Description

Acne is a skin condition that occurs when hair follicles are clogged with oil and dead skin cells. Causes whiteheads, blackheads or pimples. Acne is most common among teenagers, though it affects people of all ages.

Effective acne treatments are available, but acne can be persistent. The pimples and bumps heal slowly, and when one begins to go away, others seem to crop.

Depending on its severity, acne can cause emotional distress and scar the skin. The sooner you start treatment, the lower your risk of this type of problems.

Symptoms

Acne signs vary depending on the severity of your condition:

  • Whiteheads (closed plugged pores)
  • Blackheads (open plugged pores)
  • Small red, tender bumps (papules)
  • Pimples (pustules), which are pimples with pus at their tips
  • Large, solid, lumps under the skin (nodules)
  • Painful, pus-filled lumps under the skin (cystic lesions)

Acne usually appear on the face, forehead, chest, upper back and shoulders.

When to see a doctor

If self-care remedies-don't clear your acne, see your primary care physician. He or she can prescribe stronger medications. If acne persists or is severe, you may want to seek medical treatment from a doctor who specializes in skin (dermatologist or pediatric dermatologist).

For many women, acne can persist for decades, with flares common one week before the menstruation. This type of acne tends to clear up without treatment in women who use contraceptives.

In older adults, a sudden onset of severe acne can be a sign of an underlying condition that requires medical attention.

The Food and Drug Administration (FDA) warns that some popular nonprescription acne lotions, cleansers and other skin products can cause a serious reaction. This type of reaction is quite rare, so do not confuse with any redness, irritation or itching that occurs in areas where you've applied medications or products.

Get emergency medical help if after using a skin product experience:

  • Weakness
  • Difficulty breathing
  • The swelling of the eyes, face, lips, or tongue
  • Tightness in the throat

Causes

Four main factors cause acne:

  • The excess oil (sebum) production
  • Hair follicles clogged by oil and dead skin cells
  • Bacteria
  • Inflammation

Acne usually appear on the face, forehead, chest, upper back and shoulders because these areas of the skin most oil (sebaceous) glands. Hair follicles are connected to oil glands.

The follicle wall may bulge and produce a whitehead. Or the plug may be open to the surface and darken, causing a blackhead. A blackhead may look like dirt stuck in pores. But actually the pore is congested with bacteria and oil, which turns brown when it is exposed to the air.

Pimples are raised red spots with a white center that develop when blocked hair follicles become inflamed or infected with bacteria. Blockages and inflammation deep in the interior of the hair follicles produce cystlike lumps beneath the surface of the skin. Another from the pores of his skin, which are the openings of the sweat glands, is not usually involved in acne.

Certain things can trigger or worsen the acne:

  • The hormonal changes. Androgens are hormones that increase in boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes during mid-life, especially in women, can lead to acne breakouts, too.
  • Certain medications. Examples include medicines that contain corticosteroids, testosterone, or lithium.
  • Of the diet. The studies indicate that the consumption of certain foods, including food rich in carbohydrates, such as bread, bagels and chips — may worsen the acne. Further studies are needed to examine whether people with acne will benefit from following restrictions in the diet.
  • Stress. Stress does not cause acne, but if you have acne already, the stress can make it worse.

Acne myths

These factors have little effect on acne:

  • Chocolate and greasy foods. Eating chocolate or greasy food has little or no effect on acne.
  • Hygiene. Acne is not caused by dirty skin. In fact, scrubbing the skin too hard or cleansing with harsh soaps or chemicals that irritate the skin and can make acne worse.
  • Cosmetics. Cosmetics does not necessarily worsen acne, especially if the use of oil-free makeup that does not clog pores (noncomedogenics) and remove makeup on a regular basis. Nonoily cosmetics does not interfere with the effectiveness of the acne drugs.

