Acne Terms and Causes

Acne: Words to Know
Androgen:
A male sex hormone found in both males and females.
Anti-androgen:
A drug that slows down the production of androgens.
Antibiotic:
A drug that kills bacteria.
Comedo:
A hard plug that develops in the pores of the skin composed of sebum and dead skin cells. The mildest form of acne.
Comedolytic:
Drugs that break up comedos and open clogged pores.
Isotretinoin:
A drug that decreases sebum production and dries up acne pimples.
Sebum:
An oily material produced by sebaceous glands that keeps the skin moist.
Tretinoin:
A drug that increases the rate at which skin cells are formed and die.
CAUSES
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The exact cause of acne is not known, however, several risk factors have been identified.
• Age. Because of the effect of sex hormones, teenagers are quite likely to develop acne.
• Cosmetics. Make-up and hair sprays that contain oils can make acne worse.
• Diet. Acne is not caused by diet, but some foods can make the disease more serious.
• Disease. Hormonal disorders can increase the severity of acne problems in girls.
• Drugs. Acne can develop as a result of using certain drugs, such as tranquilizers, antibiotics, oral contraceptives, and anabolic steroids. Steroids are synthetic hormones that may sometimes be abused by athletes to increase the size of their muscles.
• Environment. Acne can become worse as a result of exposure to oils, greases, and polluted air. Sweating in hot weather can also make the condition worse.
• Gender. Boys are more likely to develop acne and tend to have more serious cases than girls.
• Heredity. Acne is more common in some families than in others.
• Hormonal changes. Acne can flare up during menstruation, pregnancy, and menopause. Menopause is the period in a woman’s life when her body stops producing certain hormones.
• Personal hygiene. Strong soaps, hard scrubbing, and picking at pimples can make acne worse.
• Stress. Emotional stress can contribute to acne.

Side Effects and Conditions Caused By Isotretinoin

Minor discomforts such as dry mouth or nose, dry eyes, dry skin, or itching usually go away as the body adjusts to the drug and do not require medical attention unless they continue or are bothersome.

Other side effects should be brought to a physician’s attention. These include:
• burning, redness, or itching of the eyes
• nosebleeds
• signs of inflammation of the lips, such as peeling, burning, redness or pain

Bowel inflammation is not a common side effect, but it may occur. If any of the following signs of bowel inflammation occur, stop taking isotretinoin immediately and check with a physician:
• pain in the abdomen
• bleeding from the rectum
• severe diarrhea

Conditions Caused By Benzoyl Peroxide and Tretinoin

The most common side effects of antiacne drugs applied to the skin are slight redness, dryness, peeling, and stinging, and a warm feeling to the skin. These problems usually go away as the body adjusts to the drug and do not require medical treatment.
Other side effects should be brought to a physician’s attention. Check with a physician as soon as possible if any of the following side effects occur:

• blistering, crusting, or swelling of the skin
• severe burning or redness of the skin>
• darkening or lightening of the skin (This effect will eventually go away after treatment with an antiacne drug ends.)
• skin rash

Other side effects are possible with any type of antiacne drug. Anyone who has unusual symptoms while using antiacne drugs should get in touch with his or her physician.
Interactions

Patients using antiacne drugs on their skin should tell their physicians if they are using any other prescription or nonprescription (over-the-counter) medicine that they apply to the skin in the same area as the antiacne drug.

Isotretinoin may interact with other medicines. When this happens, the effects of one or both drugs may change or the risk of side effects may be greater. Anyone who takes isotretinoin should let the physician know about all other medicines being used and should ask whether the possible interactions can interfere with drug therapy.

Among the drugs that may interact with isotretinoin are listed below:
• Etretinate (Tegison), used to treat severe psoriasis. Using this medicine with isotretinoin increases side effects.
• Tretinoin (Retin-A, Renova). Using this medicine with isotretinoin increases side effects.
• Vitamin A or any medicine containing vitamin A. Using any vitamin A preparations with isotretinoin increases side effects. Do not take vitamin supplements containing vitamin A while taking isotretinoin.
• Tetracyclines (used to treat infections). Using these medicines with isotretinoin increases the chance of swelling of the brain. Make sure the physician knows if tetracycline is being used to treat acne or another infection.

