- 1 Identification
- 2 Prevention
- 3 Treatment
IntroductionAcne is the most common of all skin disorders. No matter what your race or age may be, acne is a universal problem. It affects more that 95% of the world’s population. While acne usually dissipates by the time most of us reach our 30’s, some people experience adult acne well into their thirties and possibly longer. All acne is a disorder of the pilosebaceous unit, which is made up of a hair follicle, sebaceous gland, and a hair. These units are found everywhere on the body except on the palms, soles, top of the feet, and the lower lip. The number of pilosebaceous units is greatest on the face, upper neck, and chest. Sebaceous glands produce a substance called sebum, which is responsible for keeping the skin and hair moisturized. During adolescence sebaceous glands enlarge and produce more sebum under the influence of hormones, also called androgens. After about the age of 20, sebum production begins to decrease.
What is Acne?Acne is the term for plugged pores (blackheads and whiteheads), pimples, and even deeper lumps (cysts or nodules) that occur on the face, neck, chest, back, shoulders and even the upper arms. The scientific name for acne is acne vulgaris, which sounds just dreadful but literally means “common acne.” This is the type of acne that affects more teenagers and adults later in life, and is not to be confused with Rosacea. Cystic acne occurs when your skin glands become plugged with oil, which causes lesions to break out. These are commonly referred to as pimples or zits. When severe, acne can lead to serious and permanent scarring. Sometimes even less severe cases can lead to scarring. The following are visible signs of acne:
- Comedo (plural comedones)- A comedo is a sebaceous follicle plugged with sebum, dead cells from inside the sebaceous follicle, tiny hairs, and sometimes bacteria. When a comedo is open, it is commonly called a blackhead because the surface of the plug in the follicle has a blackish appearance. A closed comedo is commonly called a whitehead; its appearance is that of a skin-colored or slightly inflamed “bump” in the skin. The whitehead differs in color from the blackhead because the opening of the plugged sebaceous follicle to the skin s surface is closed or very narrow, in contrast to the distended follicular opening of the blackhead. Neither blackheads nor whiteheads should be squeezed or picked open, unless extracted by a dermatologist under sterile conditions. Tissue injured by squeezing or picking can become infected by staphylococci, streptococci and other skin bacteria.
- Blackheads are the open comedones and the visible black spot is the opening of the clogged pore, where bacteria, oil and dead skin cells have accumulated. It’s almost impossible to prevent blackheads; however there are easy methods of prevention and treatment that can even be carried at home. Try to regularly steam the skin to soften the oils that clog up the pores. Use products containing salicylic or glycolic acids to keep the pores clean, pore strips are also effective in lifting some blackheads. To rid them at home, place a warm to hot compress on the area and then gently squeeze the blackhead with a clean tissue. Don’t squeeze too hard and if it does not come out don’t keep trying as you damage the surrounding skin cells that could leave to scarring.
- Whiteheads are also known as closed comedones and should only be removed and extracted by experienced dermatologists or aesthetician. If they are not removed in the right manner, infections can occur which often lead to ugly scarring. The main thing to remember is that it is important to keep the pores unclogged to prevent whiteheads; try products containing salicylic acid. Other methods of treatment are regular facials to clean clogged pores and the use of topical drugs and/or antibiotic creams that should be prescribed by a skin health professional. Keep the skin clean and always well exfoliated followed by regular moisturizing.
- Papule – A papule is defined as a small (5 millimeters or less), solid lesion slightly elevated above the surface of the skin. A group of very small papules and microcomedone may be almost invisible but have a “sandpaper” feel to the touch. A papule is caused by localized cellular reaction to the process of acne.
- Pustule – A dome-shaped, fragile lesion containing pus that typically consists of a mixture of white blood cells, dead skin cells, and bacteria. A pustule that forms over a sebaceous follicle usually has a hair in the centre. Acne pustules that heal without progressing to cystic form usually leave no scars.
