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acne

Acne is a skin condition that affects the hair follicles (pores) of the face, chest, and back, plugging the pores and often causing inflammation as the acne bacteria multiplies.

About 20% of all patient visits to dermatologists are related to acne.
Nearly everyone suffers from some degree of acne at some point in life, usually in the teen years of puberty but some adults suffer with acne throughout life. Dr. Sikorski’s goal in your acne care is to stop breakouts, prevent future breakouts and restore your skin to a smooth healthy condition.

"Thanks so much, Dr. S. You have been super nice to me. My skin is doing great. When I get old I hope you are still a doctor so I can get treated for that too." Keriann B. Long Beach, Ca

Early and consistent Acne Therapy will help minimize or prevent scarring and psychological effects.  It’s important to give yourself or your teenager the tools to manage a common yet potentially devastating disease. Left unattended, acne may eventually go away, but the long term effects of acne on self esteem, social interaction, academic performance and activity choices can have a life long consequences

Acne Before and After Pictures
Photo Source: Candela
Results may vary

Gauging Acne Levels

In mild cases of acne, there are a few blackheads (open comedones) or whiteheads (closed comedones) with a few red or inflamed bumps (papules) and red or inflamed bumps with pus on the surface (pustules).  In moderate acne, there are more blackheads and whiteheads and increasing numbers of papules and pustules. Severe acne brings tender red cysts and nodules that often can result in scarring. The whiteheads, blackheads, papules, pustules, cysts, and nodules are medically referred to as “acne lesions.”

Each Acne Level has its own recipe for management. Mild acne is often treated with topical agents and or blue light acne therapy. Moderate acne often calls for prescription medication in the form of oral or topical antibiotics. More severe acne can benefit from Photo Dynamic Therapy along with prescription topical and oral medication. The most intense acne sufferers may be candidates for Accutane.

Acne Phototherapeutics

Acne
Photo source Phototherapetics

Go to Skinsight.com to learn more about Acne Level Photos and Condition Information

How does acne develop?

Acne begins underneath. In normal skin function, cells move out of the pores regularly and easily. For someone who has acne, theses cells become sticky and do not move out of the pore onto the skin surface like normal cells. This results in a microscopic acne lesion called the “microcomedo” that cannot be seen with the naked eye. This microcomedo can turn into any one of the types of acne lesions noted above (whiteheads, blackheads, papules, pustules, cysts).
The process of a microcomedo turning into a visible acne lesion can take several weeks. Most acne treatments are designed to prevent microcomedoes from forming and developing into other acne lesions. That is why it is important to apply acne medications to all areas of the skin where acne can develop and not just on the acne lesion itself. Unlike treatments for other conditions, acne treatment can sometimes take several weeks to see improvement, because it is preventing the formation of microcomedoes beneath the skin and their further progression into a visible acne lesion. One of the goals in controlling acne early is the prevention of Acne Scarring.

Will I “outgrow” acne?

Acne is a chronic disease, affects a majority of those 12 to 24 years of age and may continue to afflict some patients well into adulthood. The physiological, psychological, and quality-of-life impacts associated with acne are significant and well studied. The effective early treatment of acne in sufferers of all ages and types is critical and the acne patient or parents of a child or teen with acne should not “wait it out”. They key to treatment is consistent Control since acne is not “cured” as are other skin diseases.

The Acne Life Cycle

Stage 1. The first stage is clogged pores. Just as skin cells on the skin's surface are constantly being sloughed off and renewed, dead skin cells are sloughed off the skin inside the pore as well. When oil and dead skin cells get trapped in the narrow opening of the pore, this can cause cells to clump and form a plug.

Stage 2. The second stage in the acne life cycle involves the infiltration of bacteria. Normally found on the skin, the P. acnes bacteria can feed and breed inside clogged hair follicles where sebum is trapped. Your body responds by sending white blood cells to fight these bacterial invaders.

Stage 3. This leads to the next stage in the acne life cycle—inflammation. As the body fights the bacteria, your skin becomes inflamed and small pink bumps, pimples, nodules, or cysts appear.

The Acne Life Cycle
Image source NIAMS

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Acne Levels – What Level of Acne Do I Have?