Parental Concerns

Acne comes at a difficult time, the adolescent years. While mild acne can be treated with over-the-counter medications, more severe acne needs medical attention. Experts advise against a wait-and-see attitude. Treatment options can help control acne and avoid scarring.

Isotretinoin can cause serious birth defects, including mental retardation and physical deformities. This medicine should not be used during pregnancy. Sexually active adolescent females who are able to bear children should not use isotretinoin unless they have very severe acne that has not cleared up with the use of other antiacne drugs. In addition, acne treatments that can dry the skin should be used with caution by people with skin of color.

Laser Acne Treatments

Your skin has an amazing natural ability to regenerate itself and with proper nutrition and a regular cleansing routine, a new layer of skin growth will generally cover any scarring. But in the rare cases where this regeneration does not occur, then a more advanced scar treatment is in order. Always consult with your doctor or dermatologist before beginning any facial treatments to be sure you are not causing further damage. Read more

Acne Symptoms and Treatments

SYMPTOMS

Acne is often not apparent to an observer. Inflamed pores, however, can cause pain or itching. The most troubling aspect of acne for many people is the scarring that can occur. And, while acne may not be very noticeable, individuals tend to be sensitive about their appearance. Teenagers especially may become concerned about the way other people react to them.

DIAGNOSIS

People with acne are often treated by family doctors. More serious cases are referred to a dermatologist (a specialist in skin disorders) or an endocrinologist (a specialist in hormonal disorders).
Because of its appearance, acne is not difficult to diagnose. A doctor takes a complete medical history, which includes questions about skin, diet, medication use, and other factors associated with risk for acne. He or she conducts a physical examination of the face, upper neck, chest, shoulders, back, and other affected areas. The doctor determines the number and type of blemishes, whether they are inflamed or not, whether they are deep or near the surface of the skin, and whether there is scarring or skin discoloration.
Laboratory tests are not done unless the patient appears to have a hormonal disorder. In that case, blood tests and other tests may be ordered. Most insurance plans cover the cost of diagnosing and treating acne.

ANTI-ACNE DRUGS
Brand Name (Generic Name) and their pssible common side effects:

Accutane (isotretinoin) > Dry skin, dry mouth, conjunctivitis
Benzamycin > Dry and itchy skin
Cleocin T (clindamycin phosphate) Dry skin
Desquam-E (benzoyl peroxide) > Itching, red and peeling skin
Erythromycin topical (A/T/S, erycette, t-stat) > Burning, dry skin, hives, red and peeling skin
Minocin (minocycline hydrochloride) > Headache, hives, diarrhea, peeling skin, vomiting
Retin-A (tretinoin) > Darkening of the skin, blistering, crusted, or puffy skin

Acne Scar Treatments

Hormonal changes and overly active sebaceous (oil) glands that commonly occur in adolescence usually cause acne, however acne can still affect adults as well. Zits, pimples, acne, cystic skin eruptions, blackheads and white heads all fit into the acne skin malady category.

The temptation to squeeze the spots and remove the infected matter, albeit tempting, will not reform your skin to its natural radiance. In fact, secondary infection by bacteria being pushed back into the deeper layers of the skin can cause more pain, inflammation and most likely future scaring. Once the bacteria have been released, it can re-infect the surrounding skin. The facial scars are actually remnants of the bacterial infection caused by ‘procedure.’

The unfair fact is that adult acne will affect 25 percent of men and 50 percent of women in their adult lives. We know that identifying hormonal changes as the main cause of adult acne aren’t entirely proven. There isn’t just one cause. Acne in adult women can be linked to cosmetic use, some hair products and can frequently be brought on by the hormonal fluctuations associated with pregnancy. Certain types of prescription medications can also cause adult acne. Some strains of acne, such as Acne vulgaris, don’t typically show up in adults until midlife. Adult acne also forms differently, whereas adolescent acne begins on the forehead and cheek area, adult acne tends to show more on the chin, jaw line and neck.

With all this new adult acne erupting (pardon the pun) more than before, natural acne and scar treatments are gaining more acceptance as consumers want to make healthier more sustainable choices for their skincare.

Your skin has an amazing natural ability to regenerate itself and a new layer of skin growth will generally cover any scarring, but in the rare cases where this does not occur then a more advanced scar treatment is in order. Always consult with your doctor or dermatologist before beginning any facial treatments to be sure you are not causing further damage.

