Hi Acne (acne vulgaris, common acne) or pimple is a disease of the hair follicles of the face, chest, and back that affects almost all teenagers during puberty -- the only exception being members of a few primitive Neolithic tribes living in isolation. It is not caused by bacteria, although bacteria play a role in its development. It is not unusual for some women to develop acne in their mid- to late-20s. Acne appears on the skin as occluded pores ( comedones ), also known as blackheads or whiteheads, tender red bumps also known as pimples or zits, pustules (bumps containing pus), and occasionally as cysts (deep pimples, boils). One can do a lot to treat acne using products available at a drugstore or cosmetic counter that do not require a prescription. However, for tougher cases of acne, one should consult a physician for treatment options. No one factor causes acne. Acne occurs when sebaceous (oil) glands attached to the hair follicles are stimulated at the time of puberty or due to other hormonal changes. Sebum (oil) is a natural substance that lubricates and protects the skin. Associated with increased oil production is a change in the manner in which the skin cells mature, predisposing them to plug the follicular pore. The plug can appear as a whitehead if it is covered by a thin layer of skin, or if exposed to the air, the darker exposed portion of the plug is called a blackhead. The plugged hair follicle gradually enlarges, producing a bump. As the follicle enlarges, the wall may rupture, allowing irritating substances and normal skin bacteria access into the deeper layers of the skin, ultimately producing inflammation. Inflammation near the skin s surface produces a pustule; deeper inflammation results in a papule (pimple); if the inflammation is deeper still, it forms a cyst. Food: Parents often tell teens to avoid pizza, greasy and fried foods, and junk food. While these foods may not be good for overall health, they don t cause acne or make it worse. Although some recent studies have implicated a high-carbohydrate diet, milk, and pure chocolate in aggravating acne, these findings are very far from established. Dirt: Blackheads are oxidized oil, not dirt. Sweat does not cause acne and is produced by entirely separate glands in the skin. On the other hand, excessive washing can dry and irritate the skin. Stress: Some people get so upset by their pimples that they pick at them and make them last longer. Stress, however, does not play much of a direct role in causing acne. In occasional patients, the following may be contributing factors: Heredity: If one of your parents had severe acne, it is likely that your acne will be more cult to control. Pressure: In some patients, pressure from helmets, chin straps, collars, suspenders, and the like can aggravate acne. Drugs: Some medications may cause or worsen acne, such as those containing iodides, bromides, or oral or injected steroids (either the medically prescribed prednisone [Deltasone, Orasone, Prednicen-M, Liquid Pred] or the steroids that bodybuilders or athletes sometimes take). Other drugs that can cause or aggravate acne are anticonvulsant medications and lithium (Eskalith, Lithobid). Most cases of acne, however, are not drug related. Occupations: In some jobs, exposure to industrial products like cutting oils may produce acne. Cosmetics: Some cosmetics and skin-care products are pore clogging ( comedogenic ). Of the many available brands of skin-care products, it is important to read the list of ingredients and choose those which have water listed first or second if one is concerned about acne. These water-based products are usually best for those with acne. Moderation and regularity are good things, but not everyone can sleep eight hours, eat three good meals, and drink plenty of water a day. One can, however, still control acne despite one s frantic and unpredictable routine. Probably the most useful lifestyle changes one can make is to never to pick or squeeze pimples. Playing with or popping pimples, no matter how careful and clean one is, nearly always makes bumps stay redder and bumpier longer. People often refer to redness as scarring, but fortunately, it usually isn t permanent. It s just a mark that takes months to fade if left entirely alone. Open the pores Cleansing and skin care Despite what one might read in popular style and fashion magazines, there is no magic product or regimen that is right for every person and situation. Mild cleansers: Washing once or twice a day with a mild cleansing bar or liquid (for example, Dove, Neutrogena, Basis, Purpose, and Cetaphil are all inexpensive and popular) will keep the skin clean and minimize sensitivity and irritation. Exfoliating cleansers and masks: A variety of mild scrubs, exfoliants, and masks can be used. These products may contain salicylic acid in a concentration that makes it a very mild peeling agent. These products remove the outer layer of the skin and thus open pores. Products containing glycolic or alpha hydroxy acids are also gentle skin exfoliants. Retinol: Not to be confused with the prescription medication Retin-A, this derivative of Cosmetics: Don t be afraid to hide blemishes with flesh-tinted cover-ups or even foundation, as long as it is water-based (which makes it noncomedogenic). There are many quality products available. Facials: While not absolutely essential, steaming and deep-cleaning pores is useful, both alone and in addition to medical treatment, especially for people with whiteheads or blackheads. Having these pores unclogged by a professional also reduces the temptation to do it oneself. Pore strips: Pharmacies now carry, under a variety of brand names, strips which one applies to the nose, forehead, chin, etc., to pull out oil from pores. These are, in effect, a do-it-yourself facial. They are inexpensive, safe, and work reasonably well if used properly. Toothpaste: One popular home remedy is to put toothpaste on zits. There is no medical basis for this. The same applies to vinegar. These are all good basic skin regimens that may help with the acne battle: Cleanse gently twice daily. Apply a gel or cream containing 5% benzoyl peroxide; an alternative is sulfur or resorcinol. Use a pad containing 2% salicylic acid to help exfoliation