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Family Health Magazine
ADOLESCENT HEALTH

Acne
Dealing with an adolescent nightmare

Graduation, weddings, interviews and any other major life event often seem incomplete without the development of a pimple. Acne, a common skin disease, affects nearly 85 per cent of people between the ages of 12 to 24. Everyone experiences acne at some point. Acne usually disappears by the thirties although some still have it in middle age.

Some teens find acne only a slight nuisance. For others, it causes painful lesions, social embarrassment, and physical and psychological scarring. Fortunately, many treatment options are available. Choosing the right treatment begins with understanding what causes acne.

What is acne?

Acne vulgaris (from the Latin vulgar, meaning common) is a red, irritated skin rash. It is caused by a disorder of the oil-producing sebaceous glands. Acne usually appears in areas of the body that produce oil (sebum), most often on the face, chest and back. The neck and upper arms can also be affected. Comedones (blackheads or whiteheads), papules, pustules, inflammation and occasionally scarring can result. Acne is more common in males during adolesence, and in females in adulthood.

What causes acne?

Oil-producing sebaceous glands are attached to hair follicles. Follicles are tiny shafts in the skin through which a hair grows and where sebum is released from the gland to the skin.

Four factors contribute to an acne-infected hair follicle:

• Androgens, male hormones present in both genders but higher in men, are one cause of acne. Androgens enlarge the sebaceous glands in the skin and increase oil production. Extra oil plugs the follicle and serves as food for bacteria. Since androgens surge at puberty, teens are likely to develop acne.
• Flaking of dead cells in the hair follicle can also form a plug.
• Bacteria (Propionibacterium acnes) on the skin are responsible for causing acne. These bacteria infect the pool of oil that is gathering. They produce irritating substances that redden and inflame the skin.
• As bacteria causes oil to be absorbed, skin becomes more irritated and inflamed.

Simply put, hair follicles get plugged, allowing bacteria found on the skin to infect the oil that cannot escape. The skin becomes inflamed. Unfortunately, at this point we do not know why some are more likely to have plugged pores than others.

Genetic factors (factors that run in the family) and stress can also influence the development and seriousness of acne. Understanding the four-step progression allows us to counteract each step along the way, hopefully stopping acne from forming.

What are the myths of acne?

As with other areas of medicine, several myths about acne exist. Acne does not result from too much dirt on the skin or in the pores. Too much scrubbing may actually make acne worse. It does not develop after eating a lot of so-called bad foods such as chocolate or fried foods. No foods cause acne or make it worse.

Can I treat acne on my own?

Most acne is mild enough to be treated without the help of a physician. Conservative treatment includes basic cleansing and the use of OTC products. Try washing once or twice daily with soap and water to remove excess oil from the skin. An acne cleanser might also help, but keep in mind that scrubbing can make acne worse. Non-comedogenic make-up, cosmetics and skin care products are designed not to irritate the skin.

OTC treatments often have nonprescription-strength medication as part of the active ingredients. While this may help, stop using any OTC product if it causes tingling, dryness or skin irritation. Your doctor or pharmacist can also look at a particular product's ingredients to help decide if they are the right ones for you.

When should I get help from a doctor?

If you are troubled by acne and it doesnÕt improve with conservative treatment, talk to your doctor. Those with severe or tender acne that causes scarring, and women with acne who develop facial hair or irregular periods, should also get medical help. Finally, if acne worsens or is associated with fever or severe swelling of the skin, see a doctor.

If conservative methods do not improve acne, medication might be the answer. Each type of medication counteracts one of the four factors that cause acne to form. Medication may be topical (applied to the skin) or oral (taken by mouth).

What are the topical medications?

Two types of topical medications are available: retinoids and antimicrobials. Retinoids are made from vitamin A, and were first proved effective in the 1970s. They open clogged pores by decreasing oil production and creating a mild skin-peeling effect. Three main topical retinoids are tretinoin, adapalene and tazarotene. However, one frequent side effect of topical retinoids is dry, peeling skin.

Antimicrobials, the other topical medication, kill tiny organisms like bacteria. Topical antimicrobials include antibiotics (e.g. clindamycin, erythromycin, tetracycline) and benzoyl peroxide. These products eliminate the bacteria P acnes. They may be applied to the skin in the form of gels and lotions. Side effects include skin redness, peeling, dryness and burning. Benzoyl peroxide may also irritate skin and bleach hair, clothes and bed linens.

Using a combination of two medications can be very effective and has become common practice. For instance, combining a topical antibiotic with topical benzoyl peroxide may prevent resistance of the bacteria to the antibiotic.

A minimum six to eight weeks of treatment is recommended.

What are the oral medications?

Oral medications include oral antibiotics, hormone therapy and isotretinoin (Accutaneª). Oral antibiotics include tetracycline, erythromycin, doxycycline and minocycline. These all have antimicrobial effect. Since P acnes is attacked within the hair follicles, there is less progression to inflammation. Side effects can include stomach upset, vaginal yeast infection, photosensitivity (sensitivity of the eyes to light) and, in rare cases, a blue discoloration of the skin.

Only women are able to use hormone therapy for acne. These medications reduce androgens in the body, in turn lowering oil production. Products available include oral contraceptives and 'water pills' (diuretics with androgen receptor blockers).

The other medication currently available is isotretinoin (Accutaneª). This oral form of vitamin A works by stopping oil glands from enlarging and producing oil. This is a very strong medication with many side effects. It must be used with extreme caution. Side effects include dry lips, skin and eyes, decreased night vision, headache, nosebleeds and backache. It can cause elevated blood fats (triglycerides) and damage to the liver. Women who become pregnant while taking this medication can have babies with birth defects.

Those who take Accutaneª must have regular blood tests to check for problems. Women also need to be tested to be sure they are not pregnant. Accutaneª users have also reported depression and suicidal thoughts. Since it has such significant side effects, Accutaneª is normally reserved for unusual cases of acne that are either extremely severe or do not respond to other medications.

Acne is a very common problem that affects nearly every teen. Treatment can help prevent scarring and regain self-esteem. Fortunately, most people eventually grow out of acne. For those with troublesome or persistent acne, many different treatment routines are available with potentially excellent results. If you have questions about how best to treat your acne, your doctor can help.