A Comprehensive Look at Acne
Acne is something that we are all familiar with. We have all either had acne or know someone who has. Acne, particularly in the teenage years, is almost unavoidable and can be the basis for teasing and joking. For most, however, acne is no laughing matter. It is interesting to note that acne is one of the most common skin conditions in America, affecting close to 100% of all teenagers. What may also be surprising is that in many cases, acne continues to affect people well after their teenage years.
Admittedly, the symptoms of adult acne are usually less than those of teenagers. This raises a few important questions: what exactly is acne, and why does it persist after the hormonal imbalance period of the pubescent years? What exactly causes acne, and why do some people get it and some not? Even further, what are the psychological ramifications of someone with severe or persistent acne? Are all acne afflicted teenagers forced to ‘wait it out’ during their pubescent years, or is there a way to stop hormonal acne? Is baby, teenage and adult acne treatable? Here we shall delve into all of these questions to obtain a better understanding of what acne is, why we get it and ultimately how to treat or prevent it.
Acne – Biological Explanation
Your entire body is covered with an organ known as the skin. The skin protects underlying muscles and organs from infection, blood loss and physical trauma. The entire surface of the skin, with the exception of the palms, soles of the feet and lips, is filled with tiny ‘holes’ known as pores and follicles. A pore’s primary role is to secrete water, carried to it via blood cells, for the purpose of evaporating on the surface of the skin to aid in body cooling (sweat). The follicle’s primary role is to grow hair by way of constantly accumulating dead cells which eventually ‘push out’ or ‘grow’ out of the surface of the skin. Under or alongside all follicles and pores, in the subcutis area, are sebaceous glands. These glands perform a variety of functions by excreting a fatty mixture called sebum. Some functions of sebum include protecting hair from drying and cracking, keeping skin moist and waterproof, helping tears evaporate slower, protecting the ear canal (earwax) and inhibiting the growth of microorganisms on the
skin.Sebaceous glands are constantly secreting sebum. Acne is a result of sebum in the follicle mixing with other materials (dirt, residues, and dead skin cells) and clogging the pore or follicle. Once clogged, the mixture provides a perfect breeding ground for acne causing bacteria Propionibacterium Acnes, or P. Acnes. This bacterium thrives in the clogged mixture –your body detects the bacteria and defends against it by sending white blood cells, the immune system’s ‘fighter cells’. The result is even more debris (white blood cells) collecting in the clogged pore or follicle, causing a bump in the skin known commonly as a pimple. The ironic ‘worsening’ of the situation by the flooding of white blood cells is not uncommon in human biology. This same scenario is responsible for all pus and inflammation. Some inflammations which are life threatening are caused by white blood cells ‘accidentally’ attacking and accumulating at a certain area of the body when the immune system mistakes a normal body process with an invading host (as is the case with rheumatoid arthritis).
The most common acne ‘flare ups’ are called comedones which are blackheads or whiteheads. Whiteheads are caused by the aforementioned white blood cell attack and blackheads are simply clogged pores that are ‘open’. Also common with the onset of common acne, or acne vulgaris, are papules which are tiny elevations of the skin that have a sandpaper-like feel to them. When acne progresses, pustules may form, which are larger lesions that are also filled with white blood cells, dead skin cells and acne bacterium. These can grow much bigger and are usually under a lot of ‘pressure’ and can be quite painful. Progressing to worse acne, we start to see nodules. Nodules are larger pustules that are a result of increased inflammation and usually affect skin well below the surface. When nodules start to appear, the acne is then considered severe. Untreated nodular acne can finally result in cysts, which is termed nodulocystic acne. Cysts are very large lesions, filled with the same culprits: white blood cells, dead skin cells, bacterium and other types of debris. Cysts are very large, usually amalgamating with other cysts and nodules to form very large lesions that reach far under the skin. In almost all cases, nodulocystic acne will result in permanent skin damage or scarring. These are commonly referred to as ‘acne scars’.
So now that we know the biological explanation for acne, the next logical question is why do some people get acne and others don’t? In actuality, everyone gets acne at some point or another – it is literally impossible for someone to never have a clogged pore or follicle. In general, the question is really ‘why do some people get noticeable acne (from a few noticeable comedones to severe acne) while others seem to be acne free?’ The answer again lies in the sebaceous glands. Everyone has sebaceous glands but some produce more sebum than others. Sebum production level is the main cause of acne. When more sebum is produced, the oily mixture moves further up the follicle, sometimes reaching the skin in abnormal amounts, causing the skin to be oily. More importantly, the overproduction of sebum increases the chances of it coming into contact with dead skin cells and P. Acnes, thus increasing the chance of a clogged follicle and the resulting acne. Again, everyone is different, and those whose sebaceous glands produce more sebum are more likely to have worse acne.
