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Acne

Acne

[bt_quote style="box" width="0"]Acne is common and is usually treatable. You may need treatment for several months to clear spots. Inflamed acne needs to be treated early to prevent scarring. Once the spots are gone, you may need maintenance treatment for several years to keep the spots away.[/bt_quote]

[bt_accordion width="0" active_first="yes" icon="plus-square-1"][bt_spoiler title="Definition" icon="list"]Acne is a skin condition that occurs when your hair follicles become plugged with oil and dead skin cells. Acne usually appears on your face, neck, chest, back and shoulders. Effective treatments are available, but acne can be persistent. The pimples and bumps heal slowly, and when one begins to go away, others seem to crop up.
Acne is most common among teenagers, with a reported prevalence of 70 to 87 percent. Increasingly, younger children are getting acne as well. Depending on its severity, acne can cause emotional distress and scar the skin. The earlier you start treatment, the lower your risk of lasting physical and emotional damage.[/bt_spoiler][bt_spoiler title="Symptoms" icon="list"]Acne signs and symptoms vary depending on the severity of your condition: symptoms include:

-- Whiteheads (closed plugged pores). 
-- Blackheads (open plugged pores — the oil turns brown when it is exposed to air).
-- Small red, tender bumps (papules).
-- Pimples (pustules), which are papules with pus at their tips.
-- Large, solid, painful lumps beneath the surface of the skin (nodules).
-- Painful, pus-filled lumps beneath the surface of the skin (cystic lesions).

[/bt_spoiler][bt_spoiler title="Causes" icon="list"]Four main factors cause acne:
-- Oil production.
-- Dead skin cells.
-- Clogged pores.
-- Bacteria.


Acne typically appears on your face, neck, chest, back and shoulders. These areas of skin have the most oil (sebaceous) glands. Acne occurs when hair follicles become plugged with oil and dead skin cells. Hair follicles are connected to oil glands. These glands secrete an oily substance (sebum) to lubricate your hair and skin. Sebum normally travels along the hair shafts and through the openings of the hair follicles onto the surface of your skin. When your body produces an excess amount of sebum and dead skin cells, the two can build up in the hair follicles. They form a soft plug, creating an environment where bacteria can thrive. If the clogged pore becomes infected with bacteria, inflammation results.

The plugged pore may cause the follicle wall to bulge and produce a whitehead. Or the plug may be open to the surface and may darken, causing a blackhead. A blackhead may look like dirt stuck in pores. But actually the pore is congested with bacteria and oil, which turns brown when it's exposed to the air. Pimples are raised red spots with a white center that develop when blocked hair follicles become inflamed or infected. Blockages and inflammation that develop deep inside hair follicles produce cyst-like lumps beneath the surface of your skin. Other pores in your skin, which are the openings of the sweat glands, aren't usually involved in acne.[/bt_spoiler]

[bt_spoiler title="Factors that may worsen acne" icon="list"]These factors can trigger or aggravate an existing case of acne:
-- Hormones: Androgens are hormones that increase in boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy and the use of oral contraceptives also can affect sebum production. And low amounts of androgens circulate in the blood of women and can worsen acne.
-- Certain medications: Drugs containing corticosteroids, androgens or lithium can worsen acne.
-- Diet: Studies indicate that certain dietary factors, including dairy products and carbohydrate-rich foods — such as bread, bagels and chips — may trigger acne. Chocolate has long been suspected of making acne worse. A recent study of 14 men with acne showed that eating chocolate was related to an increase in acne. Further study is needed to examine why this happens or whether acne patients need to follow specific dietary restrictions.
-- Stress: Stress can make acne worse.[/bt_spoiler]

