A new school year brings new opportunities, challenges, and friends. Kids tend to want to put their “best face” forward, but for many, acne makes them feel self-conscious, shy, or awkward. For some, if severe enough, acne can keep them from joining social and sport activities.
Pimples, zits, whiteheads, blemishes are all terms for acne, or acne vulgaris. Almost everyone at some time or another in their life has experienced acne. While it usually occurs on the face, acne can also affect the neck, chest, shoulders or back.
It starts with an invisible lesion called the microcomedone. This is a pore that’s been clogged with a “sludge” of oil and dead skin cells. Normally, we shed millions of skin cells everyday without noticing. However, in those of us with oilier skin or skin influenced by teen hormones, menstrual cycles, or stress, these cells will stick together and form a plug in the pore. When this happens, more oil builds up because it is blocked from getting to the skins surface to be washed away. As these lesions become larger we will see them. They are known as blackheads or whiteheads, depending on whether the oil plug has been in contact with air at the skin’s surface, turning it dark in appearance.
From this lesion, the papule or pustule may form. We all are colonized with many bacterial species, but one in particular, P. acnes, seems to be more involved in acne than the others. P. acnes needs the oil material on our skin to survive, so in an overloaded/blocked pore, the bacteria overgrows and when this happens the wall of the pore will breakdown and rupture visibly appearing as the classic pimple or pus filled bump of acne. If this process involves many pores close together or is very intense, a cyst or nodule may form. This is the most painful and severe form of acne, and also has the highest potential for scarring.
Acne is not from dirty skin. While normal, gentle washing will help exfoliate dead skin cells and remove excess oil from the skin, scrubbing can irritate and make the inflammation of acne much worse. Over drying your skin with harsh astringents or alcohol can also aggravate this irritation as well as signal your body to make more oil further worsening acne.
While teenagers are the most commonly affected, adults can also develop acne (or continue to have it well past their teen years). Increased androgens (male hormones) associated with puberty, pregnancy, or hormonal imbalance signal the oil glands to make more oil. The opposite is also true: a decrease in estrogen (female hormones) can also allow normal levels of androgen overstimulate oil glands. This may be why some women have acne with their menstrual cycles or with the onset of menopause. The tendency to develop acne is highly genetic. Therefore, if acne runs in your family, it may be hard to avoid.
There have been many attempts to “blame” acne on chocolate or junk foods. Certainly, if you notice you or your child gets more acne when eating these things, then do your best to avoid them. Recent studies have shown that consumption of non-fat or low fat dairy products may worsen acne, especially in adolescent boys. Conversely, there have also been recent studies showing a beneficial effect of fish oil on acne. This can either be eaten or taken as a supplement.
If you or your child suffers with acne, there are several steps you can take to improve your skins appearance. In general, gentle cleansing twice daily is recommended. Do your best not to pick, pop, or scratch your pimples, blackheads, or whiteheads. This generally leads to more inflammation, a greater risk of introducing more bacteria into the skin, and if severe enough, more scarring. Look for products and make ups that say “non-comedogenic”. This term signifies that all of the ingredients have been shown not to clog up pores or aggravate acne.
If you feel you’ve tried all of these methods and nothing has helped, make an appointment with your dermatologist. There are multiple medications that help acne when used consistently and correctly. Oral antibiotics mainly target the inflammation of acne and are safe to use for a few months at a time. Topical preparations containing antibiotic, benzoyl peroxide and sulfur also help calm inflammation while decreasing the amount of bacteria on the skin. A special class of medicines called retinoids is particularly helpful in acne. They are powerful anti-inflamatory drugs, and they also help reduce the amount of oil produced by the skin. It is customary for most dermatologists to use these medications in various combinations depending on your age, skin type, and severity of your acne. No single one medication works best for everyone, so it’s important to let your dermatologist examine your skin and ask you questions about your acne.
Finally, remember treating acne can take time. A minimum of 6 weeks of treatment may be necessary to see noticeable changes in your skin. So patience is also an important tool in treating this frustrating problem.