Acne Vulgaris

Causalities, Symptoms, Relief!

ACNE is a terrible disease that afflicts many people in North America and around the world.  It is marked by redness in the face and sometimes body, comedones (pimples) on the face which can either be white heads or blackheads, cystic nodules, and can also cause pain.  The condition is incredibly uncomfortable and can cause problems with self-esteem, mental health and sometimes can lead to suicide.  To understand acne is to understand one of the most complex systems in the body.

Your skin and how it works:

The skin on the face is a unique system of it’s own within the entire capacity of the largest organ on the body.  The skin on the face has hair on it (though sometimes we wish to be rid of it) as well as oil glands.  The skin itself, in the most basic of sense, is a layered organ with the cells that we see on the outside being manufactured by the body on the lowest layer.  When the cells are fully formed they make their way to the surface of the skin where we see them every day.  The old cells on the surface eventually dry up and flake off in particles so small you likely can not see them with your naked eye.  In the middle layer of the skin, or the basal layer, you find both the oil glands and the hair follicles.  Above this, on the epidermal layer (epi meaning outside or around and dermal meaning skin) we find the end of the hair follicles and the pores.  In normal skin, the system works perfectly and the old skin flakes off, new cells emerge, the oil from the sebaceous (se-BAY-sh-us) glands work in harmony moisturizing your skin.  Unfortunately, no one has truly perfect skin.

How acne happens:

Acne happens to most people, no one is particularly immune.  When too much oil is produced by the sebaceous glands, it tends to pool in the hair follicle where heat and humidity breed an abnormal amount of bacteria, which is already on your skin every day, when the amount of bacteria overwhelm the space, the body reacts by activating your immune system which, in turn, causes the redness in the face as well as the “whiteheads” that are commonly seen.  There are two types of comedones or “zits”:

Whiteheads:  an infected hair follicle that has been overwhelmed with white blood cells (pus) which are fighting the infection from inside the body.  They are not open to air, so the material inside does not oxidize and remains white.

Black heads: comedones that have a wider than normal opening. They are filled with plugs of sebum and sloughed off cells and have undergone a chemical reaction resulting in the oxidation of melanin. This gives the material in the follicle the typical black color.
Other pimples include pustules, nodules, papules and cysts all of which are inflamed pores that can be especially painful.

There are many causes for acne flare-ups, they can be drugs, stress, hyperactive oil glands, or an accumulation of dead skin cells.  One thing that does not cause acne to flare up is food.  There is no scientific evidence that specific things like chocolate or French fries will make acne appear.  Many health professionals will suggest that people who suffer from acne follow a healthy diet, but not just for the acne; it is better for your health over all to choose healthy foods that will benefit your entire body.

Where previously it was thought that hormones that stimulate the sebaceous glands played a role in the occurrence of acne, it is now seen that it is a malfunction of the glands and follicle systems of the skin on the face.  Excess water retention in the skin causes it to tighten which in turn tightens the pores un-naturally which leads to the pore not having enough access to air and being more susceptible to clogging and breeding bacteria. 

Acne is not at all caused by poor hygiene.  In fact, it is just the opposite, over cleaning the skin can lead it to be dry, which results in the sebaceous glands over producing oils, which then clog the hair follicles causing acne.  It is very important to remember to wash the skin with a gentle cleanser no more than twice daily, then apply a toner, moisturize, and use a sunscreen of at least SPF 30.

Acne is not caused, worsened or cured by having or not having sex.  Masturbation, intercourse, lack of sexual activity or celibacy will never contribute to or cure an acne problem.

Development of Acne Vulgaris (the most common form of acne) is very uncommon in adults, because the onset of adolescent acne is directly connected to the release of the hormone testosterone (TEST-toss-TAIR-own) which eventually becomes more controlled in both boys and girls as they age, adult acne may actually result from an underlying condition of either Rosacea or PCOS (polycystic (polly-SISS-tick) ovary syndrome.)  If you suspect you may have either of these illnesses, please see you doctor.

There are countless treatments available for acne these days.  It seems as though the shelves are lined with one “miracle” product after the next.  In terms of treatment time, it usually takes up to 3 months to see the results from any acne treatment.  Usually in the first few weeks it is not uncommon to see the acne worsen.  Patience is no doubt a virtue when dealing with acne, though many people find that using two products concurrently tends to help more than one single product alone.