[bt_spoiler title="Risk Factors" icon="list"]Risk factors for acne include:
-- Hormonal changes: Such changes are common in teenagers, women and girls, and people using certain medications, including those containing corticosteroids, androgens or lithium.
-- Family history: Genetics plays a role in acne. If both parents had acne, you're likely to develop it, too.
-- Greasy or oily substances: You may develop acne where your skin comes into contact with oily lotions and creams or with grease in a work area, such as a kitchen with fry vats.
-- Friction or pressure on your skin: This can be caused by items such as telephones, cellphones, helmets, tight collars and backpacks.
-- Stress: This doesn't cause acne, but if you have acne already, stress may make it worse. [/bt_spoiler] [bt_spoiler title="Preparing for your appointment" icon="list"]If you have acne that's not responding to self-care and over-the-counter treatments, make an appointment with your doctor. Early, effective treatment of acne reduces the risk of scarring and of lasting damage to your self-esteem. After an initial examination, your doctor may refer you to a specialist in the diagnosis and treatment of skin conditions (dermatologist).
Here's some information to help you get ready for your appointment.

What you can do:
-- List your key medical information, such as other conditions with which you've been diagnosed and any prescription or over-the-counter products you're using, including vitamins and supplements.
-- List key personal information, including any major stresses or recent life changes.
-- List questions to ask your doctor Creating your list of questions in advance can help you make the most of your time with your doctor.[/bt_spoiler] [bt_spoiler title="Tests and Diagnosis" icon="list"]If over-the-counter (nonprescription) products haven't cleared up your acne, your doctor can prescribe stronger medications or other therapies. A dermatologist can help you:
-- Control your acne.
-- Avoid scarring or other damage to your skin.
-- Make scars less noticeable.

Acne medications work by reducing oil production, speeding up skin cell turnover, fighting bacterial infection or reducing inflammation — which helps prevent scarring. With most prescription acne drugs, you may not see results for four to eight weeks, and your skin may get worse before it gets better. It can take many months or years for your acne to clear up completely.
The drug your doctor recommends depends on the type and severity of your acne. It might be something you apply to your skin (topical medication) or take by mouth (oral medication). Often, drugs are used in combination. Pregnant women will not be able to use oral prescription medications for acne. Talk with your doctor about the risks and benefits of medications and other treatments you are considering.

Topical medications
These products work best when applied to clean, dry skin about 15 minutes after washing. You may not see the benefit of this treatment for a few weeks. And you may notice skin irritation at first, such as redness, dryness and peeling.
Your doctor may recommend steps to minimize these side effects, including using a gradually increased dose, washing off the medication after a short application or switching to another medication. The most common topical prescription medications for acne are:
-- Retinoids: These come as creams, gels and lotions. Retinoid drugs are derived from vitamin A and include tretinoin (Avita, Retin-A, others), adapalene (Differin) and tazarotene (Tazorac, Avage). You apply this medication in the evening, beginning with three times a week, then daily as your skin becomes used to it. It works by preventing plugging of the hair follicles.
-- Antibiotics: These work by killing excess skin bacteria and reducing redness. For the first few months of treatment, you may use both a retinoid and an antibiotic, with the antibiotic applied in the morning and the retinoid in the evening. The antibiotics are often combined with benzoyl peroxide to reduce the likelihood of developing antibiotic resistance. Examples include clindamycin with benzoyl peroxide (Benzaclin, Duac, Acanya) and erythromycin with benzoyl peroxide (Benzamycin).
-- Dapsone (Aczone). This gel is most effective when combined with a topical retinoid. Skin side effects include redness and dryness.

