Acne is the most frequent skin condition in the United States. It is characterized by pimples that appear on the face, back and chest. Every year, about 80% of adolescents have some form of acne and about 5% of adults experience acne.
Acne is made up three kinds of blemishes:
- Whiteheads/Blackheads, also known as comedones, are non-inflammatory and appear more on the face and shoulders. As long as they remain uninfected, they are unlikely to lead to scarring.
- Red Papules and Pustules are inflamed pores that fill with pus. These can lead to scarring.
- Nodules are deep seated, often painful lesions which frequently lead to scarring.
In normal skin, oil glands under the skin, known as sebaceous glands, when stimulated by testosterone, produce an oily substance called sebum. The sebum moves from the bottom to the top of each hair follicle and then spills out onto the surface of the skin, taking with it sloughed-off skin cells. With acne, the structure through which the sebum flows gets plugged up. This blockage traps sebum and sloughed-off cells below the skin, preventing them from being released onto the skin’s surface. If the pore’s opening is fully blocked, this produces a whitehead. If the pore’s opening is open, this produces blackheads. When plugged follicles rupture, they become inflamed appear as red papules or pustules.
It is important for patients not to pick or scratch at individual lesions because it can make them inflamed and can lead to long-term scarring.
Although acne can be treated successfully in almost all cases, there is no overnight remedy. Some treatments include:
- Benzoyl Peroxide — Used in mild cases of acne, benzoyl peroxide reduces the obstruction in the hair follicles.
- Oral and Topical Antibiotics — Used to reduce both inflammation and the population of bacteria in the pores.
- Hormonal Treatments — Can be used in teenaged and adult women with more significant hormonally induced acne.
- Tretinoin/Tazarotene— Derivatives of Vitamin A, these topical medications unplug the blocked-up material in whiteheads/blackheads. They represent the foundation of acne treatment.
- Extraction — Removal of whiteheads and blackheads using a small metal instrument that is centered on the comedone and pushed down, extruding the blocked pore.
- Isotretinoin-- formerly known as Accutane, this vitamin A derivative is the most effective treatment for acne, and the only treatment with the potential for curing the disease. Isotretinoin is very safe unless one is pregnant, but is always associated with some annoying, but usually minor side effects.