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All about Acne

Acne is a chronic skin disease involving inflammation of the sebaceous glands. It affects 80% of teenagers and many adults, especially women, 35% being between the ages of 30 and 40. Acne represents 15-20% of all dermatology consultations.  

Disease overview

Description

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Acne is a skin disease that is particularly common among adolescents, though some people have acne that lasts into adulthood. Gollnick 2003

Acne involves a disorder with glands in the skin that are located next to hair follicles. These glands, called sebaceous glands, secrete an oily substance called sebum. Everyone has these glands, and the secretion of sebum is normal, but people with acne have larger glands that release more sebum in into the skin. The excess sebum can trap oil, bacteria, and skin cells. One bacterium in particular, known as P. acnes , is able to thrive in these conditions. P. acnes is normally present in the skin, however in people with acne they are present in much greater numbers. The growth and proliferation of these bacteria can cause inflammation of the skin, leading to pimples. Gollnick 2003

Diagnosis

In most cases, a dermatologist or other health care provider can diagnosis by examining the affected skin. However, your doctor may ask several questions that are aimed at ensuring a proper acne diagnosis and to rule out other skin disorders. These include questions about: Bershad 2008

  • Areas of sensitive skin, or eczema
  • Other diseases that may affect the ability to handle medications
  • Previous drug allergies
  • Use of steroids (e.g., for bodybuilding)
  • Mood disorders or depression
  • Use of contraceptives, irregular menstrual period, current or past pregnancy, breast feeding

In some cases acne can mimic other related skin disorders, such as rosacea. This information will help your doctor make an informed diagnosis. Bershad 2008

Emotional Consequences

Having acne does not just mean superficial or cosmetic changes to the skin—it has an emotional aspect to it as well. Since the face is one of the primary areas affected by acne, symptoms of the disease can change the appearance of those affected, and this can lead to stress and anxiety. Depending on the severity of the condition, acne can lead to a negative self-image, including: Hamilton 2009

  • Low self-esteem
  • Loss of confidence
  • Depression

These emotional consequences affect anyone who is suffering from acne—both men and women, young and old. Gollnick 2003  In addition to reducing the quality of life of people with acne, the emotional aspects of the disease have been shown to reduce productivity and employability. This impact on quality of life is comparable to what is seen in diseases like epilepsy or asthma. Hamilton 2009  There are also several myths surrounding acne, and this can cause misplaced feelings of guilt that worsen the emotional effects of the disease. Goodman 2006

Causes, Triggers, and Risk Factors

The exact cause of acne is not known, but researchers think that both genetic and environmental factors play a role. Family history of acne is a risk factor which suggests a genetic component. In addition, there are environment factors, or “triggers,” that also increase the risk of acne. You may notice that certain factors in your daily life may trigger your acne symptoms and cause pimples to flare up. Triggers can be very different from one person to the next, and it is important for you to keep track of your triggers to help you avoid them and minimize flare-ups.

Factors that may trigger acne include:

Certain medications

Certain steroid medications can cause symptoms very similar to those seen in acne. These symptoms will typically appear suddenly and progress rapidly. Corticosteroids, for example, can induce a characteristic form of acne that does not have comedones (blackheads or whiteheads), but rather papules and pustules. Anabolic steroids can also induce acne, in this case with prominent blackheads and whiteheads on the surface of affected skin. If you feel that a medication you are taking is making your acne worse, mention this to you doctor.Bershad 2008

Certain cosmetics and skin care products

Many cosmetics contain agents that are noncomedogenic—in other words, these agents don’t plug pores and cause whiteheads or blackheads. However, there are still some cosmetics with comedogenic agents.Goodman 2006 If you are worried that applying cosmetics or other skin care products is making your acne worse, you can look for labels that specify that these products are “noncomedogenic,” “non-pore-clogging,” or “oil free.” Bershad 2008

Sweating

There is some indirect evidence that sweating or humid environments may trigger acne. It is possible that excess humidity partially blocks pores, leading to acne. Avoiding excess sweating and humid environments may help keep your pores free of clogging and result in fewer acne symptoms.Goodman 2006

There are also known risk factors for acne. Anyone can develop acne, but these factors can alter your risk of showing symptoms:

Family history

Hereditary factors seem to play a large role in acne development. This means that if acne runs in your family, you’re more likely to have it yourself. Bershad 2008

Menstrual period

Many women note that their acne tends to get better and worse in cycles, and that this is related to their menstrual period. Roughly 40% of female patients note acne flare-ups in the days leading up to their period.Bershad 2008

Pregnancy

Hormonal changes during pregnancy may also result in temporary acne flares. Some treatments for acne are associated with serious birth defects if used during pregnancy, so it is important to report pregnancy to your dermatologist, and to inform your doctor of all acne medications you are taking.Bershad 2008