Below are some products that are known to help alleviate the symptoms associated with acne:

SALICYLIC ACID: An astringent product that exfoliates the skin and kills bacteria, easy to find, does not stain or discolor clothing.  You can buy pads soaked with the acid or a product called glycolic acid or you can apply either to a rough washcloth and scrub gently to slough off the skin cells.  It is important to note that the term “peel” refers to the destruction of the uppermost layer of the skin; the dead skin cells that we can not see. 

BENZOYL PEROXIDE: A chemical that kills the bacteria that causes acne using the same action as a mild bleach.  This removes the risk of developing new lesions but may dry out the skin excessively, cause redness and irritation and is commonly used with a non-comedogenic moisturizer to prevent over drying.  The chemical may also bleach hair or clothing that may be present in the treatment area.

TOPICAL ANTIBIOTICS like stivea and erythromycin creams are available through the pharmacy on prescription only from your doctor.  They are generally not as effective as those antibiotics that are taken orally, but when used in conjunction have been found to provide some relief.  They work by killing the bacteria that causes acne in the hair follicles and they also have the benefit of avoiding the side effects of most antibiotics: upset stomach, interference with the contraceptive pill, and drug interactions.

ORAL ANTIBIOTICS like Minocycline and Tetracycline work to kill the bacteria that causes acne from the inside but will not prevent the over excretion of oils for the sebum glands.  Doctors have also found that the more antibiotics that are taken, the more resistant acne bacteria is to them and that soon after treatment, the acne reappears.

ORAL CONTRACEPTIVE: For many women, it is found that taking an oral contraceptive is effective in controlling acne because of it’s hormone controlling properties.  With the hormones in check, the sebum glands on the face do not produce as much oil and therefore limit the appearance of acne on the face.

CORTISONE: If a pimple is large and very painful, a doctor may inject a shot of cortisone directly into the comedone to reduce it.  This will result in a marked decrease in redness and swelling, effectively flattening the pimple and making the healing time much quicker.  This procedure may be costly though and is usually performed by a cosmetic surgeon or dermatologist.

VITAMIN-A derived topical creams are usually applied topically (Retin-A, Tazorac) and control the life cycle of the cells involved with acne.  The creams normalize the rate of death in the cells, preventing dead cells from building up and clogging pores.  

These creams have been in use through prescription only for over 30 years and are not as popular as other over the counter treatments.  They can also cause excessive irritation and some users find that soon after starting to use the creams, their faces flare up quite a bit before the acne begins to get better.

ORAL RETINOIDS: Similar to topical retinoids in that they are derived from vitamin A, oral retinoids are taken daily and prevent the sebaceous glands from over-producing oil.  These drugs (Accutane, Sotret) may also have beneficial effects on all the mechanisms that cause acne.  They are taken over a period of 4-6 months and have been shown to be 80% effective in clearing up acne.  These drugs can cause very serious side-effects and while taking them, you must be regularly supervised by your doctor.

PHOTOTHERAPY: A completely different treatment for acne comes in the form of phototherapy.  Most physicians agree that over exposure to sunlight alone is not beneficial in the treatment of acne, actually, it tends to worsen the condition and may also lead to other illnesses (always apply a sunscreen before going outside, even if it’s cloudy.)  However, treatments taken with a blue radiant light use the acne to fight itself.  The blue light changes the chemical properties of the acne, releasing free radicals from the bacteria themselves and killing them.  Thus aiming a  blue light that has absolutely no UV properties at a pimple will cause the bacteria that has infected the pore to turn the energy it produces into a type of poison that will eventually kill it.  This treatment works the same if not slightly better than benzoyl peroxide and since it is not antibiotic resistance is not a problem.  The only downside is that the equipment needed, though portable and can be used at home, is very expensive.

MICRODERMBRASION: Once your acne has disappeared, it is common for scars to appear, especially if the acne has taken a “volcanic” shape on the face or body.  More common treatments available today can be done in the home.  One of the most popular is microdermabrasion which is done on a weekly basis after initial treatment and works to remove the outer microscopic layer of the skin minimizing the look of scars.

SURGERY is also an option and is usually performed by a cosmetic surgeon or dermatologist, the procedure involves loosening the scar beneath the surface of the skin and allowing blood to pool, this then flattens the scar against the rest of the skin on the face, minimizing it’s appearance.   Procedures done surgically should always be performed by a licensed medical doctor in a controlled environment.