Oral medications
-- Antibiotics For moderate to severe acne, you may need oral antibiotics to reduce bacteria and fight inflammation. Choices for treating acne include tetracyclines, such as minocycline and doxycycline.
Your doctor likely will recommend tapering off these medications as soon as your symptoms begin to improve or as soon as it becomes clear the drugs aren't helping — usually, within three to four months. Tapering helps prevent antibiotic resistance by minimizing undue exposure to these medications over a long time.
You will likely use topical medications and oral antibiotics together. Studies have found that using topical benzoyl peroxide along with oral antibiotics may reduce the risk of developing antibiotic resistance.
Antibiotics may cause side effects, such as an upset stomach and dizziness. These drugs also increase your skin's sun sensitivity. They can cause discoloration of developing permanent teeth and reduced bone growth in children born to women who took tetracyclines while pregnant.
-- Combined oral contraceptives. Combined oral contraceptives are useful in treating acne in women and adolescent girls. The Food and Drug Administration approved three products that combine estrogen and progestin (Ortho Tri-Cyclen, Estrostep and Yaz).
The most common side effects of these drugs are headache, breast tenderness, nausea, weight gain and breakthrough bleeding. A serious potential complication is a slightly increased risk of blood clots.
-- Anti-androgen agent. The drug spironolactone (Aldactone) may be considered for women and adolescent girls if oral antibiotics aren't helping. It works by blocking the effect of androgen hormones on the sebaceous glands. Possible side effects include breast tenderness, painful periods and the retention of potassium.
-- Isotretinoin This medicine is reserved for people with the most severe acne. Isotretinoin (Amnesteem, Claravis, Sotret) is a powerful drug for people whose acne doesn't respond to other treatments.
Oral isotretinoin is very effective. But because of its potential side effects, doctors need to closely monitor anyone they treat with this drug. The most serious potential side effects include ulcerative colitis, an increased risk of depression and suicide, and severe birth defects.
In fact, isotretinoin carries such serious risk of side effects that women of reproductive age must participate in a Food and Drug Administration-approved monitoring program to receive a prescription for the drug.

Therapies:
These therapies may be suggested in select cases, either alone or in combination with medications.
-- Light therapy: A variety of light-based therapies have been tried with success. But further study is needed to determine the ideal method, light source and dose. Light therapy targets the bacteria that cause acne inflammation. Some types of light therapy are done in a doctor's office. Blue-light therapy can be done at home with a hand-held device. Possible side effects of light therapy include pain, temporary redness and sensitivity to sunlight.
-- Chemical peel: This procedure uses repeated applications of a chemical solution, such as salicylic acid. It is most effective when combined with other acne treatments, except oral retinoids. Chemical peels aren't recommended for people taking oral retinoids because together these treatments can significantly irritate the skin. Chemicals peels may cause temporary, severe redness, scaling and blistering, and long-term discolouration of the skin.
-- Extraction of whiteheads and blackheads: Your dermatologist uses special tools to gently remove whiteheads and blackheads (comedos) that haven't cleared up with topical medications. This technique may cause scarring.
-- Steroid injection: Nodular and cystic lesions can be treated by injecting a steroid drug directly into them. This improves their appearance without the need for extraction. The side effects of this technique include thinning of the skin, lighter skin and the appearance of small blood vessels on the treated area.
[/bt_spoiler] [bt_spoiler title="Prevention" icon="list"]Once your acne improves, you may need to continue your acne medication or other treatment to prevent new breakouts. You might need to use a topical medication on acne-prone areas, continue taking oral contraceptives or attend ongoing light therapy sessions. Talk to your doctor about how you can keep your skin clear. You can also use these acne-prevention tips:
-- Wash acne-prone areas only twice a day<: Washing removes excess oil and dead skin cells. But too much washing can irritate the skin. Wash affected areas with a gentle cleanser and use oil-free, water-based skin care products.
-- Use an over-the-counter acne cream or gel to help dry excess oil: Look for products containing benzoyl peroxide or salicylic acid as the active ingredient.
-- Use nonoily makeup: Choose oil-free cosmetics that won't clog pores (noncomedogenics).
-- Remove makeup before going to bed: Going to sleep with cosmetics on your skin can clog your pores. Also, it's a good idea to throw out old makeup and regularly clean your cosmetic brushes and applicators with soapy water.
-- Wear loose fitting clothing: Tight fitting clothing traps heat and moisture and can irritate your skin. When possible, avoid tight fitting straps, backpacks, helmets, hats and sports equipment to prevent friction against your skin.
-- Shower after strenuous activities: Oil and sweat on your skin can lead to breakouts.
-- Avoid touching or picking at the problem areas: Doing so can trigger more acne. [/bt_spoiler] [/bt_accordion]

 

Acne is common and is usually treatable. You may need treatment for several months to clear spots. Inflamed acne needs to be treated early to prevent scarring. Once the spots are gone, you may need maintenance treatment for several years to keep the spots away.

