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| The Cause Of Acne | ||
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Implicated in a wide range of conditions and illnesses, hormones also play a role in the development of acne. Androgens,
male hormones that are secreted in different amounts by both men and women, play an important role in most cases
of acne. Androgens stimulate the hormone-sensitive sebaceous glands, which produce oil, known as sebum. Sebum, in
turn, has been called "the fuel that feeds the flame of acne." |
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Genetics also seem to play a role. There are some families in which severe acne is inherited. Unfortunately, the
exact genetic component is not known yet. |
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| Home Treatment | ||
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For many people with acne-prone skin, good home care and a few over-the-counter products will help keep their complexion
clear and smooth. Washing your face with one of these products can help keep acne under control. Just look for salicylic acid on the label. Many people believe that acne is a disease of dirt. It is not. Scrubbing will only inflame and irritate an already sensitive area. Wash your skin gently with a cleanser specially formulated for acne-prone skin. Ask a pharmacist for help in choosing one that is right for you. Available over-the-counter in several concentrations, benzoyl peroxide helps dry up the skin and reduce bacteria. If your skin is dry from using benzoyl peroxide, look for a moisturizer labeled noncomedogenic or nonacnegenic. Products carrying these labels are specifically formulated for acne-prone skin. |
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| Professional Treatment | ||
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If the acne does not respond to home and over-the-counter treatments after two months, it is a good idea to see a
dermatologist before the condition produces scarring and/or takes an emotional toll. Dermatologists have numerous
prescription medications and procedures available. Available as creams and lotions, these vitamin A acids can help unblock pores and reduce the skin's bacteria. These creams and lotions can help reduce acne inflammation and skin bacteria. Though not usually the first course of treatment, oral antibiotics such as tetracycline are often used to help reduce the inflammation of acne. Women who use oral contraceptives may notice that their acne improves significantly. In fact, the FDA has approved one birth control pill specifically for acne treatment. For severe acne that does not respond to other treatments, your dermatologist may prescribe isotretinoin. This medication must be used with care, however, since it can cause birth defects. It is never a good idea to remove blackheads or whiteheads (both called comedones) or pimples on your own. A dermatologist has the proper equipment to extract them without leaving scars. |
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| Seven Common Myths About Acne | ||
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Myth #1. Chocolate and greasy foods cause acne. Dietary factors neither cause nor cure acne. In almost all cases, the food you eat has almost nothing to do with your acne. There is two exception…iodine and muscle-enhancing steroids. If you ingest large amounts of iodine (look at the label of your mineral pills), your acne can flare. Steroids have long been known to cause a type of acne, called steroid acne. Myth #2: Dirty skin, and hair in my face can cause acne. This myth has caused countless acne-sufferers to scrub their face with harsh and abrasive cleansers. Acne is not dirt, so you can't wash it away. Blackheads are clumps of dead skin cells mixed with the skin's own oil which sit in the pore of the skin. When this clump of cells push to the skin surface and is exposed to oxygen, it turns black. This is not dirt, but oxidized sebum, which extends slightly beneath the skin surface. No amount of soap or water can scrub this away. In fact, overly aggressive scrubbing can break down the wall of the pore, and cause more inflammation. Myth #3: Harsh cleansers, facial vacuum machines, etc. clean deep inside the pore. Nothing can get deep inside the pore, which extends deep inside your skin. These cleansers, vacuums, etc. often only irritate the skin. Cleansers can only clean the surface of the skin. Myth #4: I can do something to permanently change the size of my pores. The size and shape of your pores cannot be changed. Their size is genetically set. Pores are anatomic structures that allow sweat to be released to control body temperature. Everyone has pores. Since pores have no muscle around them, they cannot "open" or "close." Pore openings usually stay the same size, unless a blackhead pushes up and dilates it. The myth that says hot water opens pores and cold water closes pores is not true. Think about it. Steam or hot water causes the skin surrounding the pore to swell, while cold water reduces any skin swelling. The surrounding skin may change, but the pore size does not. Myth #5: Acne only affects teenagers. Acne does affect a large number of teenagers, but affects others as well. It can start earlier, and in many cases, extend past the teenage years. Sometimes it can start in your twenties or even thirties. It is also, unfortunately, untrue that acne disappear by age twenty. Myth #6: If I find the right cosmetic, my acne will get better. Cosmetics may mask acne, but they will not treat or improve your acne. So many acne-sufferers believe often misleading advertisements for products are expensive, and just do not work. Myth #7: Sexual feelings causes acne. Sexual thoughts, unclean thoughts, too much sex, not enough sex, and masturbation have absolutely nothing to do with acne. During adolescence, you start your emotional and physical sexual development. Both of these occur because of the surge of sexual hormones during adolescence. Hormonal changes cause both sexual maturity and acne. But thoughts cannot cause acne. |
