Acne

Acne is a common skin disorder, and is thought to affect up to 85% of persons between ages 12 and 25. It may continue to cause problems for people beyond their 20's but usually is less severe. Treating acne, whether in its mild or more severe forms, requires understanding and commitment to the skin care and therapy recommended by your Physician and/or Nurse.

What is Acne?

Acne is an ongoing disorder that involves the skin's oil-producing glands (sebaceous glands) and the hair follicles. Breakouts of acne will occur where these glands are concentrated, such as the face, neck, upper arms and chest.

Normally, the sebaceous glands produce a natural oil that flows from the oil ducts through the hair follicle openings to lubricate and soften the skin. Bacteria is also present, but rarely causes a problem. At the onset of puberty, hormones stimulate and enlarge the sebaceous glands, thereby increasing their activity. Changes in the linings of the hair follicles (also referred to as pores) cause an increase in the number of dead skin cells being shed by the body. A buildup of debris may occur in the hair follicle, causing an obstruction of the oil flow and bacteria. This buildup or congestion results in the formation of COMEDONES - "whiteheads" and/or "blackheads". Trapped bacteria and other aggravating factors may lead to inflamed lesions - red papules and pustules. In more severe cases, long lasting cysts and nodules may occur.

Aggravating Factors

No one factor explains acne, but some conditions may increase the severity of Acne.

Diet

Diet is not considered a factor in the production of acne lesions. Well balanced diets are encouraged for overall health, but no study has proven that foods such as chocolate, cola, milk and milk products will exacerbate acne. If you feel those products impact your acne, then you should avoid excessive amounts.
Stress

Stress (emotional and physical) is a frequent factor in worsening of acne. Stress is difficult to avoid since students are under pressure to perform well and meet deadlines. Difficulties in relationships, fatigue, poor eating habits, lack of exercise and/or illness may all cause physical and emotional stress.
Hormones

Hormones stimulate the sebaceous glands and oil production. Hormonal factors explain why acne begins at puberty, and why women often experience increased oiliness and/or acne flares prior to their menstrual periods. Hormone supplements (i.e. birth control pills, steroids) may also impact acne. It's advisable to discuss acne with your physician before starting birth control pills.
Friction and Sweating
Friction and Sweating, especially in combination can lead to increased acne lesions. Touching of hands to the face is a common source of friction and bacteria. Sweating produces increased bacteria and is problematic in occluded areas such as:
- Sweatbands or ball caps on forehead
- Tight fitting helmets
- Shoulder straps and backpacks
Jobs
Jobs or activities in hot, humid or dirty environments may tend to increase acne.

Examples include:
- Restaurant kitchens or factories
- Construction or landscape sites
- Aerobics and/or weightlifting workouts
- Showers using the stronger, antibacterial soaps are desirable after
  these activities.
Hair Products
Skin Products
The use of skin products is often a major problem in aggravating acne lesions. Reading labels is essential. Labels on moisturizers, makeups, and sunscreens should state:
- oil free
- Non-comedogenic (no comedones) for "acne prone skin"

Treatment

The routine acne treatments do not cure acne, but only control acne while it subsides on its own. Often a period of 6 weeks of treatment is necessary before benefits are seen. Acne treatments are divided into topical treatments (applied to the skin) and oral treatments (pills by mouth). These treatments are effective because of their antibacterial, anti-inflammatory, or keratolytic ("unplug pores") actions.

Anti-Bacterial
Topical:
(Apply 15 minutes after washing to reduce irritation)

Benzoyl peroxides (soaps and washes, gels, lotions)

Antibiotics - Clindamycin, Erythromycin, Sulfacetamide

Benzoyl peroxide plus erythromycin = Benzamycin

Antibacterial soaps (e.g., Dial, Coast, Irish Spring, Lever 2000)
Oral Antibiotics:

Erythromycin

Tetracycline

Doxycycline

Minocycline
Anti-Inflammatory Agents
Oral and Topical Antibiotics as listed above.
Intralesional injection locally of a corticosteroid suspension into persistent cysts or nodules. Oral steroids are rarely used, only in severe cases.

Keratolytic Agents:
- Tretinoin (Retin-A) cream, gel, liquid
- Azelaic Acid Cream (Azelex)
- Isotretinoin (Accutane) - an oral drug approved by the FDA for the treatment of severe cystic acne, which has not responded to the more standard acne treatment. Accutane requires close medical supervision with frequent appointments and blood tests. It is a very effective, expensive treatment, and is usually administered for 5 months.
Exfoliants
- Alpha Hydroxy Acids (AHA) (cleansers, solutions, lotions)
- Sulfur (soaps, lotions)
- Salicylic Acid (soaps, washes, lotions)

Final Note

As mentioned above, it is important to use oil-free "noncomedogenic" skin products. Unless directed otherwise by your nurse/physician, use mild soaps to your face, antibacterial or acne soaps to your chest/back.

Mild Soaps (Examples)

Neutrogena
Purpose
Basis
Cetaphil
Dove
Oil of Olay

Moisturizers (Examples)

* Use SPF formulas when possible in morning

Neutrogena facial lotion
Purpose
Eucerin Facial lotion
Moisturel
Oil of Olay

Cosmetics (Examples)

Most of the major companies have products which are noncomedogenic, e.g., Almay, Avon, Mary Kay, Estee Lauder, Clinique, Revlon, etc.