Acne Overview
Acne is a red, irritating skin rash that is almost universal among individuals going through puberty in industrialized societies. It can, however, occur at all ages. Typical acne affects the skin of the face, chest, and back and rarely the neck and upper arms of teenagers and young adults.

adult acne
Because acne typically occurs during a time of dramatic physical and psychological changes associated with the development of one’s body image, it can exacerbate social withdrawal and even depression. Left untreated, severe acne can lead to disfiguring scarring which can be difficult to treat.
Several myths exist about acne.

Acne is not a result of uncleanliness or infrequent washing. In other words, acne does not result from too much dirt on the skin or in the pores. Too much scrubbing may actually make acne worse.

Acne is not caused by eating “fast” foods, chocolate or high-fat foods.
Acne Causes
Several factors contribute to the development of acne. The primary problem is the abnormal development of cells inside the hair follicle, leading to the formation of a plug or blackhead (comedo). The plug inhibits the normal movement of hair, skin cells and grease (sebum), resulting in enlargement and eventually rupture of the hair follicle. A ruptured hair follicle spills its contents of oil and debris into the skin where it leads to swelling and causes redness (inflammation).
Propionibacterium acnes, a type of bacteria that normally lives in the skin hair follicles, also plays a role in acne. These bacteria produce substances that cause redness and irritation (inflammation). They also make enzymes, which dissolve the sebum from the oil glands in the skin into irritating substances. These substances also make the inflammation worse.

Certain hormones called androgens are an additional factor in causing acne. Androgens are male hormones that are present in both men and women but are higher in men. Androgens do two things: First, they enlarge the sebaceous glands in the skin. Second, they cause these glands to increase sebum (oil) production. The increased sebum production exacerbates plug formation and serves as more “food” for the bacteria. Androgens surge at puberty, which is why teens develop armpit and pubic hair and why boys develop facial hair and deeper voices. This hormonal surge also contributes to the development of acne in teens.

Estrogens, which are the female hormones, actually can help to improve acne in girls. A woman’s monthly menstrual cycle is due to changes in the estrogen levels in her body. This is why acne in a female may get better and then get worse as she goes through her monthly cycle. A doctor may recommend acne treatment with birth control pills, which contain the helpful estrogens.

It is now also believed that severe acne can run in some families. This may be due to genetic factors that has not yet been discovered.

Anatomy of the hair follicle: Hair follicles exist on virtually all skin except for the palms of the hands and soles of the feet. Inside the follicle, the hair extends up from the deep layers of the skin and comes out of a pore. Near the surface, the oil gland (sebaceous gland) enters the hair follicle where it empties sebum at a relatively constant rate. The sebum lubricates the skin and provides a protective barrier to prevent drying. Skin on the face, chest, and back has an especially large number of sebaceous glands. These are the areas where acne occurs.

Acne lesions: There are two major types of acne lesions: noninflammatory and inflammatory. Noninflammatory acne lesions include blackheads (open comedones) and whiteheads (closed comedones). Open and closed comedones along with papules and pustules are referred to as papulopustular acne, a form of inflammatory acne. Nodular acne is the most severe form of inflammatory acne.

Noninflammatory acne: Open comedones result from the enlargement and dilation of a plug that forms from oil and skin cells inside the hair follicle.

The hair follicle pore remains open, exposing a black plug (known as a blackhead). The dark color is not dirt inside the pore. Instead it is the oil inside the pore, which has become exposed from the outside air.

A closed comedo forms if the hair follicle pore remains closed. The plug in a closed comedo or whitehead is therefore not exposed to the outside air, and no black color develops. The closed comedo simply appears as a tiny, sometimes pink bump in the skin.

Inflammatory acne: Inflammatory acne lesions consist of red blemishes, pimples also called zits (papules, pustules), and larger, deeper swollen tender lesions (nodules).

Papules are closed comedos, which have become red, swollen, and inflamed.

Pustules are closed comedos, which become inflamed and begin to rupture into the skin forming pustular heads of various sizes.

Nodules represent large, tender, swollen acne lesions, which have become intensely inflamed and rupture under the skin. If untreated, these can produce deep scarring.
When to Seek Medical Care
Acne that does not improve with over-the-counter medicines should be evaluated by a doctor.

People with acne that is severe and tender or who already have scarring should also be seen by a doctor.

Women with acne who develop facial hair or have irregular periods require evaluation by a doctor.

Anyone with a sudden severe worsening of their acne or acne withfever and severe swelling should see a doctor immediately. These could be signs of a serious skin infection. laser-for-acne
Self-Care at Home
Wash once or twice daily with soap and water to remove excess oil from the skin. An acne cleanser purchased over-the-counter in any drug store can also be helpful. Avoid scrubbing or using abrasives because this can actually irritate the skin and cause acne to worsen.

Over-the-counter acne medications can be used either at bedtime or during the day. Always follow the directions on any acne product. These products generally do not have any beneficial effects on inflammatory lesions, pimples, and are essentially used to prevent the development of new lesions. Therefore they should be applied to all of the skin in affected areas.

Many cover-up products are available without a prescription to improve the appearance of blemishes while they have a chance to heal. Most work well and should not worsen acne. If makeup is worn, it should be water-based, and the ingredients of the makeup should list water as a major component.

Some cosmetics and other skin-care products, however, can cause acne to worsen. Look for makeup, cosmetics, and skin-care products labeled with the word noncomedogenic. This means that it does not cause or worsen acne.

Recent, very preliminary, reports seem to associate cow’s milk with more severe cases of acne.

It is of major importance that the patient with acne does not manipulate their lesions. Manipulation (pinching, squeezing, etc) of any type is almost uniformly going to result in worsening of any existing disease, potentially enhancing the chance for scarring and producing more long-lasting pimples.

Treatment:

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