- Macule – A macule is the temporary red spot left by a healed acne lesion. It is flat, usually red or red-pink, with a well-defined border. A macule may persist for days to weeks before disappearing. When a number of macules are present at one time they can contribute to the “inflamed face” appearance of acne.
- Nodule – Like a papule, a nodule is a solid, dome-shaped or irregularly-shaped lesion. Unlike a papule, a nodule is characterized by inflammation, extends into deeper layers of the skin and may cause tissue destruction that results in scarring. A nodule may be very painful. Nodular acne is a severe form of acne that may not respond to therapies other than isotretinoin.
- Cyst – A cyst is a sac-like lesion containing liquid or semi-liquid material consisting of white blood cells, dead cells, and bacteria. It is larger than a pustule, may be severely inflamed, extends into deeper layers of the skin, may be very painful, and can result in scarring. Cysts and nodules often occur together in a severe form of acne called nodulocystic. Systemic therapy with isotretinoin is sometimes the only effective treatment for nodulocystic acne. Some acne investigators believe that true cysts rarely occur in acne, and that (1) the lesions called cysts are usually severely inflamed nodules, and (2) the term nodulocystic should be abandoned. Regardless of terminology, this is a severe form of acne that is often resistant to treatment and likely to leave scars after healing.
- Oily skin: The sebum production increases so that your skin looks and feels oily.
- Hyperpigmentation: After the inflammation subsides, the skin can be discolored by brown acne stains, called Hyperpigmentation, and damaged by scars. Acne scars are common and may occur even in mild acne.
Acne EffectsAcne is not just a cosmetic disease. It is obvious that acne can worsen your looks and can result in permanent physical scars; however, it is usually never life-threatening. This does not mean acne is a simple cosmetic disease though.
- Acne pimples or zits can be tender and painful.
- Acne can cause embarrassment and anxiety, even to the point of depression. Emotional effects can lead to mood changes, depression, social withdrawal and poor performance in school or at work. If acne is bad enough to leave scars, you may have to endure these emotional issues for years, because scarring is not readily correctable.
- Acne also has significant economic impact. Americans spend well over a hundred million dollars a year for non-prescription acne treatments, not even taking into account special soaps and cleansers. But there are also the costs of prescription therapies, visits to physicians and time lost from school or work. In extreme cases, the pimples can drain pus and blood, soiling pillowcases and clothing.
Who Gets Acne?Almost everyone will have acne – most get mild cases, some moderate, and a few are severe. Teens aren’t the only ones who get it. Acne has been diagnosed in young infants as well as in the elderly, but it is most often seen in teens and young adults with 85-100% of adolescents and up to 10% of young adults getting it.
- Baby acne most often occurs a few weeks after your child’s birth. While it may alarm you, the most important thing to remember is: Don’t panic. The condition will usually go away on its own. You can help your baby’s skin by not using creams or oils and try to avoid over-scrubbing their faces. It’s probably safe to say that the acne is not bothering your baby, so try not to let it bother you. Baby acne should go away in 4 to 6 months as your child’s hormones level out.
- Before children reach puberty, acne is more commonly seen in girls. During puberty, acne affects boys and girls almost equally, but boys generally have more severe cases. Acne most often starts at around age 11 for girls and 13 for boys. Often it will last for about 5 years, but can persist for as long as 10-20 years. About 25% of teens who have acne will still have it when they turn 25. The cause is not understood, but it’s becoming more common for women who are in their 20s, 30s, and 40s to develop acne, often for the first time.
- Acne affects young men and young women about equally, but there are differences. Young men are more likely than young women to have more severe, longer lasting forms of acne. Despite this fact, young men are less likely than young women to visit a dermatologist for their acne. In contrast, young women are more likely to have intermittent acne due to hormonal changes associated with their menstrual cycle and acne caused by cosmetics. These kinds of acne may afflict young women well into adulthood.
