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Acne

Hair folicleAcne  is a common skin problem of people in their teens and twenties.  It’s severity may range from an occasional pimple to severe scarring.  Areas of the body usually affected include the face, chest, shoulders, and upper back.

What happens?

Acne happens because of plugging of or inflammation around the oil glands that are part of the body hair systems.  Everybody’s skin is normally covered with little hairs and their accompanying oil glands.  During adolescence and early adulthood, the body’s hormones stimulate the body hairs to grow (in both sexes) and the oil glands to excrete more oil.  The hair and oil channels and their openings (pores) tend to plug up with a material which traps the oil.  Bacteria are trapped with the oil.  Whiteheads occur when the oil channels are plugged up and blackheads appear when the material at the surface of the channel is oxidized.  Pimples (either red bumps or whitish pustules) occur when the body sets up an inflammatory reaction to the contents of the plugged channel.  Sometimes the inflammatory response is severe causing nodules, cysts and subsequent scarring.

Cleanliness

It is a misconception that acne is caused by dirt and that prolonged and vigorous washing and scrubbing will make the problem go away.  Over-scrubbing may actually worsen the condition.  Briefly washing with a mild soap and water twice a day is sufficient.

Squeezing pimples - Don’t do it.  It increases the likelihood that the material in the blocked gland will rupture beneath the skin and cause more inflammation.

Diet

Foods do not cause acne, but there has been ongoing debate about whether some foods may aggravate it.  Eat a healthy, well-balanced diet.  If you are convinced that a particular food aggravates your acne, don’t eat it.

Sex

There is no relationship between acne and sexual activity, sexual inactivity, or masturbation.

Cosmetics

Use water-based products as oil-based products may plug pores and worsen acne.

Your Treatment

Follow your clinician’s instructions as they are directed at your particular situation.

Topical Treatments

These are external anti-acne treatments.  All are applied regularly to the areas likely to break out with acne.  They work slowly to stop the appearance of new lesions.  No benefit may be seen for a month or more, and the benefit may increase over two to three months.  About 2/3 of patients get a good response.  Stick to the treatment and be patient.

Benzoyl peroxide and Retin-A, especially, may be irritating.  To minimize irritation, they should be applied thinly, with care taken to avoid application in folds around the eyes, nose and mouth.  They are more irritating to moist skin, so they should not be applied within 15 minutes of washing.  Washing should be infrequent (twice a day) and with mild soap.  Strong acne soaps tend to increase irritation.

Benzoyl Peroxide  This helps to reduce inflamed pimples and will also reduce blackheads.  It should be applied twice a day - to the point that the skin feels slightly dry and tight, but not to the point of redness or irritation.  Some people can tolerate it only once a day, but most people can tolerate it twice a day.  Find the schedule that suits your skin.  Occasionally, an allergy to it will develop, so if an itchy red rash occurs, stop treatment.  Also, be aware that benzoyl peroxides have a mild bleaching action on dark clothing.

Topical Antibiotic  Like benzoyl peroxide, topical antibiotics help prevent new pimples.  They have no effect on blackheads.  Most are in alcohol solutions and may be slightly drying, but usually don’t irritate as benzoyl peroxides might.  They do not bleach clothing.  They are applied twice daily to acne-prone areas.

Retin-A  is the brand name of tretinoin.  It works best against blackheads but also reduces pimples.  It can be used once a day or twice a day.  It is used in very small amounts and massaged in gently.

Other Treatments

In resistant cases, an antibiotic may be prescribed to be taken by mouth.  These take several weeks before a helpful effect occurs.

Accutane may be used in severe nodular/cystic acne.  Because of its toxicity and ability to damage unborn babies, its use is beyond the scope of Student Health Services.