Acne Myths v.s. Facts

By Shohreh Shirkhorshidi, FNP

Nearly 17 million people in the United States suffer from acne. Nearly 85% of adolescent and young adult between ages of 12 to 24 develop acne. Although acne is not a serious health threat, there are emotional consequences. Low self esteem and depression have been linked with acne and acne scarring in adolescents and young adults.

Acne is a disorder of the skin's sebaceous glands that results in clogged pores and lesions commonly called pimples or zits.

What causes acne?

The exact cause of acne is unknown, but doctors believe it results from several factors. The main factor is high hormone levels of androgens, which increase during puberty. Stress, especially severe or prolonged emotional tension, may make acne worse. Certain drugs can cause acne. Greasy make up, rubbing the skin or pressure from such items as helmets and back packs, or environmental irritants like pollution or high humidity can aggravate the condition. Acne is not caused by eating chocolate or greasy food.

Physiology of acne

Small glands called sebaceous glands are located around hair follicles and produce an oily substance called sebum. Sebum seeps onto the skin surface through the opening of the follicle.

Acne occurs when sebum is not able to pass through the hair follicle. Cells lining the follicle shed too fast and clump together, plugging the follicle's opening. The mixture of sebum and cells causes bacteria to grow in the plugged follicles and produce enzymes that can cause inflammation. When a plugged follicle can no longer hold its content, it burst and spills sebum, skin cells and bacteria onto the skin.

Different stages of acne

Acne causes lesions called comedones, which are enlarged hair follicles plugged with oil and bacteria. Papules are inflamed lesions that are small pink bumps on the skin that are tender to touch. Pustules are inflamed pus filled lesions that are red at the base. Nodules are large painful, solid lesions that are lodged deep within skin. A cyst is a deep inflamed puss filled lesion that can cause pain and scaring.

Treatment of Acne

The purpose of treatment is to treat acne and prevent scaring. Acne medications reduce blockage of hair follicles, oil production, bacteria and inflammation. Some common over the counter medications are; benzoyl peroxide, salicylic acid, sulfur, and sulfur with resorcinol. Prescription medications include antibiotics and other chemicals that decrease the growth of the bacteria. These include benzoyle proxide, clindamycin solution, erythromycin solution, tetracycline tablets, minocin tablets, and tretinoin. If acne is severe or the patient suffers from cystic acne he or she may be treated with Isotretinoin (Accutane) for 12-16 weeks. Special precaution should be taken with young females of childbearing potential when on Isotretinoin.

Other treatments are steroids, anti-androgen drugs, and birth control pills. Usually it takes about four to six weeks before improvement is noticed. Use of Hydroquinone to treat hyperpigmentation of skin during and after treatment of acne is useful. Laser, intense pulsed light (IPL), chemical peels, and photodynamic therapy have become very popular in treatment of acne in recent years and they usually have good results. Laser resurfacing has become very popular to correct scaring from acne.

There also things one can do to help in the treatment of acne: wash skin gently one to two times per day, choose skin care products that are non-comedogenic, wash hair regularly, and tanning should be avoided. Choose your cosmetics carefully, they should be oil free.

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