Acne

1.    What is Acne?

Acne vulgaris is an inflammation of the sebaceous glands of the face, back, or other body regions, occurring most frequently in adolescents but often in adults as well.  A combination of genetic and environmental factors is thought to be the cause.  These include a given individual’s amount of sebaceous glands in the skin, hormone levels, skin sensitivity, emotional stress, and their diet’s glycemic index.  A diet rich in high glycemic index foods, like sugary snacks, white bread, and milk, may contribute to acne.  Diets with complex or low carbohydrates may help acne improve.  Acne can be both physically and psychologically devastating to an individual, and may contribute to embarrassment, anxiety, and even depression.  In addition, acne may leave scars that often burden an individual for life. 

2.    What Does Acne Look Like?

Acne may involve blackheads, whiteheads, red and inflamed pustules, nodules, or cysts, and primarily affects the face, chest, shoulders, back, and buttocks. 

3.    Who Does Acne Affect?

Acne is most common among males ages 14-19 and females ages 10-17 years, however, adult acne may begin from age 25 onwards.  It is more severe in males than in females, and affects all races, but is less common among Asians and blacks.  For most people, acne usually subsides by their thirties; however, some people continue to have acne into their forties and fifties.

4.    What Causes Acne?

Acne is caused by a combination of multiple factors and events.  The skin of the affected region is composed of thousands of small hair follicle units producing both seen and unseen hairs.  Each hair unit has adjoining sebaceous glands that release sebum (oil), into the follicle (canal) where the hair leaves the epidermis.  During puberty, menstruation, or other hormonally-fluctuating periods, the levels of sebaceous gland cells increase and sebaceous glands themselves enlarge, producing more sebum.   This extra sebum, along with the hair shaft and free-floating sebaceous gland cells can produce a comedone (plug) in the follicle that blocks the pore opening.  This causes further accumulation of sebum, on which bacteria can then grow.  If the plug reaches the skin surface, it opens up and its contents react with oxygen and turn dark, appearing as a black comedone (blackhead).  If it remains beneath the skin surface it stays fully plugged, and appears as a white comedone (whitehead).  Bacterial products then stimulate the recruitment of cells of the immune system; this produces the red, inflamed bumps and swelling involved in acne.  Occasionally, the walls of the follicle break and its contents leak below the epidermis, which provokes an even greater response and may lead to larger pimples, bumps, nodules, or cysts.  Intense inflammation or rupture often leads to scarring.

5.    What Triggers Acne?

Many factors may trigger and exacerbate acne flares.  Emotional stress has been shown to correspond with increased acne levels.  In addition, an increase in androgen (male hormone) levels during puberty occurring in both males and females may cause sebaceous glands to enlarge and sebum levels and acne to increase.  Similar hormonal changes such as pre-menstruation, pregnancy, or stopping birth control pills may also cause acne.  Another very important factor is continued pressure on the skin, caused by sports helmets, equipment, tight collars, or by leaning the face on the hands or on a telephone (acne mechanica).  Extensive exposure to grease from oily cosmetics, kitchens with fry vats, or other environmental sources may alter follicle cells to stick together and form acne plugs.  New data also suggests a link between acne flares and high glycemic index diets (diets high in simple sugars and low in complex carbohydrates).  Finally, rigorously scrubbing the skin, as well as squeezing or picking acne blemishes may significantly worsen acne flares.  Things that do not cause acne include “dirty skin”, or sexual behaviors.

6.    How Can My Acne Be Treated?

Acne is a very treatable condition.  Providers at the Berman Skin Institute are committed to bringing every patient’s acne under control, and have a number of treatments available.  For general acne flares, Photodynamic Therapy  (PDT) has proven to be one of the most successful treatments.  During PDT, a topical medicine is applied to the skin’s surface.  After waiting a half hour or more, a blue light or laser beam is passed over the skin, activating the medicine.  Once active, the medicine goes to work shrinking the sebaceous glands and killing off bacteria that cause acne.  A series of treatments are usually performed.  For black and white comedones, cysts, and large pustules, an aesthetician may perform gentle, surgical extractions to remove plugs and restore an environment in which the skin can heal without scarring.  In certain cases topical or oral antibiotics are used often in combination with benzoyl peroxide gels and cleansers.  Topical retinoids such as adapalene, tretinoin, tazorotene creams are effective in normalizing sebaceous cell growth as well as inhibiting inflammation, and may help decrease acne.  Newer technologies in topical acne treatments, such as Aczone, can now treat acne without harshly irritating your skin like more traditional topical treatments used to do.  Severe, cystic acne may be treated with oral retinoid medications.  In addition, aestheticians may provide light glycolic acid and salicylic acid chemical peelssilk peels, or microdermabrasion  to help loosen blackheads, exfoliate the outermost layer of skin, and stimulate collagen deep within the dermis to refresh and renew the skin.  For more information on available treatments for acne, or to schedule a visit, please call and speak with a representative at the Berman Skin Institute.

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