Acne

Acne is caused by overactive oil-producing, or sebaceous, glands that start producing more sebum.  The excess sebum can clog pores, which leads to inflammation, redness, and swelling.  This usually begins at puberty, and can last a couple of years, or it may continue into adulthood.  As well, some babies develop acne shortly after birth.  Heredity can be a factor in determining who gets acne and how severe - if either of your parents had acne, you are more likely to develop acne too.

There are three levels of severity with acne:

1. Mid acne consists of a few lesions that are close to the surface and not deep or inflamed

2. Moderate acne involves of deeper nodular lesions that cover more of the face, and some redness

3. Severe acne is marked by many lesions, multiple cysts, lots of redness and inflammation over most of the face

Mild to moderate acne can usually be treated with topical over-the-counter products.  More severe, stubborn, or widespread acne may need to be treated by a physician.  Seeking treatment sooner rather than later is important to getting acne under control.  Even mild acne can potentially lead to scarring, and there's no way of predicting if mild acne will progress to becoming more severe over time or continue into adulthood.  Most acne treatments aim to decrease sebum production, kill acne bacteria, help to normalize skin shedding, and fight inflammation.  Treatments can come as both nonprescription (over-the-counter) medications, and prescription medications.

For mild acne, you can usually try nonprescription (over-the-counter) medications before turning to your doctor for help.  Over-the-counter (OTC) products are usually milder than prescription-strength medications, and are also readily accessible.  OTC acne treatments include medicated cleansers, topical creams, and gels.  Usual active ingredients in OTC treatments usually include salicylic acid or benzoyl peroxide.  Salicylic acid is used for anti-inflammatory and peeling action.  Benzoyl peroxide causes drying and slight peeling, and also kills bacteria.  

If nonprescription medications are not enough to treat your acne, you may want to talk to your doctor about prescription medications.  Some common prescription medications used to treat acne are:

• Topical antibiotics (e.g. erythromycin, clindamycin) are recommended to help control the inflammation associated with the redness and swelling of acne

• Oral antibiotics (e.g. tetracycline, minocycline) are recommended for moderate to severe acne of the chest, back, and shoulders, as they reduce the presence of acne bacteria

• Hormonal agents such as oral contraceptives are recommended for moderate to severe acne, or cystic acne, after other treatments have failed, and are often used when acne has begun or gotten worse in adulthood.  Acne that is connected to hormones, such as jaw line acne, or acne that flares up in the premenstrual part of the cycle, often responds well to this treatment

• Retinoids (vitamin A derivatives) are recommended only for severe cases of acne that do not respond well to other treatment options.  These are available in both topical (e.g. tretinoin, adapalene, tazarotene) and oral forms (e.g. isotretinoin)

A number of factors can trigger an acne flare up or lead to breakouts, and these can vary from person to person.  Some common factors are:

• Cosmetics - Some make-up and hair care products can clog pores.  To prevent this, look for these labels on products; "oil-free", "non-comedogenic", or "non-acnegenic".

• Physical pressure - Anything kept close to you for an extended period of time, such as a phone receiver, sports helmet, or headband, can lead to localized acne.  Many today wear masks for extended periods of time, which can also lead to breakouts.  This is colloquially referred to as "mask-ne."

• Sweating - If sweat is trapped under clothing, it can worsen acne in some people.

• Overwashing - It is recommended to wash your face twice a day with a mild cleanser for acne-prone skin.  Washing more often, scrubbing/exfoliating, or using strong cleansers or astringent products can strip the skin and irritate it.

• Medications - Certain medications can cause acne to flare up, such as oral corticosteroids, progestin-only contraceptive pills, and anti-convulsives.

• Mentrual cycle - Many female patients notice that their acne flares up at this time.

• Picking or squeezing - Doing this can make your acne worse and can raise the risk of permanent scarring.  Squeezing or popping pimples can cause an eruption of sebum and bacteria into surrounding skin tissues leading to more swelling, redness, and possibly even infection.

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