Complications

People with darker skin types are more likely than are people with lighter skin to the experience of these acne complications:

  • The scars. Faced to the skin (acne, scars) and thick scars (keloids), and can stay long-term after the acne has healed.
  • Changes in the skin. After the acne has disappeared, the affected skin may be darker (hyperpigmented) or lighter (hypopigmented) that before the condition occurred.

Risk factors

Risk factors for acne include:

  • Age. People of all ages can get acne, but it is more common in adolescents.
  • The hormonal changes. Such changes are common during puberty or pregnancy.
  • The history of the family. Genetics plays a role in acne. If both parents had acne, it is likely to develop it too.
  • Fatty or oily substances. You may develop acne when your skin comes in contact with oil or grease lotions and creams.
  • The friction or pressure on the skin. This can be caused by items such as telephones, cell phones, helmets, tight collars and backpacks.

Treatment

If you have tried the-counter (nonprescription) acne products for several weeks and have not helped, ask your doctor about prescription-strength medications. A dermatologist can help you:

  • Control your acne
  • To avoid scarring or other damage to the skin
  • To make the scars less visible

Acne medications work by reducing oil production and the swelling, or for the treatment of bacterial infection. With most prescription acne drugs, you may not see results for four to eight weeks. It can take many months or years for your acne to disappear completely.

The treatment regimen your doctor recommends depends on your age, the type and severity of your acne, and what you are willing to commit to. For example, you may need to wash and apply medications to the affected skin twice a day for several weeks. The topical medications and drugs you take by mouth (oral drugs) are often used in combination. Treatment options for pregnant women are limited because of the risk of side effects.

Talk with your doctor about the risks and benefits of medications and other treatments you are considering. And to make follow-up appointments with your doctor every three to six months until the skin improves.

Topical medications

The most common topical prescription medications for acne are:

  • Retinoids and retinoid-like drugs.Medicines that contain acids, retinoic acid or tretinoin are often useful for moderate acne. These come as creams, gels and lotions. Examples include tretinoin (Avita, Retin-a, others), adapalene (Differin) and tazarotene (Tazorac, Avage, other). Apply this medication in the evening, beginning with three times a week, then daily as your skin adjusts to it. Prevents the plugging of the hair follicles. Do not apply tretinoin at the same time as the benzoyl peroxide. Topical retinoids increase your skin's sensitivity to the sun. They can also cause dryness of the skin and redness, especially in people with brown or Black skin. Adapalene may be better tolerated.
  • Antibiotics. These work by killing excess skin bacteria and reducing redness and inflammation. During the first few months of treatment, you can use both a retinoid and an antibiotic, the antibiotic is applied in the morning and a retinoid at night. Antibiotics are often combined with benzoyl peroxide to reduce the likelihood of developing resistance to antibiotics. Examples include clindamycin with benzoyl peroxide (Benzaclin, Duac, and others), and erythromycin with benzoyl peroxide (The). Topical antibiotics alone are not recommended.
  • Azelaic acid and salicylic acid.Azelaic acid is a natural acid produced by a yeast. It has antibacterial properties. A 20% azelaic acid cream or gel appears to be as effective as many of the conventional treatments for acne when used two times a day. Prescription azelaic acid (Azelex, Finacea) is an option during pregnancy and during breastfeeding. It can also be used to manage the discoloration that occurs with some types of acne. Side effects include skin redness and minor skin irritation. The salicylic acid can help prevent connected to hair follicles and is available in wash-off and leave-on products. The studies that show its effectiveness is limited. The side effects include discoloration of the skin and minor skin irritation.
  • Dapsone. Dapsone (Aczone) 5% gel twice daily is recommended for inflammatory acne, especially in women with acne. Side effects include redness and dryness.

Retinoids and retinoid-like drugs. Medicines that contain acids, retinoic acid or tretinoin are often useful for moderate acne. These come as creams, gels and lotions. Examples include tretinoin (Avita, Retin-a, others), adapalene (Differin) and tazarotene (Tazorac, Avage, other). Apply this medication in the evening, beginning with three times a week, then daily as your skin adjusts to it. Prevents the plugging of the hair follicles. Do not apply tretinoin at the same time as the benzoyl peroxide.

