Acne is the most common skin condition in the U.S. affecting up to 80% of teenagers and young adults as well as significant numbers of older adults. There are a variety of manifestations of acne, including small clogged pores or blackheads, larger red inflamed pimples or deep tender cysts with potential for permanent scarring. The type of acne a person gets will vary, depending on age, whether male or female, and hormonal changes. Also the pattern and severity of acne within a given individual tends to change over time.
A combination of factors can predispose a person to acne, including onset of puberty or other hormonal changes, family history of acne and skin type. There is no scientific evidence to suggest acne is caused by fatty diet, inadequate washing or any particular personal habit. It is important to remember that acne is something that happens to you, not something that you have done to yourself.
There are at least 4 separate changes that happen in the skin which appear to play a role in the formation of acne. First, the skin cells fail to shed from the surface as they are supposed to, forming a small plug within the pore that leads to a blackhead. Then, excess oil released from enlarged glands builds up within the blocked pore. Bacteria present naturally within pores then break down the oil into different irritating chemicals. Finally, these chemicals draw white blood cells into the pore, generating inflammation that leads to formation of pimples.
Different medications are used to treat the different aspects of acne. Various prescription creams are available to improve clogged pores, decrease growth of bacteria in the skin or inhibit inflammation. Antibiotic pills are used to inhibit bacterial growth and suppress larger inflamed pimples. Some medicines can shrink down the enlarged oil glands. Often, combinations of different drugs are prescribed to target the different aspects of a given individual's acne.
Be realistic with your expectations regarding treatment. No one can cure your acne such that you will never have another pimple again. The goal of therapy is to keep your acne to an acceptable minimum. When assessing the response of your acne to treatment, it is important to keep in mind that acne has natural waxing and waning patterns. Periodic flares will occur that are completely unrelated to any therapy. You should evaluate the overall pattern of your acne over several weeks, not just a few bad days, before deciding whether the prescribed treatment is working or not. We recommend a trial of at least 6 to 8 weeks with prescribed treatments before seeking a change in therapy. Also remember that acne is a long term condition that requires daily treatment to maintain suppression. Usually, antibiotic pills can be eventually stopped and remission maintained long term with prescription creams.
Proper skin care is important. Most topical medicines dry and irritate the skin. Over washing and use of abrasive soaps needs to be avoided. Acne is not caused by dirt and is not helped by simply washing the face. Wash only once or twice a day, using mild liquid cleansers designed for sensitive skin (Cetaphil, Purpose, Neutrogena). Any creams, moisturizers or sunscreens should be labeled as `safe for acne-prone skin' or `non-comedogenic'. Skin products that feel greasy may clog pores and worsen acne. Make-up foundation should be oil-free. Make-up powders are safe.
Even though acne is a long-term persistent skin condition, it is quite manageable with proper use of many different available medications. We will work with you to find the right combination of medicines that will keep your acne in remission and keep you looking your best.
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