What You Should Know About Acne

Acne is a skin problem that begins about the time someone becomes a teenager and usually goes away as he or she gets older. Almost every teenager develops some acne, but some teenagers develop more pimples than others.

During the time that a person has acne, it can be made better but it cannot be cured. This means that medicines that can make acne better need to be used for a long time. This information sheet is meant to help you understand acne and how to make it better.

What Causes Acne?

Pimples begin in certain pores or openings in the skin. These pores have oil glands connected to them. At puberty, the time that you begin to grow into an adult, certain hormones (called androgens) cause the oil glands to become more active. This causes the sebaceous glands in the skin to produce more oil, which may cause acne.

You may have noticed that your skin became oilier before acne began. The oil and cells that line your skin pores stick together, causing a plug or block in the pore. The result is a blackhead or whitehead.

The blackhead is not dirt and scrubbing or washing will not remove it. Whiteheads are the beginnings of larger pimples.

Bacteria becomes trapped in these clogged pores, causing more inflammation. The oil in whiteheads may break through the pore wall and cause irritation under the skin, forming a pimple.

What Makes Acne Worse?

• If you pinch, pop or pick at pimples you may cause them to become larger, take longer to disappear or cause scars.
• Washing too often or with harsh soaps may irritate the skin and make it hard to use the medicines that are prescribed by your doctor. To prevent this, wash only once or twice a day with a mild soap (Lever 2000, Dove, New Ivory)
• Some make-ups, cover-ups or hair greases may block pores and make your acne worse. If you use makeup or moisturizers, choose those that are oil-free and labeled as or nonacnegenic or noncomedogenic. If you use a hair grease, try not to get it on the skin.
• Equipment (like helmets or chinstraps) or tight clothing that puts pressure on the skin may make acne worse in this area.
• Many young women notice a worsening of acne before a menstrual period. This is caused by normal changes in hormones.
• For some teenagers, stress may cause flare-ups of acne.
• Acne is not related to what you eat. There is no proof that chocolate, fatty foods, nuts, or soft drinks cause acne. They are just unhealthy.
• Acne is not contagious- you can not get acne from another person.

How Do We Treat Acne?

Acne does not go away overnight with treatment. It takes time - more time than you would like to unblock the pores. In fact, it takes 6 to 8 weeks using medicine before you see a change in your skin. Try to be patient. Do not give up too soon.

There are a number of medicines we may use. Some work better for some people than others. We need your help to tell us which ones work best f you. Sometimes we need to use more than or medicine.

Medicines Commonly Used To Treat Acne

• Benzoyl Peroxide (antibiotic and anti-inflammatory)- over the counter
• Tretinoin (Retin A)- available in creams, gels, and liquids- sun may break down- use at night
• Azeleic acid
• Adapatene Gel
• Benzamycin Gel (benzoyl peroxide and erythromycin)- must be refrigerated
• Topical antibiotics (applied to skin)- erythromycin and cleocin
• Oral antibiotics- amoxicillin, minocycline, doxycline, tetracycline
• Accutane- used for severe pustular acne- pregnancy test must be done and cholesterol and triglycerides must be checked before starting.

Using Topical Medications

Many of the medicines used to treat acne (like benzoyl peroxide, tretinoin and certain antibiotics) are placed on the skin. There are a few basic rules about using these medicines:

• Do not start the medication, then stop it. Using it steadily, as prescribed, produces the best results, over time.
• Continue using your acne medication, whether or not your skin improves at first. You may not see a change for several weeks. Be patient.
• Do not apply medication right after you wash your face. Waiting 20 to 30 minutes will help prevent drying and redness of your skin.
• Do not use too much medicine. A little bit is good, but too much is NOT better. If too much medicine is used, your skin may become dry or red. To get the right amount, place a dab of medicine the size of a small pea on your finger. Dab the medicine on each side of your forehead, on each cheek, and on your chin. Then spread the medicine to make a thin coat over all areas where you get pimples. Some medicines are liquids that come with an applicator.
• Remember that the medicine should be placed over all problem areas and not just on pimples.
• If your skin becomes dry you may use an oil-free, nonacnegenic or noncomedogenic moisturizer. If it becomes too dry, red, or irritated, call your doctor.

How Long Must The Medicines Be Used?

Even though acne usually goes away as one gets older, it can last for years. How long you will need to use medicines depends on your skin. Remember, acne should not last forever, so be patient.

Content adapted from "Help your acne patients help themselves," by Walter W. Tunnessen, Jr., MD