About Acne

La Jolla, California

What is Acne?

acne-scarring-2-image-galleryAlmost everyone “knows what acne is” and anyone who’s ever had it, hated it! Most people experience some stage of acne, whether a single pimple or full-fledged painful nodules. What any acne sufferer wants is to get rid of the problem! Although we’re familiar with the blackheads, whiteheads, pimples (zits) and inflammation caused by this condition, most of those with acne know little about the disease beyond what’s discussed in commercials or popular magazines.

Basically, acne occurs when a necessary function of the skin goes wrong. Human skin comes equipped with oil-producing glands (sebaceous glands) which are associated with pores and hair follicles. The oil glands provide a lubricant (sebum) that helps our skin retain natural moisture. Too much oil, combined with two other “ingredients,” practically guarantees some level of acne during puberty and throughout the early 20’s – especially for males.

Acne’s Recipe

With acne, three things are going on at once:

  • The oil gland produces more oil than is needed.
  • P. Acnes, ordinary bacteria present on everyone’s skin, multiply at a higher rate than normal.
  • Finally, oil, dead cells, and bacteria are shed heavily and erratically. These accumulate in the hair follicle, create a plug and provide a food source for the bacteria. That set of conditions is common to all stages of acne.

Causes of Acne – Why Do I Get Acne and My Friend Does Not?

While doctors know what happens when acne is present, all the underlying influences are still not fully known. There do seem to be some genetic factors at play, but most commonly, the big factor in the presence of acne is hormones. Shifting hormone levels encourage acne breakouts. Because teens and young adults experience intense hormonal surges as they reach maturity, acne will typically begin during those years. Conditions and medications that cause hormone changes can also bump up the number and frequency of outbreaks. Pregnancy, menopause, and the use of birth control have all been associated with acne because of their hormone-related activities in the body. Acne is also known to increase when you’re under stress. A common complaint is that acne is most likely to strike right before a wedding, a graduation, an important date or job interview…the most difficult times in our lives can trigger acne, making situations even more stressful.

Specific substances may be involved in certain cases. Makeup, perfumes, soaps, conditioners, along with exposure to a range of environmental factors can influence your acne symptoms. Some people believe certain foods can cause acne. So far there is no proof supporting the belief; however, many doctors do take diet into account when treating acne, with varying reported degrees of success. A few suspect and studied foods? Milk, fried foods, sugar and hormone-laden red meats are at the top of the list. Conscientious acne sufferers often do find a correlation between certain foods and dietary habits and find improvement by following controlled food intake. There is some evidence that a vegetarian diet improves acne as well.

From A to Z – Grades of Acne

What Level Am I At and What Treatments Should I Consider?

Dermatologists sort acne by the severity of the symptoms. The most common sorting system breaks acne cases down into four grades: mild, moderate, advanced and severe.

Mild acne (Stage I)  is non-inflammatory, producing the most easily managed problems. The characteristic signs are blackheads, whiteheads, and occasional small pimples on the face, most often around the nose, mouth, chin and hairline. Home treatment is the most common method for managing Stage I acne. You’ll be encouraged to wash regularly, but gently: abrasives and rough scrubbing can make acne worse rather than better. Over-the-counter products containing salicylic acid, lactic acid, glycolic acid, sulfur, benzoyl peroxide, and resorcinol are used to dry skin, reduce oil levels, and ensure that dead skin is regularly washed away.

Moderate acne (Stage II) involves an increase in the severity of infection, and wider spread of the symptoms. Blackheads, whiteheads and pimples are present at almost all times. Redness and swelling are seen in Stage II acne, as debris and germs build up in pimples and cause irritation and injury to the surrounding tissue. While some doctors begin antibiotic treatment at the first indication of acne, others delay until this stage.  Alternatives to antibiotic treatment include Isolaz, a unique vacuum/broad spectrum light system which clears the pores and kills bacteria at the same time and Blu-U blue light acne therapy which reduces surface and mid-level acne bacteria. Vitamin-A derived medications (including the well-known Retin-A and Renova) encourage fast turnover of the surface cells of the skin, with new cells quickly replacing the old, helping keep the follicles clear and unplugged. Antibacterial creams and lotions containing combinations of prescription-level benzoyl peroxide and topical antibiotics such as clindamycin may also be prescribed.

Advanced Acne (Stage III) involves all the previous symptoms, but at this stage, they have become chronic and have begun to include more severe levels of tissue damage which typically results in long term scarring. At this stage physicians are likely to add laser and light therapies combined with photosensitizing topicals like Levulan in what is termed PhotoDynamic Therapy. Lasers help destroy the infection without hurting the surface layer of the skin; and it can be highly targeted. Blue light acts like a natural antibiotic by killing bacteria. Light-based therapies have a positive effect on the texture of the skin as well as destroy bacteria, and can improve healing.

Severe Acne (Stage IV) involves the wide spread of irritated, infected skin: face, neck, back, shoulders, chest, and often other parts of the body are involved. Cysts, boils, and nodules mesh and feed into each other, and form a network under the skin; making effective treatment more difficult. In many cases, there is extensive scarring.

PhotoDynamic Therapy, along with oral and topical antibiotics are often necessary to gain control of severe acne. Until recently, isotretinoin (Accutane) was a popular oral drug used for acne which did not respond to other treatments. Strict monitoring (including mandatory birth control for females) makes compliance difficult and its generic equivalents are not as often prescribed.

What Do I Do Now?

Anyone who suffers from Acne beyond an occasional pimple should have a proper medical evaluation of their acne levels. Prevention of the progression of acne is a key step in maintaining control and preventing both physical and psychological scars. Relying on over-the-counter preparations seldom resolves acne beyond the mild stages. An active, physician-monitored treatment program will often be far less expensive than years of tried-and- tossed products and future expensive procedures required to reduce scarring. Additional Resources: Skinsight.com

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