OVERVIEW

• Acne is a skin condition that causes pimples to develop. 

• Acne is the most common skin disorder in North America, affecting an estimated 85 percent of adolescents. 

• Effective medical treatments are available to treat existing pimples and prevent new ones from developing. 

• Cosmetic treatments can help to reduce scarring and skin color and texture changes caused by acne.

STAGES OF ACNE FORMATION

• Hair follicles become blocked with an overabundance of normal skin cells. These cells combine with sebum (an oily substance that lubricates the hair and skin), creating a plug in the follicle.

• The glands that produce sebum, known as sebaceous glands, enlarge during adolescence and sebum production increases. Numerous sebaceous glands are found on the face, neck, chest, upper back, and upper arms.

• The increase in sebum production allows for the overgrowth of a bacterium called Cutibacterium (formerly Propionibacterium) acnes that normally lives on the skin.

• Inflammation occurs as a result of bacterial overgrowth or other factors. This can lead to the rupture of the follicle and the formation of a red or tender pimple.

CONTRIBUTING FACTORS

• Hormonal Changes
  • Hormonal changes during adolescence cause the sebaceous glands to become enlarged, and sebum production increases. In most people with acne, hormone levels are normal, but the sebaceous glands are highly sensitive to the hormones.
  • Less often, hormone levels in females are affected by an underlying medical problem known as polycystic ovary syndrome (PCOS).
  • Acne tends to resolve between ages 30 to 40, although it can persist into or develop for the first time during adulthood. Post-adolescent acne predominantly affects females, in contrast to adolescent acne, which predominantly affects males. Acne can flare before the menstrual period, especially in people older than 30 years.

• External Factors
  • Oil-based cosmetics may contribute to the development of acne. Oils and greases in hair products can also worsen skin lesions. Water-based or "noncomedogenic" products are less likely to worsen acne.
  • People with acne often use soaps and astringents. While these treatments remove sebum from the skin surface, they do not decrease sebum production; frequent or aggressive scrubbing with these agents can actually worsen acne. 
• Diet
  • The role of diet in acne is controversial and strong evidence is lacking
  • There is some data to support the relationship between acne and the consumption of foods that create inflammation in the body, such as items containing large amounts of sugar, processed ingredients, and refined carbohydrates. 
  • Some studies have also found weak associations between cow's milk and an increased risk of acne, perhaps because of hormones that occur naturally in milk. 
• Stress
  • Several studies of students have shown that acne severity appears to worsen during times of increased emotional and psychological stress. 

TREATMENTS

There is no single best treatment for acne, and combinations of treatments are sometimes recommended. Since acne lesions take at least eight weeks to mature, you should use a treatment for a minimum of two to three months before deciding if the treatment is effective. In rare cases, people can have a severe allergic reaction to an ingredient in an acne product, so for the first three days, you might consider trying new products on just a small area or skin.

• The Three Staples (+1)
  • Wash
    
    • Wash your face no more than twice daily using a facial skin cleanser and warm (not hot) water. 
    • Avoid use of a rough washcloth or loofah. Vigorous washing or scrubbing can worsen acne and damage the skin's surface. To remove thick foundation or mascara, it is ok to use a gentle cloth.
    • Do not pick or squeeze pimples because this may worsen acne and cause skin swelling and scarring. It can also cause lesions to become infected.
  • Moisturize
    • A moisturizing agent can be used to minimize dryness and skin peeling, which are common side effects of some acne treatments. 
    • Moisturizers that are labeled as "noncomedogenic" and "oil-free" are less likely to block skin pores. 
  • Sunscreen
    • Some acne treatments increase the skin's sensitivity to sunlight (eg, retinoids, doxycycline). To minimize skin damage from the sun, avoid excessive sun exposure and use a sunscreen with SPF 30 or higher that is broad spectrum (blocks both UVA and UVB light) before sun exposure.
  • Antioxidants 
    • STAY TUNED...

• Can I treat my own acne?
  • If you have mild acne, you can try nonprescription products. A combination of treatments may be more effective than using one single product alone. Nonprescription acne treatments may include ingredients such as:
    • salicylic acid
    • benzoyl peroxide
    • sulfur
    • alpha hydroxy acids (i.e., glycolic acid, lactic acid)
    • various retinoids, such as retinol, retinal, retinoin, and adapalene all of which are available in nonprescription strengths.
      • Acid preparations and peroxides inactivate retinoids. Use them at separate times.
      • Sunlight inactivates most retinoids. Use them at night only.

• If you do not improve after three months of using nonprescription products or you have moderate or severe acne, consult a healthcare provider for advice on the most effective treatments.