Minimal

Mild

Moderate

Sever

Few comedones

Comedones

Comedones

Comedones

Rare papules

Few papules

Many papules

Extensive Papules

No nodules/scars

Few pustules

Many pustules

Extensive Pustules

Face only

No nodules

Nodules on the face

Nodules on the face

   

Scars may be present

Scars on face/chest and back


Acne Treatments

Minimal

Mild

Moderate

Sever

Acne cleansers

Acne Cleansers

RX Acne
Cleansers

RX Acne
Cleansers

OTC Treatments
(Over-the-counter)

OTC Treatments

 

 

 

Topical Retinoids

RX Topical Retinoids

RX Topical Retinoids

 

Topical Benzoyl Peroxide

RX levels
Benzoyl Peroxide

RX levels
Benzoyl Peroxide

 

RX Topical antibiotics

RX Topical Antibiotics

RX Topical Antibiotics 

   

RX Oral
Antibiotics

RX Oral
Antibiotics

 

AHA or Salicylic Chemical Peels

Hormone pills

 

 

Blue Light

Salicylic Peels to help unblock clogged pores

Salicylic Peels to help unblock clogged pores

   

Blue Light and/or
Photo dynamic Therapy

Photo dynamic Therapy

   

Mixto Laser for Scars

Mixto or Sciton Laser for Scars

   

Intensive RX
Oral retinoids

(Isotretinion or Accutane)
Must be monitored

Intensive RX
Oral retinoids

(Isotretinion or Accutane)
Must be monitored


Treatment applied to the skin

Patients with mild acne usually respond well to topical treatments.

There are several OTC topical medicines used for mild acne. Each works a little differently. Following are the most common ones:

Benzoyl peroxide – destroys P. acnes, and may also reduce oil production

Resorcinol – can help break down blackheads and whiteheads

Salicylic acid – helps break down blackheads and whiteheads. Also helps cut down the shedding of cells lining the hair follicles

Sulfur – helps break down blackheads and whiteheads.

RX treatment

If your acne becomes worse and you have a lot of inflamed spots, topical treatment alone may not be adequate.
Several types of prescription topical and oral medicines are used to treat acne. They include:

  • Antibiotics – help stop or slow the growth of bacteria and reduce inflammation - topical and oral
  • Vitamin A derivatives (retinoids) – unplug existing comedones (plural of comedo), allowing other topical medicines, such as antibiotics, to enter the follicles. Some may also help decrease the formation of comedones. These drugs contain an altered form of vitamin A which helps regulate cell turnover. Some examples are tretinoin
  • Others – may destroy P. acnes and reduce oil production or help stop or slow the growth of bacteria and reduce inflammation. Some examples are prescription strength Benzoyl peroxide, sodium sulfacetamide/sulfur-containing products, or Azelaic acid (Azelex).

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Accutane for Severe Acne

In very serious cases which do not respond to the above treatment, or in cases of severe nodulocystic acne, a medication called isotretinoin (Accutane) may be prescribed by Dr. Sikorski. People with nodules or cysts should be treated by a dermatologist as self treatment is ineffective.

Isotretinoin is a Vitamin-A derivative oral drug that is usually taken once or twice a day with food for 15 to 20 weeks. It markedly reduces the size of the oil glands so that much less oil is produced. As a result, the growth of bacteria is decreased. Accutane usage is government monitored. Patients who are deemed potential candidates and desire to enter into an Accutane program must agree to follow all the guidelines within the iPLEDGE Program

Advantages of Isotretinoin (Accutane)

Isotretinoin is a very effective medicine that can help prevent scarring. After 15 to 20 weeks of treatment with isotretinoin, acne completely or almost completely goes away in most patients. In those patients where acne recurs after a course of isotretinoin, the doctor may institute another course of the same treatment or prescribe other medicines.

Disadvantages of Isotretinoin (Accutane)

Isotretinoin can cause birth defects in the developing fetus of a pregnant woman. It is important that women of childbearing age are not pregnant and do not get pregnant while taking this medicine. Women must use two separate effective forms of birth control at the same time for 1 month before treatment begins, during the entire course of treatment, and for 1 full month after stopping the drug. You should ask your doctor when it is safe to get pregnant after you have stopped taking isotretinoin.