Diet

Diet has long been a controversial subject in acne research. There is a popular notion that greasy foods somehow contribute to oily or acne-prone skin. However, scientific studies of the causes of acne have not shown this to be true. Researchers have discovered some links between acne and certain components of a “Westernized diet”—specifically high-sugar foods and dairy products. However, there is no conclusive evidence for other food items such as chocolate or saturated fats. Goodman 2006, Spencer 2009

KEY MESSAGES:

IMPORTANT FACTS ABOUT Acne

  • Acne is not infectious, and is not caused by poor hygiene
  • While acne typically first appears in adolescence, it may persist well into adulthood
  • Acne requires short- and long-term therapy
  • Acne has an emotional side, with many people feeling stress or anxiety about the way it changes their appearance
  • There is no conclusive evidence that fatty foods or chocolate are responsible for acne
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I. Disease overview

["ack-nee"]

Acne is a skin disease that is particularly common among adolescents, though some people have acne that lasts into adulthood. Gollnick 2003

Acne involves a disorder with glands in the skin that are located next to hair follicles. These glands, called sebaceous glands, secrete an oily substance called sebum. Everyone has these glands, and the secretion of sebum is normal, but people with acne have larger glands that release more sebum in into the skin. The excess sebum can trap oil, bacteria, and skin cells. One bacterium in particular, known as P. acnes, is able to thrive in these conditions. P. acnes is normally present in the skin, however in people with acne they are present in much greater numbers. The growth and proliferation of these bacteria can cause inflammation of the skin, leading to pimples. Gollnick 2003

In most cases, a dermatologist or other health care provider can diagnosis by examining the affected skin. However, your doctor may ask several questions that are aimed at ensuring a proper acne diagnosis and to rule out other skin disorders. These include questions about: Bershad 2008

  • Areas of sensitive skin, or eczema
  • Other diseases that may affect the ability to handle medications
  • Previous drug allergies
  • Use of steroids (e.g., for bodybuilding)
  • Mood disorders or depression
  • Use of contraceptives, irregular menstrual period, current or past pregnancy, breast feeding

In some cases acne can mimic other related skin disorders, such as rosacea. This information will help your doctor make an informed diagnosis. Bershad 2008

Having acne does not just mean superficial or cosmetic changes to the skin—it has an emotional aspect to it as well. Since the face is one of the primary areas affected by acne, symptoms of the disease can change the appearance of those affected, and this can lead to stress and anxiety. Depending on the severity of the condition, acne can lead to a negative self-image, including: Hamilton 2009

  • Low self-esteem
  • Loss of confidence
  • Depression

These emotional consequences affect anyone who is suffering from acne—both men and women, young and old. Gollnick 2003  In addition to reducing the quality of life of people with acne, the emotional aspects of the disease have been shown to reduce productivity and employability. This impact on quality of life is comparable to what is seen in diseases like epilepsy or asthma. Hamilton 2009  There are also several myths surrounding acne, and this can cause misplaced feelings of guilt that worsen the emotional effects of the disease. Goodman 2006

The exact cause of acne is not known, but researchers think that both genetic and environmental factors play a role. Family history of acne is a risk factor, which suggests a genetic component. In addition, there are environment factors, or “triggers,” that also increase the risk of acne. You may notice that certain factors in your daily life may trigger your acne symptoms and cause pimples to flare up. Triggers can be very different from one person to the next, and it is important for you to keep track of your triggers to help you avoid them and minimize flare-ups.

Factors that may trigger acne include:

Certain medications

· Certain steroid medications can cause symptoms very similar to those seen in acne. These symptoms will typically appear suddenly and progress rapidly. Corticosteroids, for example, can induce a characteristic form of acne that does not have comedones (blackheads or whiteheads), but rather papules and pustules. Anabolic steroids can also induce acne, in this case with prominent blackheads and whiteheads on the surface of affected skin. If you feel that a medication you are taking is making your acne worse, mention this to you doctor.Bershad 2008

Certain cosmetics and skin care products

· Many cosmetics contain agents that are noncomedogenic—in other words, these agents don’t plug pores and cause whiteheads or blackheads. However, there are still some cosmetics with comedogenic agents.Goodman 2006 If you are worried that applying cosmetics or other skin care products is making your acne worse, you can look for labels that specify that these products are “non-comedogenic,” “non-pore-clogging,” or “oil free.” Bershad 2008

Sweating

· There is some indirect evidence that sweating or humid environments may trigger acne. It is possible that excess humidity partially blocks pores, leading to acne. Avoiding excess sweating and humid environments may help keep your pores free of clogging and result in fewer acne symptoms.Goodman 2006

There are also known risk factors for acne. While anyone can develop acne, but these factors can alter your risk showing symptoms:

