Acne is a common condition caused by inflammation of a specialized type of hair follicle typically located on the face, back and chest. It is not considered a disease when it is severe enough to cause pain, physical scars or emotional scars.
Acne is not contagious but is affected by several environmental factors. It is suggested that sunlight makes acne better and stress makes it worse. Diet has not been shown to have any significant effect on acne. Nevertheless, if a patient notices that a particular food seems to worsen acne, that food should be avoided. In some women, hormonal changes may cause acne to worsen a few days prior to the menstrual period. Exercise appears to have no effect on acne, but sweating tends to worsen acne in about 15% of patients.
In order to fully understand the way that acne treatments work, it is first necessary to understand how acne occurs. Acne is most common and severe during adolescence. It is the end result of the increased hormonal activity that begins to occur as children mature into adults. These hormones (testosterone in the male and progesterone in the female) are both metabolized to dihydrotestosterone. This hormone causes enlargement of oil glands and increases the flow of oil from the glands and production of scales along the ducts of oil glands. These oil glands are attached to small hair follicles. If oil is able to pass freely to the surface of the skin, acne does not occur. However, if oil flow is impeded due to oil duct blockages (so called “microcomedones”), acne may result.
Because oil causes no trouble once it reaches the skin surface, repetitive washing of oily acne-prone skin does not significantly improve acne. Soaps are not especially helpful in acne control. In fact, washing excessively or using harsh facial scrubs may actually irritate the skin and make acne worse. Picking and squeezing often causes local damage if not performed carefully and may result in scarring.
There are six classes of medications that predictably effective against acne.
1. Accutane® pills will often permanently cure or dramatically lessen acne after a six-to-seven-month course of treatment.
2. Antibiotic pills are often very effective for acne on the back and chest.
3. Benzoyl peroxide is a topical medication that fights acne by removing excessive scales from oil gland linings and also by reducing bacterial activity within the skin.
4. Retin-A® is one of the more effective acne medications for comedonal (whiteheads and blackheads) and small popular (little pink bumps) acne.
5. Topical antibiotics are often used in conjunction with benzoyl and Retin-A® and they work by decreasing bacterial counts within open pores so that oil and excessively scales are less likely to clog pores and cause acne.
6. Chemical peels with trichloro-acetic acid, glycolic acid and alpha-hydroxy acid can have a beneficial effect when administered to acne-prone skin by dermatologists.