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| Questions and Answers About Acne | ||
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Blackheads, Pore Problems, Oily Skin, Dry Skin I am constantly getting blackheads, which I cannot leave alone! Therefore, I am left with large pores making their way across my nose, forehead, and chin. What can you suggest for the blackheads and breakouts and for the enlarged pores? I keep my face clean, use a toner, and good foundation and I still get these blackheads. It is never a good idea to pick or squeeze pimples. When you squeeze a pimple yourself, you ALWAYS make it worse. This is because squeezing at the level of the skin pinches the center of the pimple, allowing some pus to leave the top of the skin. What you don't see is pus being pushed deeper into the skin, causing more redness and inflammation, swelling, and an increased chance for bacterial infection. This is why a picked pimple always looks worse than one that is not picked. Continued picking can cause scabs to develop, and possible scarring. Pores are natural structures in our skin that allow for sweat to escape. Some people have larger pores than others. As we age, pore size increases. Blackheads and breakouts are different from enlarged pores. General skin care should include:
Blackheads are not caused by dirt. They are caused by oil in the pores of your skin, which oxidizes and turns dark. The nose is a very common site for blackheads in people of all races. Properly performed acne surgery can extract these collections of oil, without leaving scars. Prescription topical and oral medications can prevent their recurrence. What can I do to prevent plugged pores? I get bumps under the skin -- hard white spots, not really pimples, just white bumps, plugged pores. Bumps under the skin can be due to many things. Some pimples develop first under the skin and you can feel them before you can see them. These are often the origins of acne and can be treated with extraction or medications. Larger cysts can develop under the skin. Often, these need to be drained, or if very inflamed, a drop of diluted hydrocortisone injected into the cyst will flatten it out. This is what I am often asked to do for young movie actors, who develop an "undergrounder." Sometimes small white bumps develop on the skin of the face. These are called "milia," and squeezing them will not work. A physician can use a small lancet to release the material inside. My face is generally of the oily type and I'm 73 years old. Quite regularly, I develop pimples and Metrogel has been somewhat effective in correcting this condition, especially around my nose area. I also press pimples to remove pus. I sometimes also use Clearsil. Is there something I should be doing to suppress the production of face oil that appears to be causative in developing pimples? What you are describing is called "acne rosacea," which is a combination of acne and rosacea. Typically, this affects patients above the age of 30. The patient complains of redness, worsening visible blood vessels, flushing of the skin, and pimples. Rosacea is made worse by drinking hot foods or drinks, drinking alcohol, sun exposure, or stress. If you can avoid hot drinks, spicy foods, red wine, and sunlight, it will help. Of course, no one can avoid all of these all the time, but even minimizing them will help. Also, see if one particular thing (such as spicy foods) makes it worse than other things, and try to avoid that particular triggering factor. Topical treatments for rosacea include metronidazole (trade names: Metrogel, MetroCream, Noritate), which is an anti-fungal, or sulfacetamide/sulfur lotions (Sulfacet-R, Clenia), or topical antibiotics (clindamycin or erythromycin). Systemic therapy is more effective. Common treatments include oral tetracycline, doxycycline, Bactrim, or even low-dose Accutane in severe cases. The acne portion of acne rosacea can be treated as you would treat acne. That is why Clearsil has helped. Who would have ever thought wrinkles and acne could coexist, but they do. During the winter I need moisturizer, yet the product I use seemingly worsens my acne. Are there any tips to lessen or prevent acne while lessening dry skin? Unfortunately, adult acne is a very common problem, especially in adult women. And since acne typically affects teenagers with oily skin, many of the acne preparations cause the skin to become dry. As you age, your skin gets more dry. This is caused by a number of factors that have to do with decreased collagen, hyaluronic acid, etc. So it is a double whammy when you are older, and have dry skin and acne. But there is good news, too! Many acne products (Retin-A, Tazorac) have also been found to lessen wrinkles and fight aging. And since these products are not being used in older individuals, the companies that make them have come out with these same products in a more moisturizing base (Renova). I would try these products. Also, using gentle cleansers, avoiding scrubs, will help you tolerate acne products without irritating your skin. How do you know the difference between adult acne and rosacea? Acne is basically zits, pimples, and cysts, and most often occurs in teens and young adults. Rosacea most often affects adults rather than teens, and consists of redness and flushing made worse by hot foods and drinks, spicy foods, alcoholic beverages, and stress. But it is not uncommon for people to have both acne and rosacea simultaneously. When that happens, we treat both of them as a unit, and improve your skin. Scarring What is the best procedure to get rid of pitted scars from adult acne? If the scars are depressed and they disappear when you stretch the skin, laser often helps a great deal. If the scars are what we call "ice-pick scars" -- meaning they don't change even if you stretch the skin -- then laser is much less likely to work. Most times, people have combinations of both, and the laser will help the distensible scars. Filler materials, such as collagen and Restylane, can also fill in depressed scars, especially if they are