What Is Acne? Causes, Types, and Treatments
At Illinois Dermatology Institute, we understand your desire for clear, touchable skin. Using today’s latest methods, we diagnose and treat acne based on underlying causes for breakouts and skin issues.
Here, you can learn more about acne, its common causes, and today’s latest treatment options.
What is acne?
Acne is a term that describes any Condition, such as comedones (blackheads, whiteheads, etc.), large nodules, and red pimples. Acne can be present on the face and appear on the shoulders, arms, back, chest, and buttocks. There may be a connection to genetics when it comes to acne, but this is uncertain.
What Causes Acne?
Acne starts when sebaceous (oil) glands, which are tied to hair follicles, secrete sebum. These glands are usually most active during puberty, resulting in more oily skin than normal. The oil is then excreted into hair follicles, clogging the follicle with dead skin cells. This can lead to closed comedones (whiteheads) or open comedones if there is no inflammation at the site.
The inflammation and red bumps or nodules associated with acne are caused by a buildup of bacteria known as Propionibacterium, consuming the sebum and attracting your body’s immune cells.
What Are the Types of Acne?
There are three acne types:
Cystic acne is an inflammatory acne that causes painful, pus-filled pimples to form deep under the skin. This is the most severe type of acne and occurs when oil and dead skin cells clog the pores.
Inflammatory acne occurs when the immune system tries eliminating bacteria or other inflammatory elements lodged in the pores. The body’s immune response can result in severe blemishes, like cysts.
Hormonal acne occurs in adulthood and is linked to the overproduction of sebum (oil) in the skin glands. This oil clogs pores (often in the face, neck, and upper back), which leads to blackheads, whiteheads, and painful cysts.
What makes acne worse?
It is thought that prolonged periods of stress can aggravate acne symptoms. It may worsen in women just before menstruation due to the change in hormone levels. Sugary foods such as chocolate and soda may also make acne worse, and avoiding these foods may help to improve skin conditions.
Make-up products containing oil ought to be avoided as this can contribute to clogging your pores. If you are experiencing acne around your hairline, try to avoid greasy or oily gels. Opt for oil-free and water-based cosmetics for your best chance to prevent acne.
Many different medications are available to help you manage your acne. Your skin takes roughly 30 days to cycle, meaning you should allow up to three months for any signs of skin improvement.
Treatments and medications for acne include:
- Benzoyl peroxides: these creams and washes kill bacteria on your face, which cause acne
- Glycolic acids: these toners, lotions, and peels use acid to keep your pores from clogging and regulate your skin cycle process. They can also help the red spots which occur after an acne outbreak to fade.
- Vitamin A and Retinoids: when used each night, retinoids unclog your pores and bring down inflammation. It can lead to mild flaking in the skin, however.
- Clindamycin is an important item in the treatment of acne.
- The Propionibacterium Acnes is an anaerobe (It thrives in Oxygen poor areas). Benzoyl Peroxide releases Oxygen and easily kills the P. Acnes. Thus, Even though the P. Acnes can and does become resistant to antibiotics, it can never become resistant to Oxygen.
- Topical Erythromycin and topical Clindamycin (both antibiotics) are often used singly in mild cases of acne or combination with Benzoyl Peroxide in moderate to severe cases. P.Acnes is largely resistant to both, but their anti-inflammatory action still helps make them useful agents to combat acne.
- Topical Azelaic Acid (Azelex™, Finacea™), has proved to be a very useful topical agent to combat acne, in that it has an anti-inflammatory action and kills the P.Acnes.
- Topical Sulfur/Sulfacetamide combinations are still popular after nearly 50 years of continuous use. They are anti-inflammatory, suppress P.Acnes and exfoliate the plugs.
- Retinoids (Retin-a™, Differin™, Tazorac™ are very important topical products in that they stimulate a more rapid turnover of cells and help the skin shed the acne-producing plugs and also discourage plug formation.
Specific treatments include:
- Deep pore cleansing
- PCA peels
- Blue light therapy
- PCA masks
- CCSD restart peels
- AviClear™ laser treatment
Systemic Therapy for Acne
Systemic Antibiotics including Tetracycline and its derivatives Doxycycline and Minocycline have been used to treat acne for many years (since the 1950-s). They are still being used today, mainly for their anti-inflammatory actions. Other antibiotics, such as Penicillins and Cephalosporins, are used more rarely.
Nicotinamide, a Vitamin in large doses, has also been used for a long time to treat acne, again for its anti-inflammatory actions.
For women with resistant acne, Spironolactone, a diuretic with some anti-androgen activity, has been used for several years. Caution must be exercised in following the Potassium level and avoiding Pregnancy.
Birth Control Pills have been used with variable success to fight acne.
If everything fails, Accutane is extremely effective, but it has some unpleasant side effects.
Photodynamic Treatment with an intense pulsed light
Recently, it has been noticed that Photodynamic Treatment with an intense pulsed light, especially the Isolaz, can clear severe cases of acne. In Photodynamic Therapy, a solution of aminolevulinic acid (Levulan) is painted on the patient’s skin.
The patient waits between 30 and 60 minutes (some authors have obtained good results even with 10-minute wait). During this time, the aminolevulinic acid is absorbed preferentially into the fast-dividing cells of the oil glands and the Propionibacterium Acnes bacteria. Then, the intense pulsed light transforms the aminolevulinic acid into a toxic compound (Protoporphyrin) which damages the oil gland and its ability to produce oil. At the same time, the pores are opened by the suction, the biofilm plug is pulled out, and the protoporphyrin also kills the remaining Propionibacterium Acnes bacteria. None of the other devices presently on the market have the vacuum power of the Isolaz.
The blue lights (Blu-U, Omnilux, etc.), even though more specific in wavelength than the Isolaz, don’t penetrate as deeply due to the shorter wavelength and do not have any vacuum. Nowadays, with Isolaz and Levulan, severe cases of acne can be cleared in 3 visits, 2 to 4 weeks apart.
Does acne ever go away?
In general, acne tends to subside during the late teens or early 20s, although some people will experience acne into adulthood. Predicting exactly when acne will disappear on its own is very difficult to do, however. Acne will typically go through cycles of eruption and improvement while it is active.
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While acne does not usually lead to severe health conditions, it can cause permanent scarring and damaging emotional effects for patients of any age. Patients should seek dermatologic treatment for acne if symptoms do not respond to over-the-counter treatment methods or scarring develops as the acne clears.