Acne Overview

Acne is a disorder of the skin's oil glands. Oil glands make an substance called sebum that normally rises up through a hair-containing canal called a follicle and empties onto the skin surface. During adolescence, rising hormone levels are thought to increase the number of oil glands and the amount of sebum they produce. The increased production of sebum causes blockage of hair follicles, leading to the formation of small bacteria-filled cysts called comedones. If these comedones remain intact and no not rupture, they can progress into open comedones (whiteheads) or closed comedones (blackheads). When comedones rupture, an inflammatory reaction occurs and can spread into the surrounding tissue. 

The following may cause or worsen acne:

• Family history of acne
• Greasy/oily cosmetic or hair products containing vegetable or animal fats
• Hormonal changes associated with adolescence, pregnancy, or menstruation
• Certain medications such as corticosteroids, androgens, oral contraceptives, lithium, halogens, isoniazid, phenytoin, phenobarbital, and high levels of iodine
• Environmental irritants such as industrial cutting oils, tar, wood preservatives, sealing compounds, and other pollutants
• Sweating and friction, such as from headbands, back packs, bicycle helmets, or tight collars
• High levels of humidity
• Squeezing and picking comedones

Although still controversial, some researchers believe that stress and sun exposure can also cause or aggravate existing acne. This may be due to the use of oily sunscreens however, as some people with acne actually experience improvement in symptoms with exposure to the sun.

The main goals of acne treatment are to prevent scarring, reduce the number of painful lesions, and minimize the stress and embarrassment related to the condition so as to get the best possible outcome. The basic principle of skin care is to wash the affected area no more than one to two times per day with a mild, nondrying soap. Frequent washing and the use of harsh soaps can actually make the condition worse. Healthcare practitioners will often recommend topical medications as their first choice for treating acne (generally either benzoyl peroxide or a class of drugs known as retinoids). These are designed to wear away the top layer of skin (exfoliate) as well as to reduce abnormal clumping of cells in the follicles, oil and bacteria production, and inflammation. Additionally, facial steaming with accompanying manual extraction of the comedones (such as by a professional aesthetician) is valuable for exfoliation as well. People also may experience an improvement in acne symptoms from herbal sources or other alternative medicines. Expect to use medications and/or complementary and alternative remedies for at least 6 to 8 weeks before seeing a noticeable improvement in symptoms.