Biological Explanation of Baby Acne
Baby acne is thought to be the result of two causes. When women are pregnant, they go through obvious hormonal changes. Trace hormones stay with the baby and cause acne by stimulating the sebaceous glands and resulting in more sebum production. Another cause, still being researched, is certain medications or supplements taken by women during their pregnancy. This has not been proven but is thought to be true by many dermatologists. It is important to understand that baby acne is very common and usually goes away after a few weeks. Under no circumstances should you excessively scrub your baby’s acne or use over the counter acne medications. Baby acne will usually disappear in a couple of weeks – if it persists more than a couple months, simply visit your dermatologist.
Teenage Acne
When an adolescent goes through puberty, hormone production skyrockets. One of the hormones in greater abundance is called Androgen. Androgen stimulates the sebaceous glands, causing them to enlarge and produce more sebum. The result is a greater chance of acne in the pubescent or adolescent years. Further enabling the onset of teenage acne is the fact that many adolescents tend to shed skin faster when experiencing puberty – the extra dead skin cells create even more chances for follicles to clog and result in more acne. This is why almost 100% of teenagers get acne, but the degrees of severity differ.
Biological Explanation of Adult Acne
1 in 5 adults suffer from adult acne, which loosely describes people suffering from acne well after their pubescent years. Adult acne can be caused by hormonal changes just like teenage acne. Hormonal changes can be for different reasons such as menstruation, pregnancy, menopause (and the male equivalent) etc. Further, certain cosmetics can cause adult acne (look for non-comedogenic products). It is important to treat adult acne different than teenage acne. When buying an acne treatment product, stay away from the ones specifically designed for teenagers. As an adult, simply booking an appointment with a dermatologist can swiftly do away with many acne problems.
Back Acne
We should touch quickly on back acne because in many cases back acne can have worse psychological impacts than facial acne. Further, back acne, or ‘bacne’ as it has been insensitively coined, usually consists of nodules and cysts and is very often more severe than facial acne. Back acne treatment can be identical to facial acne treatment with a few caveats; benzoyl peroxide, a common acne bacteria fighting agent, can bleach clothes and; avoid some fabric softeners can leave a waxy residue on clothes, further exacerbating the acne problem; avoid tight fitting clothes and backpacks that put undue stress on the skin of the affected area.
Psychological Effects
It should not be surprising to anyone that acne can have negative effects on self esteem. Particularly for teenagers, where social interaction is paramount, acne problems can result in serious depression. Up until recently, not much attention had been paid to the psychological effects of acne. It is only now that we are seeing various mental ailments as a direct result. Among them are depression (which can lead to other ailments both mental and physical), self-esteem/self-worth issues, isolationist behaviour, poor body image, and more. Many people, especially children and teenagers, will withdraw from social events citing other reasons or excuses. This can have a devastating snowball effect where other, more serious mental disorders become more prevalent over time. In the physical sense, people with acne are less likely to be invited to social events and are less likely to even be hired for a position of employment. In severe cases, suicide has been known to be caused by, among other factors, acne. But why does acne have such a negative effect on the well-being of an individual?
The reason stems directly from the stigmas surrounding acne, most myths, which we will extinguish here. First of all, acne is usually directly associated with ‘dirt’ and ‘uncleanliness’. This is a complete myth – acne is caused by the blockage of follicles due to increased levels of sebum production from the sebaceous gland. As you have already learned, what clogs the pores themselves are usually dead white blood cells, dead skin cells and keratin. The reason this stigma came about is because of the ‘oily’ look of the skin when someone is affected by severe acne. Many people assume the skin is ‘oily’ and ‘filthy’ due to lack of hygiene, where in fact it is simply due to a very natural bodily function, the production of sebum.
Another stigma attached to acne is that it is caused by excessive ingestion of junk food. Again, this is not true. In particular, people who are overweight and suffer from acne are targets of this stigma. The fact is, although diet is important for skin health in general (Vitamin A for example), it has been proven that, say, chocolate and potato chips do not cause acne.
It is easy to understand how suffering from acne can have significant negative social impact on an individual. These myths and stigmas need to be erased from the stereotypical norm so as to educate everyone on this completely normal skin condition. If you are reading this article, you are either a teenager, were a teenager at one time or are possibly raising teenagers. In all cases, stamping out acne jokes and talking to a friend or family member about acne is the best thing you can do. Be supportive. Let the acne sufferer know that not only is acne normal, but in all likelihood it can be easily cured by even a simple washing routine. Helping someone clear up a bad acne problem may be one of the greatest gifts they will ever receive.