A healthy, well-balanced diet plays a large role in helping your body and skin to regenerate itself to its optimal condition. Many dermatologists recommend a diet high in natural minerals. These minerals are to maintain the health of the skin cells, which in turn should prevent a further outbreak of acne and repair damaged tissue. Diets, which include plenty of green vegetables, un-cooked vegetables such as carrots, spinach and cucumbers, have also helped many to maintain smooth, blemish-free skin. The idea is to try to create a new fresh layer of skin so that the scars reduced or eradicated.

Are you drinking enough water?

By consuming a regular amount of water daily, you can improve the look of your skin. The average human body is comprised of 60 percent water. Drinking more water, instead of sugar-laden sodas or energy drinks will keep the skin moist and smooth; it will also clear away the dead skin cells, flush toxins and aid in the regeneration of new skin cells. Mixing water with natural ingredients like citrus, fruit or vegetable juices, can also be helpful to exfoliate the skin.

With a proper nutritious diet, vitamins and plenty of water, most see results within a few months. It can take up to a year for acne scars to heal completely. Acne scars do not show up overnight and removing them can take the same amount of time if not more. It takes patience, but with the proper motivation for beautiful, glowing skin, it will be well worth the wait.

Of course, some scars may be so deep as to require dermalogical treatments such as lasers or painful acid peels. Try the natural methods first, as theses procedures can be quite costly. Any effort you make to regenerate your skin naturally will only help the dermatologist’s treatments even further.

Always remember to gently cleanse and moisturize your skin everyday as well. Applying harsh, drying chemicals to your acne will usually cause further inflammation and breakouts. One natural treatment that had shown good results is to mix pure sandalwood oil with rose water, apply it to your scar(s) and leave on the skin overnight. Cleanse face as usual in the morning.

Benzoyl Peroxide and Tretinoin

When applying antiacne drugs to the skin, people should be careful not to get the medicine in the eyes, mouth, or inside the nose. They should not put the medicine on skin that is wind burned, sunburned, or irritated, and not apply it to open wounds.

Because anti-acne drugs such as benzoyl peroxide and tretinoin irritate the skin slightly, users should avoid doing anything that might cause further irritation. They should wash the face with mild soap and water only two or three times a day, unless the physician says to wash it more often. They should also avoid using abrasive soaps or cleansers and products that might dry the skin or make it peel, such as medicated cosmetics, cleansers that contain alcohol, or other acne products that contain resorcinol, sulfur, or salicylic acid.

If benzoyl peroxide or tretinoin make the skin too red or too dry or cause too much peeling, the user should check with a physician. Using the medicine less often or using a weaker strength may be necessary. Benzoyl peroxide can irritate the skin of people with skin of color and cause darkened spots called hyperpigmentation on the skin. Benzoyl peroxide may discolor hair or colored fabrics.

ORAL DRUGS. Oral antibiotics are taken daily for two to four months. The drugs used include tetracycline, erythromycin, minocycline (Minocin), doxycycline, clindamycin (Cleocin), and trimethoprim-sulfamethoxazole (Bactrim, Septra). Possible side effects include allergic reactions, stomach upset, vaginal yeast infections, dizziness, and tooth discoloration.

The goal of treating moderate acne is to decrease inflammation and prevent new comedones from forming. One effective treatment is topical tretinoin, used along with a topical or oral antibiotic. A combination of topical benzoyl peroxide and erythromycin is also very effective. Improvement is normally seen within four to six weeks, but treatment is maintained for at least two to four months.

Special Conditions

People who have certain medical conditions or who are taking certain other medicines may have problems if they use antiacne drugs. Before using these products, the physician should be informed about any of the following conditions.

ALLERGIES. Anyone who has had unusual reactions to etretinate, isotretinoin, tretinoin, vitamin A preparations, or benzoyl peroxide in the past should let the physician know before using an antiacne drug. The physician should also be told about any allergies to foods, dyes, preservatives, or other substances.

PREGNANCY. Teens who are pregnant or who may become pregnant should check with a physician before using tretinoin or benzoyl peroxide. Isotretinoin causes birth defects in humans and must not be used during pregnancy.