Definition
Acne is a skin condition that occurs when your hair follicles become plugged with oil and dead skin cells. Acne usually appears on your face, neck, chest, back and shoulders. Effective treatments are available, but acne can be persistent. The pimples and bumps heal slowly, and when one begins to go away, others seem to crop up.
Acne is most common among teenagers, with a reported prevalence of 70 to 87 percent. Increasingly, younger children are getting acne as well. Depending on its severity, acne can cause emotional distress and scar the skin. The earlier you start treatment, the lower your risk of lasting physical and emotional damage.
Symptoms
Acne signs and symptoms vary depending on the severity of your condition: symptoms include:

-- Whiteheads (closed plugged pores). 
-- Blackheads (open plugged pores — the oil turns brown when it is exposed to air).
-- Small red, tender bumps (papules).
-- Pimples (pustules), which are papules with pus at their tips.
-- Large, solid, painful lumps beneath the surface of the skin (nodules).
-- Painful, pus-filled lumps beneath the surface of the skin (cystic lesions).

Causes
Four main factors cause acne:
-- Oil production.
-- Dead skin cells.
-- Clogged pores.
-- Bacteria.


Acne typically appears on your face, neck, chest, back and shoulders. These areas of skin have the most oil (sebaceous) glands. Acne occurs when hair follicles become plugged with oil and dead skin cells. Hair follicles are connected to oil glands. These glands secrete an oily substance (sebum) to lubricate your hair and skin. Sebum normally travels along the hair shafts and through the openings of the hair follicles onto the surface of your skin. When your body produces an excess amount of sebum and dead skin cells, the two can build up in the hair follicles. They form a soft plug, creating an environment where bacteria can thrive. If the clogged pore becomes infected with bacteria, inflammation results.

The plugged pore may cause the follicle wall to bulge and produce a whitehead. Or the plug may be open to the surface and may darken, causing a blackhead. A blackhead may look like dirt stuck in pores. But actually the pore is congested with bacteria and oil, which turns brown when it's exposed to the air. Pimples are raised red spots with a white center that develop when blocked hair follicles become inflamed or infected. Blockages and inflammation that develop deep inside hair follicles produce cyst-like lumps beneath the surface of your skin. Other pores in your skin, which are the openings of the sweat glands, aren't usually involved in acne.

Factors that may worsen acne
These factors can trigger or aggravate an existing case of acne:
-- Hormones: Androgens are hormones that increase in boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy and the use of oral contraceptives also can affect sebum production. And low amounts of androgens circulate in the blood of women and can worsen acne.
-- Certain medications: Drugs containing corticosteroids, androgens or lithium can worsen acne.
-- Diet: Studies indicate that certain dietary factors, including dairy products and carbohydrate-rich foods — such as bread, bagels and chips — may trigger acne. Chocolate has long been suspected of making acne worse. A recent study of 14 men with acne showed that eating chocolate was related to an increase in acne. Further study is needed to examine why this happens or whether acne patients need to follow specific dietary restrictions.
-- Stress: Stress can make acne worse.