Family history

· Hereditary factors seem to play a large role in acne development. This means that if acne runs in your family, you’re more likely to have it yourself. Bershad 2008

Menstrual period

· Many women note that their acne tends to get better and worse in cycles, and that this is related to their menstrual period. Roughly 40% of female patients note acne flare-ups in the days leading up to their period.Bershad 2008

Pregnancy

· Hormonal changes during pregnancy may also result in temporary acne flares. Some treatments for acne are associated with serious birth defects if used during pregnancy, so it is important to report pregnancy to your dermatologist, and to inform your doctor of all acne medications you are taking.Bershad 2008

Diet has long been a controversial subject in acne research. There is a popular notion that greasy foods somehow contribute to oily or acne-prone skin. However, scientific studies of the causes of acne have not shown this to be true. Researchers have discovered some links between acne and certain components of a “Westernized diet”—specifically high-sugar foods and dairy products. However, there is no conclusive evidence for other food items such as chocolate or saturated fats. Goodman 2006, Spencer 2009


IMPORTANT FACTS ABOUT Acne

  • Acne is not infectious, and is not caused by poor hygiene
  • While acne typically first appears in adolescence, it may persist well into adulthood
  • Acne requires short- and long-term therapy
  • Acne has an emotional side, with many people feeling stress or anxiety about the way it changes their appearance
  • There is no conclusive evidence that fatty foods or chocolate are responsible

 

II. Treatment options

Acne is a very common disease that significantly affects the lives of people who have it. Fortunately, there are treatments that can help reduce symptoms. This can improve the appearance of the skin, and lead to a better quality of life for people with acne.

Acne treatment aims to: NIAMS 2006

  • Make existing pimples go away
  • Stop new pimples from forming
  • Limit side effects to a tolerable level
  • Help prevent scarring when possible

There are several different types of acne treatment. Your doctor may suggest over-the-counter medications or prescription drugs. Some of these will be applied directly to the skin, while others are pills or capsules that are meant to be swallowed. The acne treatment will depend on the severity of your acne and may include one or more of the following types: NIAMS 2006

  • Topical retinoids
  • Benzoyl peroxide
  • Topical antibiotics
  • Oral antibiotics
  • Hormones/ antiandrogens
  • Oral retinoids (isotretinoin)

Topical retinoids are derivatives of vitamin A. These different treatments have similar abilities to improve acne, but all can irritatethe skin, particularly during the first few weeks of use. Topical retinoids can be used as initial treatment and as long-term maintenance therapy.” Gollnick 2003

Benzoyl peroxide is an antimicrobial, meaning it can kill bacteria. It is able to quickly and effectively kill P. acnes, bacteria in the skin of people with acne. Unlike antibiotics, bacteria have not been able to become resistant to benzoyl peroxide. It is available in several different concentrations. The more concentrated forms may be more irritating to the skin. Gollnick 2003  

Topical antibiotics are able to kill bacteria, including P. acnes . Antibiotics are also able to reduce inflammation in the skin. Unlike benzoyl peroxide, antibiotics are limited by resistance of bacteria. These bacteria may not be affected at all by antibiotics or may become progressively resistant over the course of therapy. To reduce the proliferation of antibiotic-resistant bacteria, antibiotics are used in combination with other treatments. Gollnick 2003

Oral antibiotics are antibacterial and anti-inflammatory, but are taken as pills or capsules rather than creams or lotions and are used in more severe forms of acne. Gollnick2003

These treatments are options for women with endocrine abnormalities or difficult-to-treat acne. Gollnick 2003

Oral isotretinoin act on the four factors involved in the pathogenesis of acne. It is used for the most severe cases of acne, or in cases where other treatments cause continued relapse or cannot prevent scarring. Women taking oral isotretinoin cannot be pregnant at the time of initiating treatment, and cannot become pregnant during treatment or one month after stopping therapy, due to birth defects caused by the drug. A strict contraception regimen must be followed. Physicians and patients must register using the iPledge program to ensure that these risks are communicated properly. Gollnick 2003

Treatments for acne can be very effective at reducing pimples and improving the appearance of skin, but this requires time. It’s natural to want to see the effects of treatment right away, but most treatments will not have a significant effect until several weeks have passed. People with acne who experience this can sometimes become frustrated with this delay, and stop taking their medication before it has had time to make an effect on their symptoms. Keep in mind that this is typical of acne treatment, and don’t be discouraged if acne does not improve in the first few days. Also, several treatments for acne may initially make symptoms worse at the start of therapy. This is a temporary effect and sticking with the treatment will typically result in symptoms improving after the first few weeks. It’s important to always take acne treatments as prescribed by your doctor and give them the necessary time before making decisions on their effectiveness. Gollnick 2003, Zaenglein 2008

It is important to understand that acne is a long-term disease. Most people’s acne resolves when they are in their twenties. However, some people with acne will have symptoms that stay with them their entire lives. There are several effective treatment options, but no one “cure” for acne. In some cases acne medications should be taken over the long term, as stopping  treatment when the acne improves can result in symptoms coming back. In some cases, your doctor may prescribe an initial treatment to get your acne under control, followed by a long-term treatment that can help keep it from coming back.