each morning. At night, apply a spot cream containing sulfur to the affected areas. Use a light skin moisturizer and water-based makeup. It s best to consult a primary-care physician or dermatologist if an individual is unable to adequately control his or her acne. The goal of treatment should be the prevention of scarring (not a flawless complexion) so that after the condition spontaneously resolves there is no lasting sign of the affliction. Here are some of the options available: Topical (externally applied) antibiotics and antibacterials: These include erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone), clindamycin (BenzaClin, Duac), sulfacetamide (Klaron), and azelaic acid (Azelex or Finacea). Retinoids: Retin-A (tretinoin) has been in use for years, and preparations have become milder and gentler while still maintaining its effectiveness. Newer retinoids include adapalene (Differin) and tazarotene (Tazorac). These medications are especially helpful for unclogging pores. Side effects may include irritation and a mild increase in sensitivity to the sun. With proper sun protection, however, they can be used even during sunny periods. The combination medication known as Epiduo gel -- which contains the retinoid, adapalene, along with the antibacterial, benzoyl peroxide -- is applied once a day. Oral antibiotics: Doctors may start treatment with tetracycline (Sumycin) or one of the related cyclines, such as doxycycline (Vibramycin, Oracea, Adoxa, Atridox, and others) and minocycline (Dynacin, Minocin). Other oral antibiotics that are useful for treating acne are cefadroxil (Duricef), amoxicillin (Amoxil, DisperMox, Trimox), and the sulfa drugs. Problems with these drugs can include allergic reactions (especially sulfa), gastrointestinal upset, and increased sun sensitivity. Doxycycline, in particular, is generally safe but can sometime cause esophagitis (irritation of the esophagus, producing discomfort when swallowing) and an increased tendency to sunburn. Despite the concern that the long-term use of tetracycline antibiotics for acne might weaken the immune system or induce bacterial resistance, these concerns seem to be unwarranted. Oral contraceptives: Oral contraceptives, which are low in estrogen to promote safety, have little effect on acne one way or the other. Some contraceptive pills have been shown to have modest effectiveness in treating acne. Those that have been U.S. FDA approved for treating acne are Estrostep, Ortho Tri-Cyclen, and Yaz. Most dermatologists work together with primary-care physicians or gynecologists when recommending these medications. Spironolactone (Aldactone): This drug blocks androgen (hormone) receptors. It can cause breast tenderness, menstrual irregularities, and increased potassium levels in the bloodstream. It can help some women with resistant acne, however, and is generally well-tolerated in the young women who need it. Cortisone injections: To make large pimples and cysts flatten out fast, doctors inject them with a form of cortisone. Isotretinoin: Accutane was the original brand name; there are now several generic versions in common use, including Sotret, Claravis, and Amnesteem. Isotretinoin is an excellent treatment for severe, scarring, persistent acne and has been used on millions of patients since it was introduced in Europe in 1971 and in the U.S. in 1982. It should be used for people with severe acne, chiefly of the cystic variety, that has been unresponsive to conventional therapies like those listed above. If taken in sufficient dosage, it should eliminate the need to continue the use of prescription drugs in most patients. The drug has many potential serious side effects and requires a number of unique controls before it is prescribed. This means that isotretinoin is not a good choice for people whose acne is not that severe but who are frustrated and want something that will knock acne out once and for all. In order to use the drug, the prescribing physician, the patient, and the supplying pharmacy must be enrolled in the online iPLEDGE PROGRAM. Used properly, isotretinoin is safe and produces few side effects beyond dry lips and occasional muscle aches. This drug is prescribed for five to six months at a dosage that has a high likelihood of preventing the return of acne. Fasting blood tests are monitored monthly to check liver function and the level of triglycerides, substances related to cholesterol, which often rise a bit during treatment but rarely to the point at which treatment has to be modified or stopped. Even though isotretinoin does not remain in the body after therapy is stopped increased risk for those taking isotretinoin compared with the general population. It is important for those taking this drug to report changes in mood or bowel habits (or any other symptoms) to their doctors. Even patients who are being treated for depression are not barred from taking isotretinoin, whose striking success often improves the mood and outlook of patients with severe disease. Light treatments: Recent years have brought reports of success in treating acne using special lights and similar devices, alone or in conjunction with photosensitizing dyes. It appears that these treatments are safe and can be effective, but it is not clear that their success is lasting. At this point, laser treatment of acne is best thought of as an adjunct to conventional therapy, rather than as a substitute. Chemical peels: Whether the superficial peels (like glycolic acid) performed by estheticians or deeper ones performed in the doctor s office, chemical peels are of modest, supportive benefit only, and in general, they do not substitute for regular therapy. Treatment of acne scars: For those patients whose acne has gone away but left them with permanent scarring, several options are available. These include surgical procedures to elevate deep, depressed acne scars and laser resurfacing to smooth out shallow acne scars. Newer forms of laser resurfacing ( fractional resurfacing ) are less invasive and heal faster than older methods, although results are less complete and the procedures may need to be repeated three or more times. These treatments can help, but they are never completely successful at eliminating acne scars. Regards DR DE