Acne Treatment Methods
Routine Cleansing
It can’t be stressed enough how much routine cleansing can help reduce latent bacteria on the skin surface. Gently washing the skin regularly with a soft soap or cleanser can greatly reduce acne problems.
However, it is important to note that washing the face alone will not prevent or treat acne, since acne is created by overproduction of oils due to increased hormone levels.
There is no need to ‘scrub’ acne – in fact this can actually make the problem worse. A simple gentle wash a couple of times a day can discard any extra sebum on the skin’s surface and also do away with dead skin cells and debris can have a tremendous effect on acne if a regular routine is consistent.
Natural Acne Treatment
I mention natural acne treatment first because, with the recent revival of naturopathy and natural cures, it may the best initial route to take when treating acne or other skin conditions. Natural treatments are almost always safe (barring allergies and unsafe mixing of ingredients – see your naturopath or dermatologist – and usually have no adverse side effects. Indeed, many natural remedies have positive side effects. Here are some common natural acne treatments
Tea Tree Oil: Tea Tree Oil (also known as Melaleuca Oil) is one of the most widely used natural treatments for skin blemishes and irritations. Applying Tea Tree Oil to affected areas after routine cleansing can have a positive effect on acne.
Licorice Root: Licorice root has long been used for digestive problems but has been found to have anti-inflammatory properties as well. Licorice root extract can aid in clearing up skin inflammation issues such as acne.
Aloe Vera: One of the most common medicinal plants, Aloe Vera has a number of medicinal properties. One of which is its use and an anti-inflammatory agent. Besides aiding in reducing the inflammation of the skin (or other parts of the body), Aloe Vera also boosts the immune as a positive side effect.
Olive Leaf: Olive leaf extract has been used for centuries to combat many different ailments. Olive Leaf has been used in many forms to aid in clearing up skin breakouts.
Lavender Extract: Lavender extract is an anti-inflammatory and a powerful antiseptic which can kill acne forming bacteria. Because of its antiseptic properties, one should test a small amount on part of the skin to test for allergy or severe drying.
Of course, natural cures are not 100% effective and don’t work for everyone. The beautiful thing about natural products (including retailed products containing refined natural ingredients and ready to use) is that they offer a treatment option with virtually no side effects. Therefore, if you suffer from minor to moderate acne and want to know how to clear up the condition, the best advice is to first create a daily cleansing routine. Follow it strictly and use a mild soap. Second, try a natural ingredient or a product made from natural ingredients specifically targeted towards acne control. If you find these products still do not help (80% of the time they will) then you will need to look at over the counter drugs and other alternatives.
Over-The-Counter and Prescriptions
Over-the-counter and prescription drug treatments usually focus on one or more of the following targets: reducing skin shedding (to reduce pore blockage), killing the P. Acnes bacterium, promoting anti-inflammatory effects, and finally, hormonal manipulation. Drugs and products that focus on more than one of these aspects are usually better, and some come as separate products or stages (such as ProActiv Solution).
Topical medicines are by far the most common acne treatments. The most common active ingredient in these treatment products is benzoyl peroxide. Benzoyl peroxide is an antibacterial (bactericidal) oxidizer that can kill P. Acnes bacteria. Further, it also acts as a keratolytic which means it dissolves excess keratin that can clog pores. Benzoyl peroxide comes in creams, gels and soaps and is used mostly as a topical solution. Benzoyl peroxide is quite effective for mild to moderate acne but can cause mild to severe dryness of the skin exacerbating irritation. Always read the label and follow direction precisely. In some cases, using a non-comedogenic moisturizer after benzoyl peroxide can help maintain a proper moisture balance. Benzoyl peroxide can also be prescribed where it is mixed with a solution that can penetrate deeper into the skin (subdermis). Other bactericidals include triclosan and chlorhexidine gluconate although these are not proven to be as effective as benzoyl peroxide.
Antibiotics
Antibiotics, which were commonly prescribed in the past, are now less prescribed and usually only administered for severe acne cases. Reasons for this include negative side effects, inability for prolonged use and the comparable effects of natural, less harmful treatments. Sometimes, however, antibiotics are the only treatment that will work.
Antibiotics can be topical or ingested orally. Common antibiotics are of the tetracycline variety including doxycycline, minocycline and oxytetracycline. Another semi-common antibiotic is Trimethoprim. As mentioned, antibiotics are not for everyone and can serious side effects. This is why they must be prescribed and should not be considered for mild acne. The purpose of antibiotics is to kill the P. Acnes bacterium. The bacteria will form immunity to the antibiotic over time and because of this acne can reappear after treatment (sometimes in a harsher form) and the use of antibiotics is slowly declining. Ask your doctor for more information about antibiotics and if they are right for you.