Your doctor will help you to decide which treatment is best for you. In addition, you may want to consider the following factors when selecting an acne treatment that is right for you:

  • First, the treatment should never be worse than the acne itself!
  • The treatment may need to be used for prolonged periods of time or continuously in order to keep acne symptoms under control
  • Some acne treatments (particulary oral treatments) are associated with birth defects; if you are pregnant or plan on becoming pregnant during acne treatment it is important to talk to your doctor about what treatment options are appropriate
  • Acne treatments may be irritating to the skin and appear to be causing even more acne, but don’t worry if this is the case, use your treatment every other day, use a non-comedogenic moisturizer and call your doctor. These irritations are temporary and generally resolve fairly quickly with continued use of the treatment.
  • Keep in mind: treatment adherence strongly influences treatment effectiveness (If you don’t use it, it won’t work!)

Cleansing

Cleansing habits are an important aspect of treating acne, but are also an area of misinformation for people with this disease. Keep in mind that acne is not caused by poor hygiene: there is no evidence that a lack of washing causes acne or that frequent washing improves it. In addition, cleansing that is too frequent or too vigorous can actually make matters worse by aggravating the skin. This is especially true if rough cloths or other scrubbing materials are used. These abrasives disrupt the follicle and cause further aggravation to the inflamed skin. The best practice is to clean affected areas using only warm water and a gentle cleanser no more than twice daily. Gollnick 2003 Also, some prescription acne treatments should not be used with harsh cleansers or scrubs because they may increase irritation. Make sure you discuss with your doctor all skin products and cleansers you are using before you start treatment with a prescription product.

The choice of cleanser is also an important consideration. Although P. acnes bacteria play an important role in acne, soaps labeled “antibacterial” have not been found to help. These soaps typically don’t affect P. acnes, in pore (where it causes problems), but can only wash off bacteria from the surface of the skin. Gollnick 2003

Skin Care Tips Gollnick 2003, NIAMS 2006

·         Clean skin gently. Use a mild cleanser in the morning, evening and after heavy workouts. Scrubbing the skin does not stop acne. It can even make the problem worse.

·         Sometimes even acne-prone skin can feel dry (particularly when first using topical medication like retinoids). Using a mild, “non-comedogenic” moisturizer may help, but avoid oily or heavy products that can clog pores.

·         Shave carefully. If you shave, you can try both electric and safety razors to see which works best. With safety razors, use a sharp blade. Also, it helps to soften your beard with soap and water before putting on shaving cream. Shave lightly and only when you have to.

·         Choose makeup carefully. All makeup should be oil free. Look for the word “noncomedogenic” on the label. This means that the makeup will not clog up your pores.

·         Stay out of the sun. Many acne medicines can make people more likely to sunburn.

KEY MESSAGES:

 

HELPFUL HINT

All topical treatments should be spread over the entire area where acne appears, not “spotted” only on visible pimples. Talk to your doctor about the best way to apply a topical medication.

CAUTION

Try not to touch your skin. People who squeeze, pinch, or pick their pimples can get scars or dark spots on their skin.

 

III. Lifestyle approach

People with acne sometimes find that lifestyle measures help improve the appearance and reduce the discomfort of affected skin. These typically involve basic skin care:

Lifestyle measures (MayoClinic)

Use a gentle cleanser

· Stay away from facial scrubs, astringents, and masks—they tend to irritate skin, which can make acne worse

· Very frequent washing or scrubbing can also irritate skin

Use noncomedogenic skin products

· You may want to avoid oily or greasy cosmetics, hairstyling products or acne concealers

· Look for products labeled "water-based" or "non-comedogenic"

Stay out of the sun

· The sun can make acne worse for some people

· Acne medications can also make you more susceptible to the sun's rays

· Check with your doctor to see if your medication makes you more sensitive to the sun, and if so, stay out of the sun as much as possible

· If you do need to be in the sun, use a non-comedogenic sunscreen that won’t clog your pores.

Find out more about acne online:

This is a global website focused on educating the public and patients about skin conditions and the different types of treatments that are available to treat and manage these diseases. This site is not intended as a substitute for medical advice from your doctor, and may include discussions about therapies or treatment options that may not be available in your country. We encourage you to use the information contained in this site to educate yourself about your disease and allow better communication between you and your healthcare professional.

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