Risk Factors
Risk factors for acne include:
-- Hormonal changes: Such changes are common in teenagers, women and girls, and people using certain medications, including those containing corticosteroids, androgens or lithium.
-- Family history: Genetics plays a role in acne. If both parents had acne, you're likely to develop it, too.
-- Greasy or oily substances: You may develop acne where your skin comes into contact with oily lotions and creams or with grease in a work area, such as a kitchen with fry vats.
-- Friction or pressure on your skin: This can be caused by items such as telephones, cellphones, helmets, tight collars and backpacks.
-- Stress: This doesn't cause acne, but if you have acne already, stress may make it worse.
Preparing for your appointment
If you have acne that's not responding to self-care and over-the-counter treatments, make an appointment with your doctor. Early, effective treatment of acne reduces the risk of scarring and of lasting damage to your self-esteem. After an initial examination, your doctor may refer you to a specialist in the diagnosis and treatment of skin conditions (dermatologist).
Here's some information to help you get ready for your appointment.

What you can do:
-- List your key medical information, such as other conditions with which you've been diagnosed and any prescription or over-the-counter products you're using, including vitamins and supplements.
-- List key personal information, including any major stresses or recent life changes.
-- List questions to ask your doctor Creating your list of questions in advance can help you make the most of your time with your doctor.
Tests and Diagnosis
If over-the-counter (nonprescription) products haven't cleared up your acne, your doctor can prescribe stronger medications or other therapies. A dermatologist can help you:
-- Control your acne.
-- Avoid scarring or other damage to your skin.
-- Make scars less noticeable.

Acne medications work by reducing oil production, speeding up skin cell turnover, fighting bacterial infection or reducing inflammation — which helps prevent scarring. With most prescription acne drugs, you may not see results for four to eight weeks, and your skin may get worse before it gets better. It can take many months or years for your acne to clear up completely.
The drug your doctor recommends depends on the type and severity of your acne. It might be something you apply to your skin (topical medication) or take by mouth (oral medication). Often, drugs are used in combination. Pregnant women will not be able to use oral prescription medications for acne. Talk with your doctor about the risks and benefits of medications and other treatments you are considering.

Topical medications
These products work best when applied to clean, dry skin about 15 minutes after washing. You may not see the benefit of this treatment for a few weeks. And you may notice skin irritation at first, such as redness, dryness and peeling.
Your doctor may recommend steps to minimize these side effects, including using a gradually increased dose, washing off the medication after a short application or switching to another medication. The most common topical prescription medications for acne are:
-- Retinoids: These come as creams, gels and lotions. Retinoid drugs are derived from vitamin A and include tretinoin (Avita, Retin-A, others), adapalene (Differin) and tazarotene (Tazorac, Avage). You apply this medication in the evening, beginning with three times a week, then daily as your skin becomes used to it. It works by preventing plugging of the hair follicles.
-- Antibiotics: These work by killing excess skin bacteria and reducing redness. For the first few months of treatment, you may use both a retinoid and an antibiotic, with the antibiotic applied in the morning and the retinoid in the evening. The antibiotics are often combined with benzoyl peroxide to reduce the likelihood of developing antibiotic resistance. Examples include clindamycin with benzoyl peroxide (Benzaclin, Duac, Acanya) and erythromycin with benzoyl peroxide (Benzamycin).
-- Dapsone (Aczone). This gel is most effective when combined with a topical retinoid. Skin side effects include redness and dryness.

