Caring for Acne

Acne Vulgaris (Acne is Greek for facialeruption; vulgaris is Latin for common) is the most common skin disorder during the 2nd and 3rd decades of life. Actually, 85% of high school students between the age of 15 and 18 years have some degree of acne. It usually begins with the onset of puberty (ages 9 to 17 years), but may begin as early as 1 to 2 years prior to the onset of puberty as a result of hormonal stimulation of the sebaceous glands within hair follicles. These glands are found in highest concentration on the face, chest, and upper back. Acne occurs more often in girls than boys and peaks in its intensity at 14 to 17 years of age for girls and 16 to 19 years for boys. Acne is often worse during the winter and better during the summer.

What causes acne?

Acne is the plugging of hair follicles on the face with an overproduction of an oily substance (called Sebum) leading to whiteheads pimples. The next stage involves the growth of the bacteria, Propionibacterium acnes (also known as P. Acnes) within the hair follicle and the accumulation of dead skin cells and sebum leading to blackheads. As the process continues, the hair follicle sac expands and eventually ruptures into the surrounding tissues causing inflammation and irritation causing pustules or nodules. This whole process is caused by the hormones of adolescence and not by poor skin hygiene.

Some causes of acne are mild and self limiting. Others may lead to scarring if the process is not treated.

What makes acne worse?

  • Picking or scratching pimples
  • Over-scrubbing of the face or use of harsh cleansers
  • Mechanical rubbing of the face, as with the helmet of a football player
  • Occlusive oil-based cosmetics
  • Heavy, oil-based moisturizers
  • Emotional stress may alter the oiliness of our skin and make acne worse
  • Tight clothing may irritate acne by increased sweating
  • Medications: some seizure meds, certain steroids, etc.

What improves acne?

  • Good skin care
  • Medications: gels, creams, or antibiotics.

Skin Care:

  • Gently wash your face once or twice a day with water and mild nondetergent soap or nonabrasive cleanser, such as Cetaphil, or Neutrogena. Avoid harsh cleansers. Avoid rough washcloths.
  • Moisturizer: If you have dry skin, use “non-comedogenic” (means will not cause acne)oil-free moisturizers, such asCetaphil, Neutrogena, or Oil of Olay.
  • Boys: Use a sharp blade when shaving face and avoid nicking pimples. Soften the skin with warm water or cream prior to shaving.
  • Girls: use water-based, oil-free cosmetics labeled as “non-comedogenic.” Remove makeup at night with cleanser and water.
  • Don’t pick or squeeze your pimples. This can cause skin injury and scarring.
  • Sunscreen: Apply an oil-free sunscreen gel or lotion of at least 15 SPF every morning.

Treatment:

□Use a benzoyl peroxide facial wash nightly.

□Wash face and remove make-up. Apply a moisturizer to face. Wait 15-30 minutes until face is dry and then apply one of the following medication.

□Apply a Benzoyl Peroxide gel nightly, such as Oxy or Clearasil (OTC).

□Begin the regular use of a retinoid cream or gel once a day at bedtime:

Apply a pea-size amount covering the entire face at bedtime every other day for 4 weeks. Then, apply daily.

Expect some redness or peeling of your face initially, but this should pass as your face gets used to the medication. If soreness or chapping of the face occurs, stop the medication for 3 days and restart.

Differin gel (0.1, 0.3%) or cream (0.1%)

Retin-A (.04, .1% micro; .025, .05, .1% cream;.01, .025% gel)

Tazorac: (.05, .1% gel)

□Begin a combination gel (Benzaclin, Duac) in the morning daily.

□Begin an oral antibiotic. Start with higher dose, then reduce in 6 weeks if improved to daily, then at 3 months if doing well reduce to every other day.

Doxocycine (50, 75, 100 BID) may cause stomach ache, nausea or photosensitivity.

Minocycline (100 daily or BID) may cause dizziness, stomach ache or skin discoloration.

Clindamycin (75, 150 TID)

Review Quiz:

True or False

  1. Pimples are caused by dirt.
  2. Eating greasy foods causes acne.
  3. Eating chocolate causes acne.
  4. Drinking Cokes or sodas makes acne worse.
  5. Washing and scrubbing your face a lot will help clear the pimples.

**All statements are false