Acne

Acne is the term for plugged pores (blackheads and whiteheads), pimples, and even deeper lumps (cysts or nodules) that occur on the face, neck, chest, back, shoulders and even the upper arms. Acne is rarely a serious medical condition, but it often causes emotional distress and can lead to scarring of the skin.

More than four out of five people between the ages of 12 and 24 have acne at least once. But while the disorder is often associated with teenagers, it can affect people of all ages. It's not uncommon for acne to occur in people in their 20s and 30s. And, some people continue to have acne in their 40s and 50s. Many adult women experience mild to moderate acne due to hormonal changes associated with pregnancy, their menstrual cycles, or starting or stopping birth control pills.

Causes and risk factors

• Hormonal changes. Hormonal changes in both boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy or starting or stopping birth control pills can also cause acne.
• Heredity or genetics. Researchers believe that the tendency to develop acne can be inherited from parents.
• Certain drugs, including androgens and lithium, are known to cause acne.
• Greasy cosmetics may alter the cells of the follicles and make them stick together, producing a plug.
• High levels of humidity and sweating.
• Friction or pressure on your skin caused by items such as telephones or cellphones, helmets, tight collars and backpacks.
• Buildup of bacteria.

There are many myths about what causes acne. Chocolate and greasy foods are often blamed, but foods seem to have little effect on the development and course of acne in most people. Another common myth is that dirty skin causes acne; however, blackheads and other acne lesions are not caused by dirt. Finally, stress does not cause acne.

Self-care steps

• Clean skin gently. Gently wash your skin with a mild cleanser, once in the morning and once in the evening and after heavy exercise. Some people with acne may try to stop outbreaks and oil production by scrubbing their skin and using strong detergent soaps and rough scrub pads. However, scrubbing will not improve acne; in fact, it can make the problem worse.
• Avoid frequent handling of the skin. Avoid rubbing and touching their skin lesions.
• Shave carefully. Nicking blemishes can be avoided by shaving lightly and only when necessary.
• Avoid a sunburn or suntan. Many of the medicines used to treat acne can make a person more prone to sunburn.
• Choose cosmetics carefully. Avoid greasy cosmetics or creams. All cosmetics, such as foundation, blush, eye shadow, and moisturizers, should be oil free. Oily hair products may eventually spread over the forehead, causing closed comedones. Products that are labeled as noncomedogenic (do not promote the formation of closed pores) should be used.
  

Acne treatment

Acne treatments work by reducing oil production, speeding up skin cell turnover, fighting bacterial infection or doing all three. With most prescription acne treatments, you may not see results for up to eight weeks, and your skin is likely to get worse before it gets better.

• Topical Medicines. Over-the-counter lotions are generally mild and contain benzoyl peroxide, sulfur, resorcinol, salicylic acid or lactic acid as their active ingredient. These products can be helpful for very mild acne. Tretinoin (Retin-A, Renova) and adapalene (Differin) are topical prescription medications derived from vitamin A. They work by promoting cell turnover and preventing plugging of the hair follicle. A number of topical antibiotics also are available. They work by killing excess skin bacteria.
• Prescription Oral Antibiotics. For moderate to severe acne, prescription oral antibiotics may be needed to reduce bacteria and fight inflammation. You may need to take these antibiotics for months, and you may need to use them in combination with topical products.
• Isotretinoin. For deep cysts, antibiotics may not be enough. Isotretinoin (Accutane) is a powerful medication available for scarring cystic acne or acne that doesn't respond to other treatments. This medicine is reserved for the most severe forms of acne. It's very effective, but people who take it need close monitoring by a dermatologist because of the possibility of severe side effects.
• Oral contraceptives. Oral contraceptives, including a combination of norgestimate and ethinyl estradiol (Ortho Tri-Cyclen, Ortho-Cyclen ), have been shown to improve acne in women.