Oral medications
-- Antibiotics For moderate to severe acne, you may need oral antibiotics to reduce bacteria and fight inflammation. Choices for treating acne include tetracyclines, such as minocycline and doxycycline.
Your doctor likely will recommend tapering off these medications as soon as your symptoms begin to improve or as soon as it becomes clear the drugs aren't helping — usually, within three to four months. Tapering helps prevent antibiotic resistance by minimizing undue exposure to these medications over a long time.
You will likely use topical medications and oral antibiotics together. Studies have found that using topical benzoyl peroxide along with oral antibiotics may reduce the risk of developing antibiotic resistance.
Antibiotics may cause side effects, such as an upset stomach and dizziness. These drugs also increase your skin's sun sensitivity. They can cause discoloration of developing permanent teeth and reduced bone growth in children born to women who took tetracyclines while pregnant.
-- Combined oral contraceptives. Combined oral contraceptives are useful in treating acne in women and adolescent girls. The Food and Drug Administration approved three products that combine estrogen and progestin (Ortho Tri-Cyclen, Estrostep and Yaz).
The most common side effects of these drugs are headache, breast tenderness, nausea, weight gain and breakthrough bleeding. A serious potential complication is a slightly increased risk of blood clots.
-- Anti-androgen agent. The drug spironolactone (Aldactone) may be considered for women and adolescent girls if oral antibiotics aren't helping. It works by blocking the effect of androgen hormones on the sebaceous glands. Possible side effects include breast tenderness, painful periods and the retention of potassium.
-- Isotretinoin This medicine is reserved for people with the most severe acne. Isotretinoin (Amnesteem, Claravis, Sotret) is a powerful drug for people whose acne doesn't respond to other treatments.
Oral isotretinoin is very effective. But because of its potential side effects, doctors need to closely monitor anyone they treat with this drug. The most serious potential side effects include ulcerative colitis, an increased risk of depression and suicide, and severe birth defects.
In fact, isotretinoin carries such serious risk of side effects that women of reproductive age must participate in a Food and Drug Administration-approved monitoring program to receive a prescription for the drug.

Therapies:
These therapies may be suggested in select cases, either alone or in combination with medications.
-- Light therapy: A variety of light-based therapies have been tried with success. But further study is needed to determine the ideal method, light source and dose. Light therapy targets the bacteria that cause acne inflammation. Some types of light therapy are done in a doctor's office. Blue-light therapy can be done at home with a hand-held device. Possible side effects of light therapy include pain, temporary redness and sensitivity to sunlight.
-- Chemical peel: This procedure uses repeated applications of a chemical solution, such as salicylic acid. It is most effective when combined with other acne treatments, except oral retinoids. Chemical peels aren't recommended for people taking oral retinoids because together these treatments can significantly irritate the skin. Chemicals peels may cause temporary, severe redness, scaling and blistering, and long-term discolouration of the skin.
-- Extraction of whiteheads and blackheads: Your dermatologist uses special tools to gently remove whiteheads and blackheads (comedos) that haven't cleared up with topical medications. This technique may cause scarring.
-- Steroid injection: Nodular and cystic lesions can be treated by injecting a steroid drug directly into them. This improves their appearance without the need for extraction. The side effects of this technique include thinning of the skin, lighter skin and the appearance of small blood vessels on the treated area.
Prevention
Once your acne improves, you may need to continue your acne medication or other treatment to prevent new breakouts. You might need to use a topical medication on acne-prone areas, continue taking oral contraceptives or attend ongoing light therapy sessions. Talk to your doctor about how you can keep your skin clear. You can also use these acne-prevention tips:
-- Wash acne-prone areas only twice a day<: Washing removes excess oil and dead skin cells. But too much washing can irritate the skin. Wash affected areas with a gentle cleanser and use oil-free, water-based skin care products.
-- Use an over-the-counter acne cream or gel to help dry excess oil: Look for products containing benzoyl peroxide or salicylic acid as the active ingredient.
-- Use nonoily makeup: Choose oil-free cosmetics that won't clog pores (noncomedogenics).
-- Remove makeup before going to bed: Going to sleep with cosmetics on your skin can clog your pores. Also, it's a good idea to throw out old makeup and regularly clean your cosmetic brushes and applicators with soapy water.
-- Wear loose fitting clothing: Tight fitting clothing traps heat and moisture and can irritate your skin. When possible, avoid tight fitting straps, backpacks, helmets, hats and sports equipment to prevent friction against your skin.
-- Shower after strenuous activities: Oil and sweat on your skin can lead to breakouts.
-- Avoid touching or picking at the problem areas: Doing so can trigger more acne.