Acne Vulgaris – All You Wanted to Know and More!

Introduction

Acne is one of the most common skin diseases that family practice physicians, pediatricians and dermatologists treat.  Acne can affect newborns, infants, prepubescent children, adolescents and mature adults.  There are many different types of acne and treatment plans vary depending on the type and severity.  Therefore, it is important to be thoroughly evaluated, so your medical provider can treat you appropriately.  This article will review acne vulgaris, the most common form of acne.  This form of acne can include comedonal acne (blackhead and whitehead), papular acne (pimple) and cystic acne.

What causes acne?

The biology of acne is broken down into four main events that occur in the skin; oil production, clogged pores/follicles, Propionibacterium acne (bacteria in the follicle) and inflammation.  Acne is driven by hormones.  Hormones in the body stimulate both oil production in the skin and clogging of pores.  The adolescent population has an increase in hormone levels and that is why acne is so common in teenagers.  Occasionally persons with acne have hormone abnormalities.  Immune system cells within the skin then respond to the clogged pore with trapped oil and bacteria within it by causing inflammation around the pore.  This is the redness that one can see around pimples.  The more inflammation that occurs around the acne bump can increase the risk of the acne bump evolving into a cyst.  Because the skin around the pore is inflamed, acne can itch or become painful.  Acne can cause permanent scarring.  It can become worse before a woman’s menstrual period, during stressful times and when sweating.  Acne is not contagious.

Psychosocial impact of acne

Acne often occurs at an age when a person is experiencing many psychological and social changes.  Acne may lead to a loss of self-esteem, anxiety, embarrassment, problems mixing with peers or depression. These issues are usually the motivating factor for seeking professional evaluation and treatment.  Many people may feel that medical providers “write-off” acne as a cosmetic issue.  This should not be the case.  The psychological impact that even the most mild acne can cause warrants proper evaluation and treatment.  Another important reason to seek treatment early is to prevent scarring.  Once scarring occurs, it is more difficult to improve the cosmetic appearance of the skin.

Therapies

There are a variety of prescription topical and oral therapies for acne.  Topical acne medicines consist of creams, gels and foams that are rubbed into the skin.  The most commonly used topical medications include preparations of benzoyl peroxides, antibiotics, anti-inflammatories, retinoids, salicylic acids, azelaic acids and sodium sulfacetamide/sulfur.  These medications aid to reduce blackhead and whitehead formation, reduce bacteria and act against inflammation in the skin.  Oral pills include antibiotics, birth control pills and isotretinoin.  Depending on acne severity, topicals only or a combination of both topical and oral pills will be used as a first-line therapy.

Acne Myths & Treatment Tips

Eat a normal diet!  Food and drink DO NOT cause acne.  So, sit back, relax and enjoy your occasional order of French fries or piece of chocolate.

Acne is not caused by dirt in your pores, nor does it mean that you are not hygienically savvy.  DO NOT SCRUB your skin with loofas, scrub gloves, scrub brushes, brillow pads or any other device that may be abrasive.  This is especially true when you are using topical anti-acne treatments.  You will only make your skin red, irritated and sore.  There are much safer ways to exfoliate!

Good sleep hygiene is vital!  Getting 8 hours of sleep a night is important for your overall health, including your skin.

PATIENCE IS A VIRTUE!!  Please, please, please be patient with your recommended treatment plan.  Usually it takes a minimum of 6 weeks to begin seeing the effects of the medications and many times up to 3 months to see the full effect.  Acne may become worse during the first few weeks of treatment.  Hang in there!  Acne therapies DO NOT cause you to break out.

Do not stop your treatment unless you are having a problem with the medication or instructed to stop by your medical provider.  Call your provider right away if you stop a medication.  Usually, an alternate treatment plan can be arranged over the telephone.

There is no such thing as “spot treatment!”  Apply your topical anti-acne treatments to the areas where you tend to break out, not just to individual pimples.  Avoid applying topical medications close to your eyes, the creases of your nose or close to your lips.  The skin in these areas is sensitive and may become dry and irritated.

HANDS OFF!  Please do not pick or squeeze your blackheads, whiteheads or pimples.  Digging, scratching and squeezing facilitates inflammation and may result in scarring.

Use only non-comedogenic (won’t cause blackheads and whiteheads) and oil-free moisturizers and make-ups on your skin.  If you are trying to manage your acne and wear an oil-based foundation daily, your acne may not get better.

SLOWLY increase the frequency of all topical anti-acne medications.  Irritation, dryness and redness are the most common side effects.  Start using just one topical 1-2 times a week, then increase it to 3-4 times a week until you gradually tolerate the medication daily.  If your provider recommends more than one topical, do not start using the second topical until you are tolerating the first.  Call your provider if you have problems or questions.

Be careful so you don’t destroy your clothes or bed linens!  Topical anti-acne medications that contain benzoyl peroxide can bleach clothes, towels, sheets and pillowcases.

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