Acne in TeensAcne commonly starts in the early teen years, when the oil glands in the body start making more sebum (oil). Some people also have too many “sticky” skin cells. In people who have acne, these cells mix with the oil and plug up the hair follicles in the skin. A “whitehead” results when the hair follicle is plugged with oil and skin cells. If this plug reaches the surface of the skin and the air touches it, it turns black and is called a “blackhead.” A blackhead isn’t caused by dirt. If the wall of a plugged follicle breaks, the area swells and turns into a red bump. If the follicle wall breaks near the skin surface, the bump usually becomes a pimple. If the wall breaks deep in the skin, acne nodules or cysts can form. This is called “cystic acne.”
Sebaceous Glands Normally Work to Moisturize the Skin…The pilosebaceous unit, which is made up of a hair follicle, sebaceous gland, and a hair, is found everywhere on the body except on the palms, soles, top of the feet, and the lower lip. The Sebaceous glands produce a substance called sebum, which is responsible for keeping the skin and hair moisturized. Normally, the sebum produced by the sebaceous gland combines with cells being sloughed off within the hair follicle and “fills up” the hair follicle. When the follicle is “full”, the sebum spreads over the skin surface giving the skin an oily appearance. When this process works correctly, the skin is moisturized and remains healthy.
…But Acne Occurs When They Become CloggedFor reasons that are still unclear, some hair follicles become obstructed. The sebum is produced but gets trapped, and the cells that are normally sloughed off become “sticky”, plugging up the follicle. A good facial routine of cleansing, exfoliating and moisturizing is important to acne prevention, especially if you are more prone to acne, like those with oily skin. It is a common perception that most cases of acne will eventually go away. But some cases of acne, if left untreated, will develop in intensity and maybe even lead to more permanent scarring. While chemical peels, laser therapy and skin fillers can certainly improve acne scarring, it is best if you can prevent their formation in the first place.
Acne CausesWhat we know for sure about acne is that it is caused by hormonal changes in adolescents and young adults, but the exact reason why some people get acne and others don’t, or why some people get much worse acne breakouts than others is unknown. We do know that acne is at least partially hereditary, which speaks more to a genetic predisposition and not something that can be physically changed or altered in your everyday routine. Almost all teenagers get acne at one time or another. You haven’t done anything to cause your acne. It’s not your fault if you have it. Pimples are caused when oil ducts in the skin get plugged up and then burst, causing redness and swelling. Although there are many myths about acne, the following are the three main factors that cause it.
- Hormones: When you begin puberty, certain hormones, called androgens, increase in both males and females. These hormones trigger oil ducts on the face, back and upper chest to begin producing oil. This can cause acne in some people.
- Heredity: If other members of your family had acne as teenagers, there may be a chance that you’ve inherited a tendency toward getting acne as well.
- Plugged oil ducts: If you are prone to acne, the cells that line the oil ducts in your skin tend to get larger and produce more oil, and the ducts get plugged. This traps the oil and leads to the formation of blackheads or whiteheads. The plugged ducts allow germs in the skin to multiply and produce chemicals that cause redness and swelling. This is why simple blackheads and whiteheads may turn red and bumpy and turn into the pimples of acne.
Keeping Acne Under ControlIf you have acne, there are some things that can make it worse. To keep acne under control, try the following:
- Pinching (or “popping”) pimples, which forces oil from the oil ducts into the surrounding normal skin, causing redness and swelling.
- Harsh scrubbing, which irritates the skin.
- Things that rub on the skin, such as headbands, hats, hair and chin straps, which also cause irritation.
- Certain cosmetics (makeup), such as creams and oily hair products, which can block oil ducts and aggravate acne.
- Some medications
- Emotional stress and nervous tension.
- Too much exposure to the sun
Shorten LifespanThere are many things you can also do to shorten the lifespan of a pimple:
- When you first notice that you are breaking out with a pimple it is important that you try your best not to touch it. This can be very difficult to do because pimples are so annoying. The less you touch it the less aggravated you will make it.
- Get a cloth and soak it in warm water. Press it against your pimple and hold it in place for one minute. This will help the swelling go down and helps pimples go away sooner.
