What is Acne Vulgaris?


Acne Vulgaris
Symptoms
Cause
What Happens
What Increases Your Risk
When To Call a Doctor
Exams and Tests
Treatment Overview
Prevention
Home Treatment
Medications
Surgery
Other Treatment


Acne vulgaris, or acne, is a skin problem that starts when oil and dead skin cells clog up your pores. Some people call it blackheads, whiteheads, pimples, or zits. When you have just a few red spots, or pimples, you have a mild form of acne. Severe acne can mean hundreds of pimples that can cover the face, neck, chest, and back. Or, it can be bigger, solid, red lumps that are painful (cysts).

Most young people get at least mild acne. It usually gets better after the teen years. But many adult women do have acne in the days before their menstrual periods. How you feel about your acne may not be related to how bad it is. Some people with severe acne are not bothered by it. Others are embarrassed or upset even though they have only a few pimples.

The good news is that there are many good treatments that can help you get acne under control.

What are the symptoms?

Acne develops most often on the face, neck, chest, shoulders, or back and can range from mild to severe. It can last for a few months, many years, or come and go your entire life.

Mild acne usually causes only whiteheads and blackheads. At times, these may develop into an in the skin pore (pimple).

Severe acne can produce hundreds of pimples that cover large areas of skin. Cystic lesions are pimples that are large and deep. These lesions are often painful and can leave scars on your skin.

Acne can lead to low self-esteem and sometimes depression. These conditions need treatment along with the acne.

What causes acne?

There are different types of acne. The most common acne is the type that develops during the teen years. Puberty causes hormone levels to rise, especially testosterone. High hormones signal skin glands to start making more oil (sebum). Oil releases from the pores to protect the skin and keep it moist. Acne begins when oil mixes with dead cells and clogs the skin's pores. Bacteria can grow in this mixture, and if it leaks into nearby tissues, it causes swelling, redness, and pus. A common name for these raised bumps is pimples.

Certain medications can cause acne to develop. This type of acne usually clears up when you stop taking the medication.

It isn't just teens who are affected by acne. Sometimes newborns have acne because their mothers pass hormones to them just before delivery. Acne can also appear when the stress of birth causes the baby's body to release hormones on its own. Young children and older adults also may get acne.

A few rare conditions of the endocrine system, such as polycystic ovary syndrome and Cushing's syndrome, can lead to outbreaks of acne.

How is acne treated?

To help control acne, keep your skin clean. Avoid skin products that clog your pores. Look for products that say "noncomedogenic" on the label. Wash your skin once or twice a day with a gentle soap or acne wash. Try not to scrub or pick at your pimples. This can make them worse and can cause scars.

For a few pimples, you can get an acne cream without a prescription. Look for one that has benzoyl peroxide or salicylic acid. These work best when used just the way the label says.

It can take time to get acne under control. Keep using the same treatment for 6 to 8 weeks. You may even notice that it gets worse before it gets better. If your skin is not better after 8 weeks, try another product.

If your pimples are really bothering you or are scarring your skin, see your doctor. A prescription gel or cream for your skin may be all you need. Your doctor may also order antibiotic pills. A mix of treatments may work best. If you are female, taking certain birth control pills may help.

If you have acne cysts, talk to your doctor about stronger medicine. Isotretinoin (such as Accutane) works very well, but it can cause depression, birth defects, or high cholesterol. Let your doctor know if you have had depression before taking this medicine. And if you are female, you must protect against pregnancy by using two forms of birth control. Even one dose of this medicine can cause birth defects if a woman takes it while she is pregnant.

What can be done about acne scars?

There are skin treatments that can help acne scars look better and feel smoother. Ask your doctor about them. The best treatment for you depends on how severe the scarring is. You can have scar tissue removed or have a shot of collagen. Collagen smoothes a pitted scar by plumping up the skin underneath. You may get the best results with a combination of treatments.

What Happens

Acne develops most often in the teen and young adult years. During this time, both males and females usually produce more testosterone than at any other time in life. This hormone spurs oil glands to produce more oil (sebum). The extra oil can clog pores and cause acne. Bacteria can grow in this mixture, and if it leaks into nearby tissues, it causes swelling, redness, and pus (pimples).

Acne usually gets better in the adult years when your body produces less testosterone. Still, some women have premenstrual acne flare-ups well into adulthood.

What Increases Your Risk

The tendency to develop acne runs in families. You are more likely to develop severe acne if your parents had severe acne.