Topical retinoids increase your skin's sensitivity to the sun. They can also cause dryness of the skin and redness, especially in people with brown or Black skin. Adapalene may be better tolerated.

Azelaic acid and salicylic acid. Azelaic acid is a natural acid produced by a yeast. It has antibacterial properties. A 20% azelaic acid cream or gel appears to be as effective as many of the conventional treatments for acne when used two times a day. Prescription azelaic acid (Azelex, Finacea) is an option during pregnancy and during breastfeeding. It can also be used to manage the discoloration that occurs with some types of acne. Side effects include skin redness and minor skin irritation.

The salicylic acid can help prevent connected to hair follicles and is available in wash-off and leave-on products. The studies that show its effectiveness is limited. The side effects include discoloration of the skin and minor skin irritation.

The evidence is strong in support of the use of zinc, sulfur, nicotinamide, resorcinol, sulfacetamide sodium or chloride of aluminum in topical treatments for acne.

Oral medications

  • Antibiotics.For moderate to severe acne, you may need oral antibiotics to reduce the presence of bacteria. Usually the first option for the treatment of acne is a tetracycline (minocycline, doxycycline) or a macrolide (erythromycin, azithromycin). A macrolide could be an option for people who can't take the tetracyclines, including pregnant women and children under 8 years of age. Oral antibiotics should be used for the shortest time possible to prevent antibiotic resistance. And that must be combined with other drugs, such as benzoyl peroxide, to reduce the risk of developing resistance to antibiotics. Serious side effects from the use of antibiotics to treat acne are rare. These drugs do not increase your skin sensitivity to the sun.
  • Combined oral contraceptives.Four of combined oral contraceptives are approved by theFDAfor the treatment of acne in women who also want to use for contraception. Are products that combine estrogen and progestin (Ortho Tri-Cyclen 21, Yaz, other). You may not see the benefit of this treatment for a couple of months, so that the use of other medicines for acne with him during the first few weeks can help. The common side effects of combined oral contraceptives are the weight gain, breast tenderness, and nausea. These drugs are also associated with an increased risk of cardiovascular problems, breast cancer and cervical cancer.
  • Anti-androgen agents. The drug spironolactone (Aldactone) may be considered for women and teen girls if oral antibiotics are not helping. It works by blocking the effect of androgens, the hormones in the oil-producing glands. Possible side effects include breast tenderness, and painful periods.
  • Isotretinoin.Isotretinoin (Amnesteem, Claravis, others) is a derivative of vitamin A. it can be prescribed for people whose moderate or severe acne that has not responded to other treatments. The possible side effects of isotretinoin oral include inflammatory bowel disease, depression, and severe birth defects. All persons receiving isotretinoin must participate in anFDA-approved risk management program. And they need to see their doctors regularly to check for side effects.

Antibiotics. For moderate to severe acne, you may need oral antibiotics to reduce the presence of bacteria. Usually the first option for the treatment of acne is a tetracycline (minocycline, doxycycline) or a macrolide (erythromycin, azithromycin). A macrolide could be an option for people who can't take the tetracyclines, including pregnant women and children under 8 years of age.

Oral antibiotics should be used for the shortest time possible to prevent antibiotic resistance. And that must be combined with other drugs, such as benzoyl peroxide, to reduce the risk of developing resistance to antibiotics.

Serious side effects from the use of antibiotics to treat acne are rare. These drugs do not increase your skin sensitivity to the sun.

Combined oral contraceptives. Four of combined oral contraceptives are approved by the FDA for the treatment of acne in women who also want to use for contraception. Are products that combine estrogen and progestin (Ortho Tri-Cyclen 21, Yaz, other). You may not see the benefit of this treatment for a couple of months, so that the use of other medicines for acne with him during the first few weeks can help.