OTHER MEDICAL CONDITIONS. Before using antiacne drugs applied to the skin, people with any of these medical problems should make sure their physicians are aware of their conditions:
• Eczema. Antiacne drugs that are applied to the skin may make this condition worse.
• Sunburn or raw skin. Antiacne drugs that are applied to the skin may increase the pain and irritation of these conditions.

In people with certain medical conditions, isotretinoin may increase the amount of triglyceride (a fatty-substance) in the blood. This may lead to heart or blood vessel problems. Before using isotretinoin, adolescents with any of the following medical problems should make sure their physicians are aware of their conditions:

• alcoholism or heavy drinking, currently or in the past
• diabetes or family history of diabetes (Isotretinoin may change blood sugar levels.)
• family history of high triglyceride levels in the blood
• severe weight problems

Using antiacne drugs with certain other drugs may affect the way the drugs work or may increase the chance of side effects.

Chloasma - skin changes through pregnancy

Chloasma or the “Mask of Pregnancy” can cause blotchy discoloration on your face and splashes of darkened skin that may appear on the forehead, nose, and cheeks in a mask-like configuration on some pregnant women — more often in dark-skinned women.

What causes chloasma: Those mischievous pregnancy hormones are toying with you again, causing hyperpigmentation on many parts of your body. You might have noticed your freckles and moles are darker now, there’s probably a dark line down the center of your abdomen (the linea nigra), and your areolas are probably a deeper shade as well. (You might as well decide this is sexy.) Dark-skinned women usually notice such hyperpigmentation more, but light-skinned women aren’t off the hook completely — they too will get their fair share of darkening skin, though it may not be as noticeable.

Despite have clear skin most of their lives, many women find another “new experience” awaiting them once they discover a pregnancy. The beginning stages can be small and unnoticeable pimples - usually showing around the jaw line or forehead due to hormonal fluctuations.

Three main factors contribute to acne: increased oil production, clogged pores, and a bacteria called P acnes. First, oil causes the dead skin cells to stick together, leading to a clogged pore, which is called a blackhead or a whitehead. Bacteria then moves into the pore, producing inflammation, which manifests as redness and pus. Addressing acne requires medications or treatments that decrease oil secretion, unclog pores, and kill bacteria.

As the pregnancy progresses, the acne will worsen. It is at this point, many women may frantically search for cures in their local drugstore or try home remedies. Perhaps they feel overwhelmed by the choices or confused by the long list of ingredients and decide to give up finding a solution. In some cases, the acne can grow to included pigmented or “age” spots as well.

All of these changes typically last the duration of the pregnancy and are due to hormonal changes and increased oil production, resulting in acne, while higher estrogen levels will activate skin color cells to make dark spots. This occurrence is so common in pregnancy that it’s been given the name “mask of pregnancy.” Sun exposure will exacerbate the issue further without a good sunscreen or sun protection.

Like many others, when facial skin suddenly becomes oily, the first reaction is to take away all moisture or anything ‘greasy’ that can increase the feel of oil on the skin layer.

Never fear, these again are temporary problems with easy fixes. First, stop using anything oil-based and switch to gel-based or water based sunscreens and moisturizers for the time being. Treat you skin as if it were the acne-prone, pigmented type and finally ask your doctor or dermatologist for a baby-safe acne treatment if the situation is really uncomfortable. Your skin should return to its previous condition soon after your baby is born.

• In the meantime - Eat foods that contain folic acid (you’ll also get plenty in your prenatal supplement), since studies have shown that a folate deficiency can be related to hyperpigmentation. Good choices include green leafy vegetables, oranges, whole-wheat bread, and whole-grain cereal.
• Stay out of the sun as much as possible and wear a sunscreen of at least SPF 15 (sunlight can also intensify hyperpigmentation). A hat and long sleeves are a good idea if you’re fair-skinned, headed to the beach, or have a historically sensitive complexion.

• If you like, use a good concealer to cover particularly pesky spots, but skip bleaches or other chemically based lightening treatments until after you give birth. No peels or lasers, either.

Check this chart for your skin condition

http://familydoctor.org/online/famdocen/home/tools/symptom/545.html

Skin Rashes and Other Changes

See complete list of charts.

The location, appearance and color of a rash will help your doctor make a diagnosis. Look for care suggestions on this chart for common rashes and other skin conditions.

