No one likes having acne in any form. It’s embarrassing, makes you self-conscious and can sometimes be rather painful to deal with. Acne can even cause emotional distress which can lead to scarring. In order to help ourselves with acne problems, it’s best to know exactly what we’re dealing with.
What causes acne? It’s mostly observed that acne is the direct result of either overproduction of oil on the skin (sebum), irregular shedding of dead skin cells, and/or a buildup of bacteria. Your skin produces sebum from the sebaceous glands under the skin and each hair follicle is connected to these glands. Sebum is created to lubricate the hair and skin. If sebum overproduces, this oil and dead skin cells plug up hair follicles and cause a soft plug. It’s thought that an elevation in hormone levels is directly linked to acne, thus explaining why the condition most often plagues teenagers and pregnant women.
There are several forms of acne that can affect your skin.* Whiteheads and blackheads are called comedones. When the comedones are open to the surface, they’re often referred to as blackheads because of the dark appearance against the hair follicle. When the comedone is closed and appear as a slightly raised, flesh colored bump, they’re called whiteheads. Papules are small raised bumps that may feel tender to the touch. These signal inflammation or infection of the follicle. Pustules are what we often think about as “pimples”- red, tender bumps with white pus at the surface. Nodules are large, solid, painful lumps deep under the skin that are formed by a buildup of secretions deep in the follicle. The worst of the blemishes are cysts- painful, pus filled, infected lumps beneath the skin that tend to have a boil like appearance. Cysts can cause scars on the skin.
Normally acne is not a serious medical condition and doesn’t require a visit to the dermatologist. However, if you experience cysts, persistent pimples, or you wish to avoid scarring or any further damage to your skin, the dermatologist may be able to prescribe something to help. If your acne or scars are affecting your self-esteem or social life, you can also inquire about how to properly control the blemishes and reduce the appearance of scarring.
Unfortunately, there are a few “wives tales” surrounding acne that are completely untrue.** Washing your face more often will not help clear up acne since we’ve proved earlier that the cause is not dirt on the skin, but issues under the skin surface. Stress does not cause acne, even though it may raise your hormone level a bit. Masturbation or sex do not cause surges in acne either. This notion dates back to the 17th century to try and convince the young not to have premarital sex and is not proven scientifically. Standing in the sun does not help clear up acne and sun burns cause even more damage to your skin.
There are plenty of ways to treat your acne. The most common are over the counter topical treatments. These are often found in lotion form and work by drying up the oil, killing bacteria, and scraping off dead skin cells. The lotions are generally mild to the skin and contain benzoyl peroxide, sulfur, resorcinol, salicylic acid or lactic acid as active ingredients. While helpful with smaller breakouts, over the counter topical treatments are not very effective against the heavier stuff. They can also cause side effects like skin irritation, dryness, and flaking, but this often improves after the first month of use.
If your acne is not effected by over the counter treatments, you may want to speak to your dermatologist about prescription topical ointments. Some examples of these prescriptions are tretinoin (Avita, Retin-A, Renova), adapalene (Differin), and tazarotene (Tazorac, Avage), which are all derivatives of Vitamin A.*** These ointments work by keeping the process of cell turnover going, making it more difficult for dead skin cells to plug up hair follicles. Some other prescriptions use the same benzoyl peroxide as over the counter treatments, but pair it with strong antibiotics to kill unwanted bacteria. These products are not without side effects though- you may experience stinging, burning, redness, or peeling.
Moderate to severe acne may require oral antibiotics to ease inflammation and reduce bacteria. Unfortunately, since these antibiotics were first used to treat acne, the bacteria may be resistant or become resistant to the medicine over time. The dermatologist will most likely take you off the medication as soon as the situation improves or they prove not to be working. While the antibiotics may be a nice change, they also come with the possible side effects of dizziness, upset stomach, or skin discoloration. They can also increase sensitivity to sunlight (so you’ll burn easier) and can reduce the effectiveness of oral contraceptives.
Sometimes antibiotics aren’t enough for the deep infected cysts you might have. Isotretinoin (Accutane) is medicine available for scarring cystic acne or resilient acne that won’t respond to other treatments so it is used for the most severe forms of acne. It’s incredibly effective, but must be closely monitored by doctors as it carries some severe side effects with it. It can cause severe birth defects so women who are pregnant or can become pregnant are not supposed to take it. Other side effects are dry eyes, mouth, lips, nose, and skin along with itching, nosebleeds, muscle aches, increased sun sensitivity, and poor night vision. It can also increase chance for depression and suicidal thoughts.
Sometimes all it takes is to eat a bit healthier, wash your face nightly, and to not pop the blemishes you have to control your acne.**** No matter what, your acne is normal, manageable and no cause for panic.