The common side effects of combined oral contraceptives are the weight gain, breast tenderness, and nausea. These drugs are also associated with an increased risk of cardiovascular problems, breast cancer and cervical cancer.

Isotretinoin. Isotretinoin (Amnesteem, Claravis, others) is a derivative of vitamin A. it can be prescribed for people whose moderate or severe acne that has not responded to other treatments.

The possible side effects of isotretinoin oral include inflammatory bowel disease, depression, and severe birth defects. All persons receiving isotretinoin must participate in an FDA-approved risk management program. And they need to see their doctors regularly to check for side effects.

Therapies

For some people, the following therapies may be useful, either alone or in combination with medications.

  • The light therapy. A variety of light-based therapies have been tried with some success. Most require several visits to your doctor's office. Further studies are needed to determine the ideal method, light source, and the dose.
  • Chemical Peeling. This procedure uses repeated applications of a chemical solution, such as salicylic acid, glycolic acid or retinoic acid. This treatment for mild acne. You may improve the appearance of the skin, although the change is not of long duration, and repeat treatments are usually needed.
  • Drainage and extraction. Your doctor can use special tools to gently remove pimples and blackheads (comedos) or cysts that have not been cleared with topical medications. This technique temporarily improves the appearance of your skin, but it can also cause scars.
  • Injection of steroids. Nodular and cystic lesions can be treated by injecting a steroid into them. This therapy has resulted in a rapid improvement and pain reduction. Side effects can include skin thinning and discoloration of the treated area.

The treatment of children

Most of the studies of medication against acne have participated in people 12 years of age or older. Increasingly, younger children are getting acne as well. The FDA has expanded the number of topical products approved for use in children. And the guidelines of the American Academy of Dermatology indicate that the topical benzoyl peroxide, adapalene, and tretinoin in children-adolescents are effective and do not cause increased risk of side effects.

If your child has acne, consider consulting with a pediatric dermatologist. Ask about drugs to avoid in children, the appropriate dosage, drug interactions, side effects and how treatment may affect a child's growth and development.

Alternative medicine

Some alternative and integrative medicine approaches can be useful in the reduction of acne:

  • Tea tree oil. Gels containing at least 5% of tea tree oil may be as effective as lotions containing 5% benzoyl peroxide, although the tea tree oil might work more slowly. Possible side effects include minor itching, burning, redness and dryness, which make it a poor choice for people with rosacea.
  • The yeast of beer. A strain of yeast called Hansen CBS seems to help reduce acne when taken orally. May cause gas (flatulence).

More research is needed to establish the potential effectiveness and long-term safety of these and other integrative approaches, such as biofeedback and ayurvedic compounds. Talk with your doctor about the pros and cons of the specific treatments before you try them.

Lifestyle and home remedies

You can try to prevent or manage mild or moderate acne with otc products, good basic skin care and other self-care techniques:

  • Wash problem areas with a gentle cleanser.Twice a day, use your hands to wash your face with a mild soap or a gentle cleanser (Cetaphil, Vanicream, others) and warm water. And be nice if you shave the affected skin. Avoid the use of certain products, such as facial scrubs, astringents and masks. They tend to irritate the skin, which can worsen acne. Too much washing and cleaning, also can irritate the skin.
  • Try over-the-counter acne products for dry excess oil and promote peeling.Look for products that contain benzoyl peroxide and adapalene as the active ingredients. You can also try products that contain salicylic acid, glycolic acid or alpha hydroxy acids. It may take a couple of weeks of use of a product before you see any improvement. Creams are less irritating than the gels or ointments. Non-prescription acne medications may cause initial side effects, such as redness, dryness and peeling — that often improve after the first month of using them.
  • Avoid irritants. Oily or greasy cosmetics, sunscreens, hairstyling products or acne concealers can make acne worse. Instead, use products labeled as water-based or noncomedogenic, which means they are less likely to cause acne.
  • Protect your skin from the sun. For some people, the sun worsens the discoloration that often persists after the acne has disappeared. And some acne medications make you more susceptible to sunburn. Check with your doctor to see if medication is one of these. If so, stay out of the sun as much as possible. Regularly use a nonoily (noncomedogenic) moisturizer that includes a sunscreen.
  • To prevent the friction or pressure on the skin. Protect your acne-prone skin contact with items such as phones, helmets, tight collars or straps, and backpacks.
  • Avoid touching or picking acne-prone areas. Doing so can cause more acne, or lead to infection or scarring.
  • Shower after strenuous activities. The oil and sweat on your skin can lead to acne breakouts.