- Wash your face with a gentle cleanser like Purpose or Cetaphil. These cleaners are great because they do not over dry skin and they help prevent future acne breakouts.
- After you have washed your face apply salicylic acid onto your pimple. We recommend using a q-tip to dot the salicylic acid onto your pimple. You can also use a cotton ball.
- In the morning after you have washed your face and removed the salicylic acid, apply a thin layer of benzoyl peroxide onto your pimple. This facial medication will help shorten the duration of your pimple.
What Doesn’t Cause Acne?Many myths are often associated with acne. For example, there is little evidence that chocolate or greasy foods have any involvement in development of acne nodules. Another common misconception is that dirty skin and poor hygiene causes acne, however, it’s normally an allergic reaction to bacteria in your pores that can cause acne and unfortunately, scrubbing won’t solve the problem. Factors that don’t cause Acne:
- Food: Acne is not caused by foods you eat. Despite what you may have heard, there is no proof that soft drinks, chocolate and greasy foods cause acne. If you happen to be one of the few who actually are affected by a certain food, then don’t eat it! As a general rule, however, your body will always respond better to a good diet and lots of water.
- Dirt: It’s not caused by dirt. The black plug in a blackhead is caused by a chemical reaction. It’s not dirt. No matter how carefully you wash your face, you can still have acne.
- Social Contact: It’s not something you can “catch” or “give” to another person. It’s not caused by sexual thoughts or masturbation.
- Hygiene: Acne is not caused by poor hygiene. Acne is caused by extra skin and oil, but if you wash your skin hard and too often, you can make your acne worse. Remember: acne is not caused by dirt or surface skin oils; therefore “over washing” your epidermis will not help.
- Stress: Acne is not caused by stress. If anything, stress may worsen acne. The worsening of acne from stress is because more sebum, or oil, is released when you are stressed out.
TreatmentMany people are able to manage their acne with over-the-counter (non-prescription) treatments. For some, however, acne is more serious. In fact, by their mid-teens, more than 40% of adolescents have acne severe enough to require some treatment by a physician. Today, virtually every case of acne can be resolved. Treatments vary, however, as the causes of acne are still somewhat unclear. In addition, it’s good to keep in mind that while some acne treatments really do work, not all acne treatments work the same for everyone. What is successful for controlling acne with one person might not necessarily be effective for someone else. Acne responds especially well to early treatment. Dermatologists recommend that acne be treated early to maximize effectiveness as well as help prevent scarring. Mild acne can often be cleared up simply by washing your face once or twice daily. If this doesn’t work, try some of the over the counter products that clear skin. Many of these drugs are “peeling agents,” which cause irritation and drying, which in turn helps the body loosen plugs and shed dead cells. If nothing is working for you, see a dermatologist. The key to getting rid of acne lesions and preventing new ones from forming lies in knowing that:
- Resolution takes time. Treatments that promise fast, miraculous or overnight results often capture the attention of acne sufferers hoping for quick resolution. However, the fact remains that acne does not clear overnight.
- On average, 6 to 8 weeks are needed to see initial results.
- Once acne significantly improves or clears, continued treatment is needed to keep acne from reappearing.
- If acne does not improve in 6 to 8 weeks, treatment may need to be adjusted as not every acne treatment clears every case of acne.
- What works for one person may not work for another. What is an appropriate treatment for one person may not clear another’s acne. Many factors affect resolution, including:
- the cause(s) of the acne
- a person’s skin type
- the kind of acne lesions present
- the severity of the acne
- types of lesions present
- co-existing conditions
- the patient’s…
- skin type
Chemical PeelsA chemical peel can smooth the skin, reduce oil, and lower the number of cystic acne nodules. We recommend our Salicylic/20 chemical peel. With more severe acne, cystic acne, we recommend alternating between the Salicylic/20 and the Lactic/50. Using the two together allows for a peel much deeper than the Salicylic/20 by itself.
