Acne is an inflammatory skin condition characterized by clogged pores, blackheads, and pimples. The oil glands, or sebaceous glands, are connected to hair follicles and release a substance known as sebum that lubricates hair and skin. Usually, sebum travels up the hair follicle and out onto your skin. But when the sebaceous glands produce too much oil and combines with dead skin cells, the follicles become blocked and inflamed. Acne most often affects the nose, forehead, cheeks, chin, back, and trunk. Up to 45 million people have acne, making it the most common skin condition in the United States. While it tends to last longer in women, men are more likely to get acne, and to have more severe cases. Acne is most common in teens and it generally goes away by age 30. Although it is not a serious health threat, severe acne can be painful and may cause permanent scarring.
There are several types of acne lesions:
Lesions can cause scars ranging from small, sunken pits to large elevated blemishes, depending on how severe the acne is and what your skin type is.
Acne is caused by the combination of too much sebum and a buildup of dead skin cells. No one knows what causes excess sebum production. In teens, rising hormone levels may be a factor. Too much sebum blocks hair follicles, and small bacteria-filled cysts called comedones form. If these comedones do not rupture, they develop into whiteheads or blackheads. When comedones rupture, the inflammation can spread into the surrounding area. Papules, pustules, cysts, and nodules are types of inflammatory lesions. Acne may be associated with certain endocrine disorders, nonendocrine diseases, and the use of certain medications. Acne is also exacerbated by certain environmental factors, such as hot, humid climate, certain medicines (such as steroids), and industrial exposure to certain chemicals.
The following may cause or worsen acne:
Acne is rarely a serious health problem. General practitioners and internists can treat most people with mild-to-moderate forms of acne. People with more severe cases are often referred to a dermatologist. Your doctor will take a complete medical history that includes questions about:
Your doctor will also examine your face, chest, back, and other areas for blemishes, lesions, and scars.
Treatment is aimed at reducing sebum production, helping the skin shed dead cells so they do not build up, and preventing bacteria from accumulating. Early treatment is essential to prevent scarring. You can help by doing the following:
Topical formulations are usually the first line therapy for acne. They are used to prevent and treat acne. Your doctor may also prescribe topical medicines to treat acne. The most commonly used include:
Your doctor may recommend a combination of topical medicines, such as benzoyl peroxide and clindamycin, or tretinoin (a retinoid) and clindamycin. Older topical preparations, such as sulfur, resorcin, and salicylic acid are still useful, particularly when newer medicines are not well tolerated.
Your doctor may prescribe oral (taken by mouth) antibiotics either alone or in addition to topical medications for moderate-to-severe acne. For those with severe, inflammatory acne that does not improve with other medications, an oral retinoid called isotretinoin (Accutane) may be prescribed.
Some women may be prescribed birth control pills that seem to reduce acne.
Surgery or other procedures may help improve the appearance of skin scarred by acne. Chemical peeling (where a chemical solution is applied to the skin that causes it to blister and eventually peel off) can reduce minor scars. Dermabrasion (a procedure that uses a rapidly rotating brush to remove the top layers of skin) can help more severe scarring. Laser resurfacing uses pulses of light to remove the top layer of skin and reduce scarring. However, few studies have compared light and laser therapy with conventional acne treatments.
Complementary and alternative therapies (CAM) may play a role in the treatment of acne. You should work with a knowledgeable provider and inform all of your physicians about any CAM therapies you are planning on using. Some CAM therapies may interfere with conventional treatments and may not be right for every person.
Some studies suggest that foods with a high gycemic load, such as processed snacks, refined sugar, and baked goods, may exacerbate acne. Dairy intake also appears to be weakly associated with acne. A low glycemic diet helps keep blood sugar stable and under control. Food allergies may also play a role in adult acne, and people may want to avoid foods that appear to make their symptoms worse.
Herbs may help strengthen and tone the body's systems. As with any therapy, you should work with your health care provider before starting treatment. You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted.
Few studies have examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for acne based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.
Pregnant women should avoid all retinoids (those either taken by mouth or applied to the skin), isotretinoin (Accutane), and the antibiotics tetracycline, minocycline, and doxycycline because they can be harmful to the fetus. The antibiotic erythromycin (either applied to the skin and taken by mouth) is safe to use during pregnancy.