Hormonal Treatment
Touching on hormonal treatment – which is reserved for women – Cyproterone (an anti-androgen) and oestrogen (Diane 35) has been proven to help reduce acne inflammations. These are usually combined in contraceptives, making contraceptives and easy for of acne treatment. However, using contraceptives as a form of birth control is not recommended by the writer of this article. Taking a contraceptive for an acne problem is, to sum it in the old axiom, ‘cutting off your nose to spite your face’. However, if you already takecontraceptives, it may be advantageous to speak to your doctor about switching contraceptives to one that is more prone to control acne flare-ups.
Cortisone, a glucocorticoid, is another type or hormonal treatment. Cortisone injected into a large pimple or cyst can bring the pimple down. After effects are a whitish patch of skin or a skin depression which eventually fills and gains its natural color back. Cortisone would most likely be administered by your dermatologist if there is a risk of scarring from a particular lesion. Some side effects of cortisone are a lowered immune system.
Retinoids
If you’ve been researching acne treatment you’ve probably heard of retinoids. Retinoids have been used for decades to combat acne and other skin inflammations. Essentially, retinoids are a harsher form of ‘retinol’ – which is synthetic Vitamin A. Retinoids affect the death and life cycle of hair follicles, thus preventing hyperkeratinisation (a disorder in the follicle where extra keratin disrupts and clogs the pore, resulting in blockage and acne). Retinoids are also being used balding research.
In most cases, retinoids are used a topical medication. If acne is severe and topical solutions are not working, retinoids can be taken orally under the direct supervision of your doctor. Retinoid-based oral treatments are said to be 80% effective. By orally ingesting retinoids for approx 4-months, some patients have completely cleared acne – for good. As perfect as this wonder drug sounds, there are potential side effects. Researchers have produced mixed findings on retinoid side effects and therefore the facts are inconclusive on many fronts. What we do know is women should not take retinoids unless absolutely necessary (which in most cases there are alternatives) because retinoids have been proven to cause birth defects. This is the reason doctors usually prescribe mandatory birth control while prescribing retinoids to women.
Blue Light/Red Light Therapy (Phototherapy)
Red light and blue light treatment can be summed up under Phototherapy. This is essentially using visible light to combat the P. Acnes bacteria. The science behind the lasers is quite extensive, so for the sake of brevity we will look at the basics of what the lasers do. Essentially, intense violet light is directed at the skin in wavelengths of less than 420nm (blue light). When the light hits the P. Acnes bacterium, a by-product of the acne bacteria called porphyrin reacts by producing free radicals which kill the acne bacteria. Laser therapy does not use UV rays and since porphyrins are not found anywhere else in the body, the method appears to be perfectly safe. Red Light therapy, which is essentially the same but uses a light with the wavelength of 660nm, is even more effective. Although blue/red light therapy is expensive, it can be more effective than benzoyl peroxide. These therapy techniques can be administered once, twice or daily for weeks depending on the advice of the technician both prior to the procedure and after reviewing the results.
Laser Therapy
Laser therapy, now widely used in surgeries of all types, is also used for acne treatment. The efficacy of these treatments is still under scrutiny however. Essentially (again, we don’t want a three page science lesson here!) the laser is used to burn away either the sebaceous gland (preventing the secretion of sebum) or to burn out the troublesome follicle altogether (also used for hair removal). Lasers have the ability of penetrating to different levels of the epidermis to burn away acne causing skin problems below the surface. Further, laser treatment is now being used to ‘burn’ scars caused by acne cysts. Laser treatment is still expensive, but is sometimes the only alternative (especially for acne scars). The procedure is relatively painless and the effects are permanent. Most procedures last approximately an hour and sometimes more than one treatment is necessary.
The Future of Acne
The future of acne looks grim – at least from acne’s point of view! Acne research is becoming big business – and with big business comes money for additional research. It is not naive to assume that we will have a definite, fast, effective and harmless cure for acne within the next decade. Until that time however, we will have to do with what we have. If you are suffering from acne, here are a few summary tips for the healing process:
· Educate yourself about acne and realize that it is a normal skin condition.
· Immediately employ routine cleansing as an easy way to reduce or eradicate your acne.
· Try some mild, recommended natural treatments or products.
· If acne persists, stay positive and see a doctor or dermatologist.
· Always get advice from a professional about potential side effects of treatments, weigh the risks and make an educated decision.
· Lastly, use this information to help others who suffer from acne.