Salicylic PeelSalicylic acid has several properties that make it a very effective treatment for acne.
- Anti-inflammatory: It acts as an anti- inflammatory to help immediately reduce the inflammation of the acne.
- Oil Soluble: Also, the salicylic acid is oil soluble so it can penetrate the sebum clogged pores better than glycolic acid or lactic acid, which are both water soluble. Oil solubility helps in two ways:
- Penetration: First, the outside layer of your skin is covered in oil, meaning that the oil-soluble salicylic molecule is able to penetrate this outer layer.
- Focus: However under this outermost layer is the dermis, and this layer is made up of mostly water. As you know oil and water don’t mix, and this keeps the salicylic acid from moving down past the outer most levels of the epidermis, making it the safest of our home chemical peels.
- Gentle: Salicylic is relatively gentle.
- Exfoliation: Salicylic is a great exfoliator.
- Low Risk: Also, the salicylic peel has little risk of complication because of the nature of the molecule.
What You Should KnowOf course nothing is without a downside, and Salicylic acid’s is that it can be very drying to the skin. So if you’re using it on a regular basis you need to apply a noncomedonic moisturizer like Cetaphil to prevent excessive dryness. Also, because it works at the surface of the skin it does not work as well at fading pigmentation beneath the epidermis as the Glycolic or the Lactic. It can also be very effective to combine the lactic acid and salicylic acid treatments. Lactic acid is a natural humectant and actually pulls moisture into the skin. By alternating between the peels you get the benefits of the salicylic without the excessive dryness. If alternating, apply them 3-4 days apart, depending on your skin’s sensitivity. For milder acne, salicylic acid helps unclog pores to resolve and prevent lesions. It does not have any effect on the production of sebum. Like many other topical acne treatments, salicylic acid must be used continuously, even after acne lesions have healed. Its effects stop when you stop using it, so your skin will return to its uneven shedding; pores become clogged, and acne returns.
BHA+ Peel: A One-Two Punch Against AcneThe Best of Both Worlds
- The Beta component, Salicylic Acid, is a common treatment for acne, but we have increased the concentration to a more effective level, but you can still purchase over the counter.
- In addition, there is second component, the Alpha Hydroxy acid: Lactic. This helps keep your skin exfoliated and fresh, preventing the ability of acne to form under the skin and in the pores.
The BHA+ peels can truly stop your acne outbreak in its tracks.
Acne Fighting RoutineWhen determining a routine, everyone’s skin is a little different. Most people tolerate salicylic acid well and can apply much more often than other peels. We recommend applying salicylic twice daily for approximately 2 weeks, to clear up any existing acne. Only apply twice daily if your skin shows no sign of irritation. If your skin becomes irritated, apply once every day, or every other day; whichever your skin will allow. Once the acne begins to clear, introduce the Benzoyl Peroxide cream as well. This cream will help fight any bacteria on the surface of your skin that is acne causing. Apply a Salicylic/20 peel in the morning, and apply the Benzoyl cream in the evening. Remember not to get frustrated. Exfoliation is a process that takes some time. The cleansing process scrubs your clogged pores that are embedded with dirt and dead skin cells. As the top layers are removed, this congestion inside the skin may emerge in the form of blemishes. The entire process takes several weeks to purge the skin, but afterwards skin should be noticeably smoother and cleaner.