Some people with acne become depressed by the changes in the appearance of their skin. Changes in mood may be intensified during treatment or soon after completing a course of medicines like isotretinoin. There have been a number of reported suicides and suicide attempts in people taking isotretinoin; however, the connection between isotretinoin and suicide or depression is not known. Nevertheless, if you or someone you know feels unusually sad or has other symptoms of depression, such as loss of appetite, loss of interest in once-loved activities, or trouble concentrating, it's important to consult your doctor.

Other possible side effects of isotretinoin include:

  • dry eyes, mouth, lips, nose, or skin (very common)
  • itching
  • nosebleeds
  • muscle aches
  • sensitivity to the sun
  • poor night vision
  • changes in the blood, such as an increase in fats in the blood (triglycerides and cholesterol)
  • change in liver function

To be able to determine if isotretinoin should be stopped if side effects occur, your doctor may test your blood before you start treatment and periodically during treatment. Side effects usually go away after the medicine is stopped.

Can hormones help my acne?

In some women, acne is caused by an excess of androgen (male) hormones. Clues that this may be the case include hirsutism (excessive growth of hair on the face or body), premenstrual acne flares, irregular menstrual cycles, and elevated blood levels of certain androgens.

The doctor may prescribe one of several drugs to treat women with this type of acne:

  • Birth control pills – to help suppress the androgen produced by the ovaries
  • Low-dose corticosteroid drugs, such as prednisone (Deltasone) or dexamethasone (Decadron, Hexadrol) – to help suppress the androgen produced by the adrenal glands
  • Anti androgen drugs such as spironolactone (Aldactone) – to reduce the excessive oil production.

Side effects of anti androgen drugs may include irregular menstruation, tender breasts, headaches, and fatigue.

Download Acne Fast Facts (pdf, 74kb)

What causes my skin to develop acne and what does not?

Many people have various beliefs and perceptions regarding the cause of acne. It is only natural to think that acne results from something you did or didn’t do, something you ate or didn’t eat, or something that you came in contact with. The worry list is almost endless and most of them are totally without basis.

In reality, acne happens for reasons that for the most part are out of our control. We can’t control changes in the cells of our pores, the fact that P. acnes lives on the skin, or the fact that our oil glands produce oil. During puberty normal hormones in the body cause the oil glands to grow and secrete more oil on the face, chest, back, and scalp. The P. acnes bacteria live on all skin – both the skin of teenagers and adults who have acne, and also on the skin of those not affected by acne.

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Common questions about acne

Does washing my face more often stop acne?

No, the changes in the cells of the pores occur too deep in the pore to be affected by vigorous washing or scrubbing. In fact, vigorous washing or scrubbing serves more to aggravate acne than to help it. Gentle face washing to remove surface oils 2 or 3 times a day is recommended to improve the oily appearance of the skin, but face washing will not prevent acne from forming. Remember, you cannot wash acne away.

Does eating fatty foods, sugary foods (including chocolate), drinking milk, or eating meat cause acne?

Most studies suggest that individual foods do not cause acne. Recently though, some studies suggest that diets low in refined sugars and sugar-containing foods (a low glycemic index diet) may be better for acne [3]. Some other studies suggest that there could be a link between acne and milk, but there is no direct evidence for this. Milk contains calcium that is especially important for bone development in young people. Any diet where milk is eliminated or reduced would need to have alternative sources of calcium. Some people are concerned about hormones in meats and other foods. There have been no studies to link these foods to the development of acne.

It does not hurt, and could help, to make healthy adjustments to your diet to see what elements might have a positive or adverse effect on your acne levels.

Will the sun make my acne better?

Some people feel that their acne is better during the summer. This may be due to the fact that oftentimes, teenagers (and adults) may be less stressed during the summer, away from school or on vacation. Many people’s moods improve in sunny environments. These potential benefits can still be achieved while protecting skin health by using an oil free or mineral sunscreen or other protective measures. Note of caution: If you have darker skin tones and are healing from acne lesions, spending time in the sun could lead to dark brown marks.

This is a result of an overproduction of melanin. If you have this problem, Dr. Sikorski may place you on a skin depigmentation program called Cosmelan which helps reduce brown patches on the skin and helps prevent new ones from occurring.

What can I do about my acne?