Wash problem areas with a gentle cleanser. Twice a day, use your hands to wash your face with a mild soap or a gentle cleanser (Cetaphil, Vanicream, others) and warm water. And be nice if you shave the affected skin.

Avoid the use of certain products, such as facial scrubs, astringents and masks. They tend to irritate the skin, which can worsen acne. Too much washing and cleaning, also can irritate the skin.

Try over-the-counter acne products for dry excess oil and promote peeling. Look for products that contain benzoyl peroxide and adapalene as the active ingredients. You can also try products that contain salicylic acid, glycolic acid or alpha hydroxy acids. It may take a couple of weeks of use of a product before you see any improvement.

Creams are less irritating than the gels or ointments. Non-prescription acne medications may cause initial side effects, such as redness, dryness and peeling — that often improve after the first month of using them.

Coping and support

The acne and the acne scars can cause anxiety and can affect their social relationships and self-image. Sometimes it can help to talk with your family, a support group or a counselor.

Stress can make acne worse. Try to manage stress by getting enough sleep, and practicing relaxation techniques.

Preparing for your appointment

If you have acne that does not respond to self-care and over-the-counter treatments, make an appointment with your doctor. Early, effective treatment of acne reduces the risk of scarring and lasting damage to their self-esteem. After an initial examination, your doctor may refer you to a specialist in the diagnosis and treatment of skin conditions (dermatologist).

Here's some information to help you prepare for your appointment.

What you can do

  • The list of your key medical information, such as other conditions that you are dealing with and any prescription or over-the-counter products that you are using including vitamins and supplements.
  • The list of personal information, including any major stresses or recent life changes.
  • List of questions to ask your doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.

Below are some basic questions to ask your doctor about acne. If any of the additional questions that occur during your visit, do not hesitate to ask.

  • What treatment approach do you recommend for me?
  • If the first treatment does not work, what would you recommend then?
  • What are the possible side effects of the medications you are prescribing?
  • How long can I safely use the medications you are prescribing?
  • How soon after the initiation of treatment, it may be that my symptoms start to improve?
  • When you are going to see me again to evaluate if the treatment is working?
  • It is safe to leave my medications if they don't seem to be working?
  • What measures of self-care, might improve symptoms?
  • You recommended changes in my diet?
  • Do you recommend any change in the over-the-counter products that I'm using on my skin, like soaps, lotions, sunscreens and cosmetics?

What to expect from your doctor

Your doctor may ask you a series of questions. Be ready to answer them may reserve time to go over any points you want to talk in-depth. Your doctor may ask:

  • When did you first develop this problem?
  • Is there anything in particular seem to trigger an outbreak of acne, such as stress or — in girls and women is the menstrual cycle?
  • What medications are you taking, including over the counter drugs and prescription drugs, as well as vitamins and supplements?
  • In girls and women: does the use of oral contraceptives?
  • In girls and women: do you have regular menstrual periods?
  • In girls and women: Are you pregnant, or planning to become pregnant soon?
  • What types of soaps, lotions, sunscreens, hair products, cosmetics are used?
  • How acne is affecting your self-esteem and their confidence in social situations?
  • Do you have a family history of acne?
  • What are the treatments and self-care measures that have been tried up to now? Have any been effective?
  • Have other members of the family had isotretinoin treatment or hormonal therapy for the treatment of your acne? Has been effective?
The symptoms and treatment of Acne