The risk of developing acne is highest during the teen and young adult years. These are the years when hormones such as testosterone are increasing. Women who are at the age of menstruation also are more likely to develop acne. Many women have acne flare-ups in the days just before their menstrual periods.

Acne can be irritated or made worse by:

• Wearing straps or other tight-fitting items that rub against the skin (such as a football player wearing shoulder pads), as well as using equipment that rubs against the body (such as a violin held between the cheek and shoulder). Helmets, bra straps, headbands, and turtleneck sweaters also may cause acne to get worse.
• Using skin and hair care products that contain irritating substances.
• Washing the face too often or scrubbing the face too hard. Using harsh soaps or very hot water can also cause acne to get worse.
• Experiencing a lot of stress.
• Touching the face a lot.
• Sweating a lot.
• Having hair hanging in the face, which can cause the skin to be oilier.
• Taking certain medications.
• Working with oils and harsh chemicals on a regular basis.

When To Call a Doctor

Call a doctor if:

• You are concerned about your or your child's acne.
• Your acne gets worse or does not improve with home treatment.
• You develop scars or marks after acne heals.
• You have tried home treatment for 6 to 8 weeks, and your acne has not improved.
• Your pimples become large and hard or filled with fluid.
• You start to have other physical symptoms, such as facial hair growth in women, or bone and muscle pain.
• Your acne began when you started a new medication prescribed by a doctor.
• You have been exposed to chemicals, oils, or other substances that cause your skin to break out.
• You may want to seek medical assistance sooner if there is a strong family history of acne, you are emotionally affected by acne, or you developed acne at an early age.

Should I see a doctor for acne?

Watchful Waiting

Watchful waiting is a wait-and-see approach. If you get better on your own, you won't need treatment. If you get worse, you and your doctor will decide what to do next. Mild acne does not need treatment if it doesn't bother you. If you have severe acne, your acne does not clear up with home treatment, or you develop acne scars, call your doctor.

Who To See

The following health professionals can diagnose and treat acne:

• Pediatricians
• Family medicine physicians or internists
• Nurse practitioners
• Physician assistants
• Dermatologists

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

When you see a doctor about acne, you'll have a physical exam, and your doctor will ask about your medical history. Women may be asked questions about their menstrual cycles. This information can help your doctor find out if hormones are playing a role in acne flare-ups. Most often, you won't have any special tests to diagnose acne.
If your doctor suspects that acne is a symptom of another medical problem (such as higher-than-normal amounts of testosterone in a woman), you may need other tests.

Treatment Overview

Acne treatment depends on whether you have a mild, moderate or severe form. Sometimes your doctor will combine treatments to get the best results and to avoid developing drug resistant bacteria. Treatment could include lotions or gels you put on blemishes or sometimes entire areas of skin, such as the chest or back (topical medications). You might also take medications by mouth (oral medications).

Mild acne

Treatment for mild acne (whiteheads, blackheads or pimples) may include:

• Gentle cleansing with a mild soap (such as Dove or Neutrogena).
• Applying benzoyl peroxide (such as Benoxyl, Benzac, or Clearasil).
• Applying salicylic acid (such as Clearasil, Propa pH, or Stri-Dex).

If these treatments do not work, your doctor may prescribe topical lotions containing antibiotics or other kinds of bacteria-killing medication.

Moderate to severe acne

Sometimes acne needs treatment with stronger medications and a combination of therapies. Deeper blemishes, such as nodules and cysts, are more likely to leave scars. As a result, your doctor may give you oral antibiotics sooner to start the healing process. Inflammatory acne may need a combination of several therapies. Treatment for moderate to severe acne may include:

• Applying benzoyl peroxide.
• Draining of large pimples and cysts by a health professional.
• Applying prescription antibiotic gels, creams, or lotions.
• Applying prescription retinoids.
• Applying azelaic acid.
• Taking prescription oral antibiotics.
• Taking prescription oral retinoids.
• Receiving high-intensity light wave therapy.
• Receiving laser treatment.

Treatment for acne scars

Treatment may improve and even remove acne scars. Sometimes a combination of treatments works best. These treatments include:

Multi-Lift Technique

Dr. Rapaport uses multiple treatments on each patient to successfully treat acne scars. His "Multi-Lift Technique" exemplifies how important it is to treat each scar not with just one method but with with different modalities. This ensures an individualized approach to treatment with each patient for optimal success.