Skin health benefits from a healthy lifestyle that includes a balanced diet that contains fruits, vegetables, and whole grains with limited refined sugars in addition to exercise, adequate sleep, and management of stress. Beginning to lead a healthy lifestyle as a teenager can have long-term benefits into adulthood. Proper skin care is geared to the type of skin that you have. In all cases it is important to cleanse the skin gently and avoid unnecessary rubbing or scrubbing of the acne. Using a soft washcloth or just the fingers is best. If the skin is oily, mild soaps or acne washes work well to remove the surface oils. If the skin is dry, gentle cleansing should be followed by use of a moisturizer.

It is a good idea to consider a moisturizer that contains a sunscreen. Some people are concerned that moisturizers or other makeup could cause or aggravate acne. In most cases, this is not true. Most products from major companies are now tested in advance to show that they are non-comedogenic (don’t cause acne). Some people have used the strips designed to remove debris from the pores. There is no harm with gentle use of these strips, which some people feel improves the appearance of their skin.

Does squeezing the pimples affect the outcome?

Does squeezing the pimples affect the outcome? It is usually advisable not to squeeze the pimples, especially if they are deep. Superficial whitish or yellowish pimples may be gentle squeezed to remove the purulent contents. If excessive pressure is required to remove the contents, then pimples should not be squeezed. Otherwise the irritant material may be squeeze into surrounding skin and produce pimples which may be bigger, last longer and result in scarring.


The Right Way to Squeeze a Pimple

Never squeeze an inflamed cyst or nodule that is tender to the touch. You can create huge problems.

If you simply can’t help yourself and must squeeze a pimple, here are the steps.

  • Start with clean skin and clean hands. Use a nail brush to remove germs beneath nails.
  • Using a cotton ball, clean the affected area with a small amount of hydrogen peroxide.
  • With a clean sewing needle which has been dipped in alcohol, break the side of the pimple to create a release hole for the pus or clogged oil.
  • Wrap your fingertips in gauze and with gentle pressure, press from above and below  the pimple. If the material inside the pimple does not easily come out, use a hot water compress for a few minutes and then try again – GENTLY! If still no results, leave the pimple alone. If it is embedded deeply, squeezing further will only force the bacteria pocket to rupture and spread the infection.
  • If you were able to express the visible pus and clog, then gently wipe the area with a clean cotton ball soaked with hydrogen peroxide.
  • Don’t pick any small scab you may have created as this will prolong the healing and may cause scarring.
  • Again, squeezing pimples is not advised, but if you do, be sure you don’t compound the problems with nails, fingers or skin that has not been properly cleaned.

What are the best over the counter products to use for my acne?

The best over-the-counter ingredient for acne is benzoyl peroxide. It is the most potent agent available to kill the P. acnes bacteria and should be the first place to start in looking for an over-the-counter acne treatment. Benzoyl peroxide is found in some acne cleansers, acne bar soaps, acne creams and gels, and in some of the popular products advertised on television. Since some products change their ingredients from time to time, the best way to find a benzoyl peroxide–containing product is to read the fine print—the list of ingredients on the back of the container or package.

A small percentage of people may be allergic to benzoyl peroxide, as evidenced by excess redness, itching or peeling of the skin following its use. In these cases, benzoyl peroxide should be avoided. Salicylic acid is also a beneficial over-the-counter acne ingredient, and it is found in many products and in makeup designed for people with acne.

Again keep in mind, all acne products work best when applied to the entire affected area, not just the acne lesions themselves. Spot treatment alone shortchanges the rest of your face. Keep in mind that benzoyl peroxide can bleach clothing, towels, and sometimes hair, so it is important to properly rinse off benzoyl peroxide washes from the chest and back and not to apply it too close to the hairline.

When over the counter products make little or no difference in your acne condition, you should see a dermatologist who can accurately access your acne levels and provide an effective program that can help keep your acne in control.

Recent developments in the treatment of acne include photo dynamic therapy, light and laser procedures that target specific causes of acne. Blue light treatments, for example, kill P. acnes, whereas red light treatments are anti-inflammatory. Photo dynamic Therapy uses a light-activated solution to kill deep-seated bacterial pockets and is very useful in the control of moderate to severe acne. Chemical peels(both AHA and Salicylic Acid) and microdermabrasion procedures, as well as procedures that involve comedo extraction, also may be useful components of acne treatment programs. Extraction of deeply embedded comedones will often speed up the effects of all other treatments.

Resources

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