Other TreatmentsBenzoyl peroxide, resorcinol, salicylic acid and sulphur are the most common over-the-counter medications used to treat acne. Each works a little differently. These medications are available in many forms, such as gels, lotions, creams, soaps or pads. In some people, over-the-counter acne medications may cause side effects such as skin irritation, burning or redness. Tell your doctor if you have side effects that are severe or that don’t go away over time. Successful acne treatments and acne products include topical bactericidals, topical and oral antibiotics, hormonal treatments for women, topical retinoids (Retin-A®), or oral retinoids (such as Accutane® or Claravis®). Retinoids work by influencing the lifecycle of the cells related to acne. Solutions for fighting acne while building stronger, healthier skin include IPL Photofacial, Blue Light Therapy, Thermage®, Laser Skin Rejuvenation and Microdermabrasion. Your doctor may recommend antibiotics, which can be very effective for treating acne. They can be taken by mouth, or used on the skin in a lotion, cream or gel. Retinoid, such as tretinoin (brand names: Retin-A, Avita, Altinac cream) and adapalene (brand name: Differin), are other medicines for treating acne. They are usually rubbed onto the skin once a day. Be sure not to get them near your eyes, mouth and the area under your nose. If you use a retinoid, you must avoid the sun or use a strong sunscreen because this medicine increases your risk of getting severe sunburn. Girls who are pregnant or may become pregnant should not use a retinoid called tazarotene (brand name: Tazorac) because it can cause birth defects. Isotretinoin (brand name: Accutane) may be used to treat severe cystic acne that doesn’t get better with other treatments. It’s a pill that is taken once a day by mouth for 15 to 20 weeks. In girls, isotretinoin can cause very serious side effects such as birth defects and miscarriages. It should never be taken during pregnancy or even 1 month before pregnancy. Girls must use 2 types of birth control or not have sex while they take isotretinoin, as well as 1 month before they start and 1 month after they stop taking isotretinoin. While taking isotretinoin, it is possible that other side effects may occur. Anyone taking isotretinoin should be closely monitored by his or her doctor.
Acne Treatment TipsWe’re afraid there is no such thing as instantaneous zit remover, despite what many ads claim. There are a couple of things you can do though, that will speed up the healing and diminish their appearance. A secret that the movie makeup artists use to remove redness from pimples and spots is to apply some Visine red eye drops. The same stuff that removes the red from your eyes will help shrink the capillaries on your spot. We also recommend applying a 20% Salicylic Acid solution for 3 minutes, and then rinse it off. If you have oily skin, and find that you need a little more oomph, you can normally leave it on overnight. The oily skin will neutralize the salicylic acid, without the need to wash it off. But be careful, you can only do this with the salicylic acid, not with any of the AHA’s like glycolic or lactic, because the molecules are different. AHA’s won’t be able to self-neutralize.
Whitehead Tips & WarningsWhiteheads, often called zits, are frustrating to anyone suffering from acne. Whitehead acne treatment is not difficult, but must be done with care to prevent acne scarring and problem skin later on in life. With caution, however, treating zits and removing whiteheads can be easily remedied at home. If your whitehead acne is persistent, consult with a doctor or an esthetician (skin care professional) for a personalized acne treatment and prevention plan. The salicylic acid works to reduce the inflation and swelling around the whitehead. It also helps to kill the bacteria causing the infection, and in the end causing the whitehead to shrink. Two methods for directly fighting whiteheads exist. The first relies almost entirely on salicylic. The second is more aggressive and physically oriented. The First Method:
- For the best effect, apply salicylic acid only to the inflamed whitehead, and leave it on. The salicylic acid will self-neutralize for the most part.
- After several minutes, if it starts to sting, take a wet paper towel and gently dab the area that is causing discomfort. This will neutralize that area, and prevent the peel from penetrating too deep.
- The peel can be removed with water when the application time is finished.
- With clean hands, gently insert the sharpened tip of the blood lancet into the whitehead. It is important to just puncture the tip of the whitehead. Do not “pick” the whitehead with the lancet. The goal is to create a small opening in the whitehead to allow the whitehead acne to drain.
- With clean fingers, and using only the fingertips, not the fingernails, apply gentle, even pressure on both sides of the whitehead. The white pus from the whitehead acne should flow slowly out of the opening created by the lancet. When finished, clean the area again with the washcloth.
- Apply one drop of tea tree oil to the area where the whitehead acne had been. Tea tree oil is a home remedy for acne. Its antibacterial properties make it an ideal natural acne treatment. Apply one to three times per day to help prevent acne or treat acne.