Subcision
Subcision is a technique in which a depressed acne scar is lifted to the skin surface with a surgical instrument such as a tiny scalpel or needle. The deep portions of the scar are released and the surface elevates with the wound repair process. Several treatments are usually necessary and are performed under local anesthesia to eliminate discomfort.

TCA CROSS
TCA CROSS (chemical reconstruction of skin scars) is a method in which trichloracetic acid is used to spot treat each scar. During the treatment, a high concentration of Trichlorocetic acid is introduced just inside the scar. The resurfacing response that occurs inside the depression stimulates collagen production which eventually causes the scar to rise up and close in on itself.

Fillers (Restylane^® & Silicone)
Restylane^® is the world's most popular filling agent. It is a clear, synthetic gel made with hyaluronic acid, a natural substance that is found throughout your body and carries little risk of allergic reaction. With its unique ability to combine with water, Restylane^® remains in your skin for many months and can be used immediately. Silicone is another filler commonly used on acne scars. It produces a permanent change in the skin. Both Restylane^® and silicone are injected into acne scars to raise the surface of the skin and give a smoother look.

Scar Excision
This surgical method of treatment uses a scapel or punch to remove the scar. Under local anesthesia, the scar is excised and the skin edges are then sutured together. Excision is typically recommended to patients with deep pitted scars that are not amendable to the TCA CROSS technique.

Laser Skin Resurfacing
Using the Erbium:YAG or CO2 laser, the skin is removed layer by layer which eliminates the scar's surface. Simultaneously, heat produced from the laser tightens the skin, which helps to smooth out the scars. This method has a significant recovery time and is used less frequently since the advent of the Fraxel^TM laser.

What To Think About

Most treatments for acne take time. It often takes 6 to 8 weeks for acne to improve after you start treatment. Some treatments may cause acne to get worse before it gets better.
If your acne still hasn't improved after several tries with other treatment, your doctor may recommend that you take an oral retinoid, such as isotretinoin. Doctors prescribe this medication as a last resort, because it has some rare but serious side effects and is expensive. Certain low-dose birth control pills may help control acne in women who tend to have flare-ups before their periods start.

Prevention

While you cannot prevent acne, there are steps you can take at home to keep it from getting worse.

• Gently wash and care for your skin every day. Avoid scrubbing too hard or washing too often.
• Avoid heavy sweating if you think it causes your acne to get worse. Wash soon after activities that cause you to sweat.
• Wash your hair often if your hair is oily. Try to keep your hair off of your face.
• Avoid hair care products such as gels, mousses, cream rinses, and pomades that contain a lot of oil.
• Avoid touching your face.
• Wear soft, cotton clothing or moleskin under sports equipment. Parts of equipment, such as chin straps, can rub your skin and make your acne worse.
• Avoid exposure to oils and harsh chemicals, such as petroleum.
• Avoid long periods of time in sunlight, as this doesn't help acne and can increase your risk of skin cancer.
• Use sunscreens when you are out in the sun.

Medications

Medications can help manage the severity and frequency of acne outbreaks. A number of medications are available. Your treatment will depend on the type of acne you have (pimples, whiteheads, blackheads, or cystic lesions). These medications improve acne by:

• Unplugging skin pores and stopping them from getting plugged with oil (tretinoin, which is sold as Retin-A).
• Killing bacteria (antibiotics).
• Reducing the amount of skin oil (isotretinoin).
• Reducing the effects of hormones in producing acne (certain oral contraceptive pills for women).
• The best medical treatment for acne often is a combination of medications. These could include medication you put on your skin (topical) and medication you take by mouth (certain antibiotics).

Medication Choices

Treatment of acne depends on whether inflammation or bacteria are present. Some acne consists only of red bumps on the skin with no open sores (comedonal acne). Topical creams and lotions work best for this type of acne. However, if bacteria or inflammation is present with open sores, oral antibiotics or isotretinoin may work better.
The most common types of medications that doctors use to treat acne include:

• Benzoyl peroxide, such as Benoxyl, Benzac, and Clearasil.
• Salicylic acid, such as Clearasil, Propa pH, and Stri-Dex.
• Topical and oral antibiotics, such as clindamycin (Cleocin, for example), sodium sulfacetamide (Novacet), erythromycin (E-Mycin, for example), and tetracycline (Achromycin, for example).
• Topical retinoid medications, such as tretinoin (Retin-A), adapalene (Differin), and tazarotene (Tazorac).
• Azelaic acid, such as Azelex, a topical cream.
• Isotretinoin, an oral retinoid.
• Low-dose birth control pills that contain estrogen (such as Estrostep Fe or Ortho Tri-Cyclen), which work well on moderate acne in women and for premenstrual flare-ups. Estrogen softens the effects of testosterone by lowering oil production.
• Corticosteroids, such as prednisone or dexamethasone, which doctors rarely prescribe to treat very severe acne. Corticosteroids lower testosterone production. These medications are taken only for short periods because long-term use can cause significant side effects.

