ACNE VULGARIS

Acne is one of the most common problems of adolescence. The unsightly pimples and blemishes of acne can result in embarrassment, anxiety, social difficulties, and eroded self-confidence far beyond the minor health risk of the disease.

The skin disease of acne commonly occurs in adolescence. The peak for acne activity is in the mid teens. During this time the skin oil (sebaceous) glands begin to become more active and produce more oil. This increased oil is noted as oily skin, but in some individuals (more than 18 million in the United States) this oil will be blocked. The blockage occurs at the skin pore openings. The pores are blocked because of sticky cells, bacteria, oil, and other materials. When the oil cannot escape through the normal skin pore, it backs up and forms a whitehead; if this is opened and exposed to the air, it becomes a blackhead. If the backed-up oil leaks into the surrounding skin, inflammation and infection occur, which will cause pimples and cysts. In other words, ACNE.

Acne can occur in both girls and boys, but boys usually have more oily skin and for that reason often have worse acne. Heredity plays a part as well; if your parents had bad acne, you may too. Foods do not seem to affect acne, and there are no known foods that make acne worse. But if you note a certain food that makes your acne worse, try to avoid it. Stress has been found to be the only consistent cause of worsening acne. For this reason, acne often gets worse before exams, before big dates, or when students begin college.

Acne is usually found on the face, shoulders, and back. The rash is made of small bumps with whitish or black tops. Squeezing expressing these NOT helpful can lead to infection scarring. In severe acne large deep cysts may form, which result in significant scarring if properly treated.

Acne is not an infection, although normal bacteria on the skin are part of the problem. For this reason, acne cannot be given or caught. For this same reason, antibiotics will not cure acne, although they do often help calm it down. Most individuals will outgrow acne by their mid 20s, but in some cases it continues. In severe cases after active acne has stopped, some small, depressed, or lumpy scars may be left. If scarring occurs, special treatment may be required, often involving surgical procedures.

There are many ways to treat acne. No matter what treatment is used, it will take 8 to 10 weeks before you notice improvement in your skin. In some cases the acne may actually get worse for a few weeks before improving. Nonmedical treatment consists of a good diet, regular exercise, daily skin hygiene with a medicated acne soap, and gentle washing (scrubbing can actually make acne worse). Salicylic acid compounds and cleansing soaps may be beneficial in washing the acne-prone areas. Oil-based makeup, suntan oil, and oils of any kind should be avoided. Stress and strong emotions can cause a flare of your acne, and if possible should be avoided.

The first medications used for treating acne are those applied to the skin. These are usually topical antibiotics and comedolytics (peeling agents). Antibiotics that are prescribed include benzoyl peroxide, erythromycin, clindamycin, and meclocycline.

Benzoyl peroxide has both comedolytic and antibiotic properties. It can be purchased without prescription in several strengths (always start at the lowest concentration). It must be used according to directions. It can be very irritating to the skin and should be stopped if the skin becomes sore. You must thoroughly and gently wash and dry your face before applying the medication to the skin. Apply the proper amount over the entire area of skin that has acne. Don't apply too much. Apply at bedtime and wash off in the morning. If it fails to work after 8 to 10 weeks or if your acne significantly worsens, see your doctor.

Oral medication or pills such as antibiotics, peeling agents (tretinoin, Retin-A, or isotretinoin), or hormones require a doctor's prescription and supervision. Antibiotics can lead to diarrhea, upset stomach, allergic reactions, and in women, yeast infections. Hormone treatment is helpful as a means to decrease oil production, but requires close doctor supervision. Isotretinoin absolutely cannot be used in patients who are pregnant or those who may become pregnant.

• Eat regularly, exercise regularly, and wash oily skin gently every day with medicated acne soap and water.
• Use cosmetics, suntan lotions, and shampoos that are oil free.
• Start treatment with the lowest strength lotion of benzoyl peroxide or over-the-counter topical medication.
• Be patient; almost everyone grows out of acne.

• Don't alter eating habits, i.e., don't avoid chocolate, french fries, or other specific foods unless you notice certain foods make your acne worse.
• Don't pinch, squeeze, express, or pick your pimples. This can lead to infection and scarring.
• Don't rub or massage acne, and avoid chin straps, shoulder pads, straps, and spandex garments that rub the skin where acne is present.
• Don't sunbathe; this can actually make some cases of acne worse. Besides, sun exposure is dangerous.
• Don't expect improvement for at least 8 to 10 weeks.
• Don't use over-the-counter medication while taking prescription medication unless your doctor knows.
• Don't hesitate to ask your doctor about acne and to tell him how you feel about it.

• If your acne is worsening despite treatment.
• If you are having emotional problems because of your acne.
• If you have significant scarring.

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