distensible. Whenever I have breakouts, the scars take a long time to disappear. Is there any way to speed up the recovery process? I have tried vitamins C and E, as well as use retinol cream from my dermatologist. There are many types of scars: elevated scars, depressed scars, flat sclerotic (hard) scars, pigmented scars, stretched scars, atrophic scars, as well as others. Different scars require different treatments. Acne scars usually are pigmented, elevated, or depressed. Pigmented scars can be treated with prescription bleach creams. If that only helps somewhat, compounded bleach creams, usually sold from a dermatologist's office, may work better. Elevated scars can be treated with injections of a mild cortisone to flatten them. Depressed scars can be treated with laser or injectable fillers, such as collagen or Restylane. Are there any treatments other than laser surgery for acne scars? I don't break out any more, but have many deep scars from picking my face when I was younger (primarily on my cheeks). I went to a dermatologist and she said the only way to get rid of them is to do plastic surgery or laser surgery -- unfortunately, I can't afford it. Please let me know if there are any alternatives. It's true, laser surgery is expensive. Be aware that there are many lasers that treat acne scars; some work better than others. The CO2 laser is still considered the gold standard among lasers. Its main drawback is that it takes a long time to heal, often more than one month. Other lasers may require less healing time, but are also less effective. I recommend that you get a few consults from reputable dermatologists, and ask lots of questions. Body Acne My boyfriend is 25 years old and is having a big problem with back acne. He has tried many over-the-counter treatments, changed laundry detergent, and fabrics of clothing. Is there any other treatment that he could explore without having to go to a dermatologist? Unfortunately for your boyfriend, acne on the back is more difficult to treat than facial acne. The cysts tend to be more resistant to therapy, and they leave pigmentation (dark discoloration), as well as elevated and depressed scars. Even worse, if scarring does occur, laser is much riskier to perform on the back, than on the face, because the back has fewer sebaceous glands to aid in healing. If your boyfriend is getting scars, he should see a dermatologist. I would recommend oral antibiotics first, and if that didn't work, then Accutane for sure. There is a lot of misinformation about Accutane (and I can discuss that in another article), but it is the single most effective treatment for cystic scarring acne. I'm 49 years old. Why do I have acne on my chest? I think it's related to a change in hormones. How can I treat it? Acne can affect any area of the body. For every person that gets acne in a specific location, each one will ask why they got it in that part of the body. Acne on the chest is one place where acne can occur. Usually, acne on the chest is more common in teens and young adults. Hormonal variations (such as menstrual cycle) can often affect acne. [I don't know] if you are male or female, or what other medications you are on, but hormones and medications can play a significant role in acne. Medications as diverse as testosterone, birth control pills, medications for endometriosis, steroids, Dilantin (an anticonvulsant), Lithium (an antidepressant) can each affect your acne. Even certain cosmetics can cause acne to flare. I'm 53 and regularly get zits on my buttocks. With rare exceptions, no where else. What could this indicate? Zits on the buttocks can be due to many things. Two common causes are conditions called keratosis piaris and also folliculitis. Keratosis pilaris is common in adolescence and consists of small bumps and pustles on the upper arms, front of the thighs, and occasionally, the buttocks. Folliculitis is an inflammation of the hair follicles, due to occlusion (sitting down), heat, or friction. Both of these conditions look similar to acne, and can be treated by your dermatologist. Hormone-Related Breakouts As a 29-year-old female, I still experience acne breakouts. My acne seems related to my monthly cycle as the breakouts occur the week just prior to starting my cycle. Are there any treatments for hormone-induced acne? Female hormones levels change and vary throughout the monthly cycle. These changes do cause acne to flare and diminish depending on the time of the month. The most effective way to treat menstrual cycle acne is to treat the acne itself. This can be done with topical medications, oral antibiotics, or even changing or adjusting a birth control pill. I've been told that adult acne in women of a certain age is mainly caused by hormonal imbalance. Is that true and what other causes are there? Hormones affect acne for sure. But having acne is not a sign of a hormonal imbalance. Changes in hormones, such as the specific point in your menstrual cycle (ovulation vs. having your period), pregnancy, or menopause all are normal, yet all can cause dramatic changes in your acne. Other conditions such as polycystic ovary disease (associated with excess facial hair) are not normal, and need to be treated. The best advice is to see your dermatologist. He or she can evaluate your skin and do blood tests if necessary to diagnose and treat your acne. I have never had a problem with breakouts until I started going through menopause. Now I have acne breakouts every month that look similar to boils. Can anything be done to prevent this? Yes, just because you are older does not mean that you cannot have cystic acne. First, try topical medications. If those do not work, then oral antibiotics, or even Accutane would be effective in treating boils. In your case, I would be a bit more aggressive, since scarring is a possibility with boils and cysts. |
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WebMaster Shirley J Gee 
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Copyright © Stuart H. Kaplan, M.D. All rights reserved. |
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