ACNE

ACNE
INTRODUCTION
Acne is a common problem. Acne will affect 85 per cent of Australians at some time during their life and acne can
be very severe in up to 5 per cent of all individuals.
Acne is the medical word used to describe anything from the occasional blemish through the spectrum of pimples,
blackheads, whiteheads and even large cysts and painful swellings. The use of the word acne does not imply that
one slight blemish will necessarily progress to anything more serious.
Acne largely affects teenagers and young adults and occurs at the time when the hormones are seeking a new
balance. However it can occur at any age from just after birth right through to middle age.
Because acne usually occurs on the face it can be extremely distressing. Many myths abound about acne and
whole industries have developed with claims of being able to control or cure acne.
THE CAUSE OF ACNE
Acne is caused by a blockage to the opening of the oil glands in the skin. These glands are called sebaceous
glands and normally provide an oily substance called sebum which is required to keep the skin supple and healthy.
The tendency for these oil glands to block may be inherited. The blockage is sometimes visible and when it takes
on a dark (melanin) pigmentation it is called a blackhead. Sometimes the blockage is invisible and the
collection of sebum under the skin appears as a small white lump or whitehead.
If the blockage is tenacious the build up of sebum can cause the gland to rupture under the skin. This causes an
inflamed red appearance and is often painful. Once this happens the white blood cells are attracted to the area of
damaged tissue. Collection of white blood cells that are visible are called pus.
Sometimes the blockage is slightly deeper causing the development of quite large cysts below the skin which
appear as either flesh coloured or red lumps. These may heal with significant destruction of the tissues causing
scarring. Acne is usually located on the face but may spread to involve the shoulder, back and chest.
MYTHS
There are many myths surrounding acne.
The first myth is that acne somehow is an allergy. Acne is not an allergic disease.
Another myth relates to diet. It was often though that chocolates, dairy foods, citrus fruits, cola and various other
foods and beverages somehow cause acne. Most patients with acne realise that changing their diet does not
eradicate their acne.
Naturally patients with acne should continue to observe a healthy diet but occasional "indiscretions" will not cause
further acne lesions to develop.
Another myth is that acne is an infectious disease. It is true that antibiotics are used in the treatment of acne but
acne is not an infectious disease. It is not contagious and cannot be spread to other people.
A further myth is that acne is due to lack of cleanliness. Acne is not caused by lack of cleanliness and in fact
excessive cleaning and scrubbing can make acne worse.
A final myth is that sunlight is beneficial for acne. Most dermatologists agree that sunlight and ultraviolet light has
no beneficial effect in the treatment of acne.
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In fact sunlight and ultraviolet light may cause premature ageing and skin cancer and should not be recommended
as treatment for acne.
TREATMENT OF ACNE
People with acne should see their local doctor. Individuals with severe acne or acne failing to improve with therapy,
may be referred to a dermatologist. There are a number of underlying factors that should be considered along with
the type and extent of acne and other disease states. A number of medications may actually cause acne or make it
worse and the over-use of oily cosmetics can also precipitate acne.
Individual pimples take up to 2 or 3 months to form even though they may appear to pop up overnight.
Thus although there is often some initial improvement in the first few weeks after starting a new treatment, it takes
at least 2-3 months of regular use before you can assess the full benefit of any acne treatment.
General Skin Care
Many preparations used to treat acne can cause skin irritation, skin peeling, dryness, or increased sensitivity to
sunlight. You should be careful about what other general skin care products you use on your skin to minimize such
problems. Avoid strongly fragranced or alcohol based products. In general use products that will not 'clog pores',
they are usually described as 'oil-free' or 'non-comedogenic' on the package. Skin care should include: a mild
cleanser and application of a non-comedogenic sunscreen on sun-exposed surfaces. If irritation, dryness and
peeling occur, an oil-free, non-comedogenic moisturizer can be used. Most people with acne do not need to
regularly use a moisturizer.
Topical Treatments
Topical treatments for acne include a wide variety of creams, lotions, gels or solutions composed of benzoyl
peroxide, salicyclic acid, alphahydroxy acids, antibiotics, or retinoids (vitamin A derivatives) such as tretinoin,
isotretinoin and adapalene.
A simple over-the-counter treatment for acne is benzoyl peroxide, which can be extremely effective in many people
with mild acne. To ensure the treatment of both present and future acne, topical medications should be applied
regularly to the entire face or region where acne occurs.
When simple over-the counter measures alone are insufficient to control acne, other topical preparations can be
applied. Many of these topical products including antibiotics and vitamin A derivatives are only available on
prescription from a medical practitioner. To maximize their beneficial effects these products are often used in
combination. Topical preparations have a mixture of beneficial effects on acne including anti-bacterial,
anti-inflammatory and/or other anti-comedogenic properties.
Oral (Internal) Treatments
More resistant or severe acne can be treated by adding or changing to oral (internal) therapy. Oral antibiotics are
effective in treating acne, however like topical preparations, they do not cure acne, and may need to be taken for a
prolonged period of time. Maximum benefit may take several months, and the dose should be adjusted to achieve
and maintain satisfactory control of acne.
Hormonal therapy is often used effectively in females with acne. Certain oral contraceptive pills can worsen acne,
while others lead to improvement. The progesterone component of the pill largely determines whether a brand of
pill will exacerbate or improve acne. Other non-contraceptive hormonal therapies including spironolactone are also
used to treat acne.
Oral isotretinoin, a vitamin A derivative, is also used in more severe cases of acne (see below).
SEVERE ACNE
About 5 per cent of the Australian community will develop severe cystic acne. This can be painful, disfiguring and
emotionally distressing. Patients with severe acne can do well with the treatments detailed above. Untreated, some
of these individuals continue to suffer from severe acne for many decades.
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Oral isotretinoin, is commonly used to treat severe cystic acne, and can be very effective in these severe and
potentially scaring cases of acne. Isotretinoin is a form of vitamin A. After completing a 4-6 month course, a large
number of people have no further trouble with acne. A significant number, however, will have some recurrence of
their acne, which is often much less severe, but may again require oral therapy.
In Australia oral isotretinoin must be prescribed by a dermatologist. Virtually all patients will experience some
discomfort while taking isotretinoin. Side effects mainly affect the skin. The skin becomes dry and may even
develop dermatitis. The lips become cracked and may be sore and the eyes and nose may also develop irritation
and discomfort. All of these side effects can be controlled by using moisturising creams or other medications
recommended by the dermatologist.
Isotretinoin is strictly controlled because of its effect on an unborn baby if taken during pregnancy. It is essential
that all females of potential child bearing age are counselled prior to treatment and that these women be on a
suitable contraceptive routine. Isotretinion has no adverse effects on male fertility.
WHY SHOULD I KEEP APPLYING OR TAKING MEDICATION AFTER MY ACNE
HAS CLEARED?
Unfortunately there is no guaranteed cure for acne. The available therapies for controlling acne are quite successful.
However, even if your acne clears, its may be necessary to continue maintenance therapy for an extended period.
TREATMENT OF ACNE SCARS
Before undertaking treatment for acne scaring it is crucial to ensure your acne is optimally controlled, this prevents
the formation of new scars due to ongoing, active acne. There have been many advances in the management of
residual changes and scars due to acne. Different types of acne scars are best managed by different therapies.
Optimum cosmetic results often require a combination of cosmetic dermatology procedures and treatments.
Options include, laser, injections or fillers, and a mixture of dermatologic surgical treatments. To learn more about
the variety of cosmetic treatments available visit our all about acne scarring and cosmetic dermatology sites.
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