Medication side effects

In general, doctors prefer to use topical products for acne rather than oral antibiotics, which are more likely to have side effects. Oral antibiotic side effects can include:

• Yeast infections (women).
• Diarrhea.
• Drug-resistance.
• Central nervous system conditions, such as lupus erythematosus bacteria (rarely).
• If you are pregnant, talk to your doctor about whether you should take antibiotics for acne. Erythromycin is the only safe antibiotic to treat acne for women who are pregnant.

Over time, bacteria can become resistant to antibiotics, which means that the antibiotics are no longer effective at killing or controlling the bacteria causing the acne. This is called drug resistance. When this occurs, a different antibiotic may be used.

Once acne is under control, you often need ongoing treatment to keep it from returning. This is the maintenance phase of treatment. Your doctor may suggest treatments other than antibiotics for long-term use because of risks of drug resistance. Topical medications usually have fewer and less serious side effects than oral medications. However, topical medications may not work as well as oral medications for severe acne.

Isotretinoin (such as Accutane) and tazarotene (Tazorac) can have serious side effects. Women who take isotretinoin or tazarotene need to use an effective birth control method to avoid having a baby with serious birth defects. Recently, the U.S. Food and Drug Administration's Center for Drug Evaluation and Research division warned that isotretinoin may cause depression, psychosis, and, rarely, suicidal thoughts or attempts. Talk to your doctor about the side effects of isotretinoin to decide whether it is right for you. If you are taking isotretinoin and feel depressed or think you may be pregnant, see your doctor for treatment. The FDA has announced that the companies that make isotretinoin have a program to register doctors who prescribe isotretinoin and the people who take it. The program is to ensure that people taking this drug understand the risk of birth defects, take precautions to avoid pregnancy, and know what to do if they become pregnant. If your doctor suggests that you take isotretinoin, you must be registered with iPLEDGE beginning March 1, 2006, in order to get the drug. You can get more information and register at www.ipledgeprogram.com or by telephone at 1-866-495-0654.

Surgery

Sometimes doctors use surgery to remove deep acne scars or to smooth skin roughened by acne. These procedures (collagen injections, gelatin implants, laser resurfacing) require special training. Seek out a doctor trained in these procedures.

Other Treatment

Your doctor may suggest other types of therapies to treat acne or acne scars.

Other Treatment Choices
For active acne, you may have:

• Whitehead and blackhead removal. A health professional uses a pen-sized metal instrument to apply pressure around the whitehead or blackhead, forcing it out. Doctors advise people not to squeeze acne themselves, because scarring can result.
• Large and painful pimples drained. A health professional uses a needle or sharp blade to open a pimple and remove oil and bacteria trapped inside. This relieves the pressure and pain and may reduce the amount of scarring.
• Light wave therapy, which uses a high-intensity blue light. This light kills acne-causing bacteria on the skin but does not damage skin, as ultraviolet light can. This therapy is rarely used, though it may be helpful in treating mild to moderate acne that has not responded to other treatments.

For acne scars, you may have:

• Collagen injections and gelatin implants, to improve the look of acne scars.
• Dermabrasion or dermaplaning, to remove scars.
• Chemabrasion, a chemical peel that removes surface scars.
• Microdermabrasion, a gentle skin buffing for mild acne scarring.
• Laser resurfacing, to remove the top layer of skin.
• Chemabrasion, dermabrasion or dermaplaning, and laser resurfacing are techniques that remove the top layers of skin. This promotes skin regrowth and collagen production. The results are better-looking skin with less noticeable scarring. Laser resurfacing is the most popular technique at present.

What To Think About

Health professionals no longer use X-rays or ultraviolet light (from a sunlamp) to treat acne. These treatments may have more risks than benefits.


Call now to schedule your complimentary consultation with Dr. Jeffrey Rapaport for acne free, healthy, younger-looking skin. Tel: (201) 227-1555.

You can also ask questions by clicking on Ask Questions