Acne is not a serious health threat, but severe acne can be painful, emotionally upsetting, and may cause permanent scarring. Squeezing lesions can rupture comedones and cause inflammation. Symptoms generally diminish after adolescence and disappear by age 30. However, adult acne, especially in women, seems to be increasing and is not unusual in women in their 30s, 40s, and beyond.
Bolognia: Dermatology, 3rd ed. St. Louis, MO: Elsevier Saunders; 2012.
Bowe WP, Shalita AR.Effective over-the-counter acne treatments. Semin Cutan Med Surg. 2008 Sep;27(3):170-176.
Bowe W, Joshi S, Shalita A. Diet and acne. Journal of the American Academy of Dermatology. 2010; (62)1.
Brown DJ, Dattner AM. Phytotherapeutic approaches to common dermatologic conditions. Arch Dermtol. 1998;134:1401-1404.
Di Landro A, Cazzaniga S, Parazzini F, et al. Family history, body mass index, selected dietary factors, menstrual history, and risk of moderate to severe acne in adolescents and young adults. J Am Acad Dermatol. 2012; 67(6):1129-1135.
Eichenfield, LF; Wortzman M. A novel gel formulation of 0.25% tretinoin and 1.2% clindamycin phosphate: efficacy in acne vulgaris patients aged 12 to 18 years. Pediatr Dermatol. 2009;26(3):257-261.
Ernst E, Huntley A. Tea tree oil: a systematic review of randomized clinical trials. Forsch Komplementärmed. 2000;7:17-20.
Enshaieh S, Jooya A, Siadat AH, Iraji F. The efficacy of 5% topical tea tree oil gel in mild to moderate acne vulgaris: a randomized, double-blind placebo-controlled study. Indian J Dermatol Venereol Leprol. 2007 Jan-Feb;73(1):22-25.
Ferri: Ferri's Clinical Advisor 2013, 1st ed. Philadelphia, PA: Elsevier Mosby; 2012.
Galobardes B, Patel S, Henderson J, Jeffreys M, Smith GD. The association between irregular menstruations and acne with asthma and atopy phenotypes. Am J Epidemiol. 2012; 176(8):733-737.
Georgala S, Schulpis KH, Georgala C, Michas T. L-carnitine supplementation in patients with cystic acne on isotretinoin therapy. J Eur Acad Dermatol Venereol. 1999;13(3):205-209.
Gfesser M, Worret WI. Seasonal variations in the severity of acne vulgaris. Int J Dermatol. 1996;35(2):116-117.
Ghali F, Kang S, Leyden J, Shalita AR, Thiboutot DM. Changing the face of acne therapy. Cutis. 2009;83(2):4-15.
Gold MH. Acne and PDT: new techniques with lasers and light sources. Lasers Med Sci. 2007 Jan 16; (Epub ahead of print).
Hamilton FL, Car J, Lyons C,Car M, Layton A, Majeed A. Lasers and other light therapies for the treatment of acne vulgaris: systemic review. Br J Dermatol. 2009;160(6):1273-1285.
Hasibur MR, Meraj Z. Combination of low-dose isotretinoin and pulsed oral azithromycin for maximizing efficacy of acne treatment. Mymensingh Med J. 2013; 22(1):42-8.
Hsu P, Litman GI, Brodell RT. Overview of the treatment of acne vulgaris with topical retinoids. Postgrad Med. 2011; 123(3):153-161.
James: Andrews' Diseases of the Skin: Clinical Dermatology, 11th ed. Philadelphia, PA: Elsevier Saunders; 2011.
Jansen T, Plewig G. Advances and perspectives in acne therapy. Eur J Med Res. 1997;2:321-334.
Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 227-230.
Jung JY, Hong JS, Ahn CH, Yoon JK, Kwon HH, Suh DH. Prospective randomized controlled clinical and histopathological study of acne vulgaris treated with dual mode of quasi-long pulse and Q-switched 1064-nm Nd: YAG laser assisted with a topically applied carbon suspension. J Am Acad Dermatol. 2012; 66(4):626-633.
Krowchuk DP. Treating acne. A practical guide. Med Clin North Am. 2000;84(4):811-828.
Leyden J, Del Rosso J, Webster G. Clinical Considerations in the Treatment of Acne Vulgaris and Other Inflammatory Skin Disorders: a Status Report. Dermatologic Clinics. 2009;(27)1.
