to reduce bacteria and fight inflammation. Choices for treating acne include tetracyclines, such as minocycline and doxycycline.Your doctor likely will recommend tapering off these medications as soon as your symptoms begin to improve or as soon as it becomes clear the drugs aren’t helping — usually, within three to four months. Tapering helps prevent antibiotic resistance by minimizing undue exposure to these medications over a long time.You will likely use topical medications and oral antibiotics together. Studies have found that using topical benzoyl peroxide along with oral antibiotics may reduce the risk of developing antibiotic resistance.Antibiotics may cause side effects, such as an upset stomach and dizziness. These drugs also increase your skin’s sun sensitivity. They can cause discoloration of developing permanent teeth and reduced bone growth in children born to women who took tetracyclines while pregnant.
Combined oral contraceptives: Combined oral contraceptives are useful in treating acne in women and adolescent girls. The most common side effects of these drugs are headache, breast tenderness, nausea, weight gain and breakthrough bleeding. A serious potential complication is a slightly increased risk of blood clots.
Anti-androgen agent: The drug spironolactone (Aldactone) may be considered for women and adolescent girls if oral antibiotics aren’t helping. It works by blocking the effect of androgen hormones on the sebaceous glands. Possible side effects include breast tenderness, painful periods and the retention of potassium.
Isotretinoin: This medicine is reserved for people with the most severe acne. Isotretinoin (Amnesteem, Claravis, Sotret) is a powerful drug for people whose acne doesn’t respond to other treatments. Oral isotretinoin is very effective. But because of its potential side effects, doctors need to closely monitor anyone they treat with this drug. The most serious potential side effects include ulcerative colitis, an increased risk of depression and suicide, and severe birth defects. In fact, isotretinoin carries such serious risk of side effects that women of reproductive age must participate in a FDA-approved monitoring program (I-pledge) to receive a prescription for the drug.
These therapies may be suggested in select cases, either alone or in combination with medications.
Extraction of whiteheads and blackheads: Your dermatologist uses special tools to gently remove whiteheads and blackheads (comedos) that haven’t cleared up with topical medications. This technique may cause scarring.
Steroid injection: Nodular and cystic lesions can be treated by injecting a steroid drug directly into them. This improves their appearance without the need for extraction. The side effects of this technique include thinning of the skin, lighter skin and the appearance of small blood vessels on the treated area.
Practicing some skin care tips may prevent acne from developing or becoming worse.
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