Lolis M, Bowe W. Shalita A. Acne and Systemic Disease. Medical Clinics of North America. 2009;93(6).
Lucky AW, Biro FM, Simbartl LA, Morrison JA, Sorg NW. Predictors of severity of acne vulgaris in young adolescent girls: results from a five-year longitudinal study. J Pediatr. 1997;13(1):5.
Lucky AW, Cullen SI, Jarratt MT. Comparative efficacy and safety of two 0.025% tretinoin gel: results from a multicenter double-blind, parallel study. J Am Acad Dermatol. 1998; 38(4): S17-S23.
Meynadier J. Efficacy and safety study of two zinc gluconate regimens in the treatment of inflammatory acne. Eur J Dermatol. 2000;10:269-273.
Papageorgiou PP, Chu AC. Chloroxylenol and zinc oxide containing cream (Nels cream®) vs. 5% benzoyl peroxide cream in the treatment of acne vulgaris. A double-blind, randomized, controlled trial. Clin and Exp Dermatol. 2000;25:16-20.
Paranjpe P, Kulkarni PH. Comparative efficacy of four Ayurvedic formulations in the treatment of acne vulgaris: a double-blind randomized placebo-controlled clinical evaluation. J Ethnopharm. 1995;49:127-132.
Preneau S. Dessinioti C, Nguyen JM, Katsambas A, Dreno B. Predictive markers of response to isotretinoin in female acne. Eur J Dermatol. 2013; 23(4):478-86.
Raman A, Weir U, Bloomfield SF. Antimicrobial effects of tea-tree oil and its major components on Staphylococcus aureus, Staph. epidermidis and Propionibacterium acnes. Letters in Applied Microbiol. 1995;21:242-245.
Sami NA, Attia AT, Badawi AM. Phototherapy in the treatment of acne vulgaris. J Drugs Dermatol. 2008 Jul;7(7):627-632.
Sandoval LF, Hartel JK, Feldman SR. Current and future evidence-based acne treatment: a review. Expert Opin Pharmacother. 2014; 15(2):173-92.
Sato T, Takahashi A, Kojima M, Akimoto N, Yano M, Ito A. A citrus polymethoxy flavonoid, nobiletin inhibits sebum production and sebocyte proliferation, and augments sebum excretion in hamsters. J Invest Dermatol. 2007 Dec;127(12):2740-2748.
Sharquie KE, Noaimi AA, Al-Salih MM. Topical therapy of acne vulgaris using 2% tea lotion in comparison with 5% zin suphate solution. Saudi Med J. 2008;29(12):1757-1761.
Sinclair W. The rational use of systemic isotretinoin: a call for moderation. S Afr Med J. 2012; 102(5):282-284.
Song BH, Lee DH, Kim BC, et al. Photodynamic therapy using chlorophyll-a in the treatment of acne vulgaris: a randomized, single-blind, split-face study. J Am Acad Dermatol. 2014; 71(4):764-71.
Thiboutot D. New treatments and therapeutic strategies for acne. Arch Fam Med. 2000;9:179-187.
Titus S, Hodge J. Diagnosis and treatment of acne. Am Fam Physician. 2012; 86(8):734-740.
Tripathi SV, Gustafson CJ, Huang KE, Feldman SR. Side effects of common acne treatments. Expert Opin Drug Saf. 2013; 12(1):39-51.
Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995: 185-186.
Whang KK, Lee M. The principle of a three-staged operation in the surgery of acne scars. J Am Acad Dermatol. 1999; 40(1): 95-97.
Whitmore, SL. Common disorders of the skin. In: Barker LR, Kern DE, Thomas PA. Principles of Ambulatory Medicine. 7th ed. Baltimore, MD: Williams & Wilkins; 2006: 1887.
Williams HC, Dellavalle RP, Garner S. Acne vulgaris. Lancet. 2012; 379(9813):361-72.
Yoon JH, Park EJ, Kwon IH, et al. Concomitant use of an infrared fractional laser with low-dose isotretinoin for the treatment of acne and acne scars. J Dermatolog Treat. 2014; 25(2):142-6.
Youn SH, Choi CW, Choi JW, Youn SW. The skin surface pH and its different influence on the development of acne lesion according to gender and age. Skin Res Tech. 2013; 19(2):131-6.
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