SYMPTOMS		DIAGNOSIS		SELF-CARE
1. Is your face, chest or back covered in small, pus-filled sacs or pimples, blackheads or sore, red bumps?		This may be ACNE, a common skin problem that often begins in adolescence.		See your doctor if over-the-counter acne treatments, such as benzoyl peroxide, don’t help. Gently washing your face with mild soap on a regular basis may be helpful. Sometimes prescription medicines, such as an antibiotic, may be prescribed by your doctor.

Benzoyl Peroxide and Isotretinoin Acne Treatments

Benzoyl peroxide is found in many over-the-counter acne products that are applied to the skin, such as Benoxyl, Neutrogena Acne, PanOxyl, and some formulations of Clean & Clear, Clearasil, and Oxy. Some benzoyl peroxide products are available without a physician’s prescription; others require a prescription. Acne treatments that can dry the skin should be used with caution by people with skin of color.
Tretinoin (Retin-A) is available only with a physician’s prescription. It comes in liquid, cream, and gel forms, which are applied to the skin. Isotretinoin (Accutane), which is taken by mouth in capsule form, is available only with a physician’s prescription. Only physicians experienced in diagnosing and treating severe acne, such as dermatologists, should prescribe isotretinoin.
Recommended Dosages

The recommended dosage depends on the type of antiacne drug. These drugs usually come with written directions for patients and should be used only as directed by the prescribing physician. Teens who have questions about how to use the medicine should check with their physician or pharmacist.

Patients who use isotretinoin usually take the medicine for a few months, then stop for at least two months. Their acne may continue to improve even after they stop taking the medicine. If the condition is still severe after several months of treatment and a two-month break, the physician may prescribe a second course of treatment.
Precautions

Isotretinoin

Isotretinoin can cause serious birth defects, including mental retardation and physical deformities. This medicine should not be used during pregnancy. Females who are able to bear children should not use isotretinoin unless they have very severe acne that has not cleared up with the use of other antiacne drugs. In that case, a woman who uses this drug must have a pregnancy test two weeks before beginning treatment and each month she is taking the drug. Another pregnancy test must be done one month after treatment ends. The woman must use an effective birth control method for one month before treatment begins and must continue using it throughout treatment and for one month after treatment ends.

Females who are able to bear children and who want to use this medicine should discuss this information with their healthcare providers. Before using the medicine, they will be asked to sign a consent form stating that they understand the danger of taking isotretinoin during pregnancy and that they agree to use effective birth control.
People using this drug should not donate blood to a blood bank while taking isotretinoin or for 30 days after treatment with the drug ends. This will help reduce the chance of a pregnant woman receiving blood containing isotretinoin, which could cause birth defects.
Isotretinoin may cause a sudden decrease in night vision. If this happens, users should not drive or do anything else that could be dangerous until vision returns to normal. They should also let the physician know about the problem.

This medicine may also make the eyes, nose, and mouth dry. Ask the physician about using special eye drops to relieve eye dryness. To temporarily relieve the dry mouth, chew sugarless gum, suck on sugarless candy or ice chips, or use saliva substitutes, which come in liquid and tablet forms and are available without a prescription. If the problem continues for more than two weeks, check with a physician or dentist. Mouth dryness that continues over a long time may contribute to tooth decay and other dental problems.
Isotretinoin may increase sensitivity to sunlight. Patients being treated with this medicine should avoid exposure to the sun and should not use tanning beds, tanning booths, or sunlamps until they know how the drug affects them.

In the early stages of treatment with isotretinoin, some people’s acne seems to get worse before it starts getting better. If the condition becomes much worse or if the skin is very irritated, they should check with the physician who prescribed the medicine.

ACNE AND ANTI ACNE DRUGS

Anti-acne drugs are medicines that help clear up pimples, blackheads, whiteheads, and more severe forms of acne.

Benzoyl peroxide is found in many over-the-counter acne products that are applied to the skin, such as Benoxyl, Clear By Design, Neutrogena Acne, PanOxyl, and some formulations of Clean & Clear, Clearasil, and Oxy. Some benzoyl peroxide products are available without a physician’s prescription; others require a prescription. Tretinoin (Retin-A) is available only with a physician’s prescription and comes in liquid, cream, and gel forms, which are applied to the skin. Isotretinoin (Accutane), which is taken by mouth in capsule form, is available only with a physician’s prescription. Only physicians who have experience in diagnosing and treating severe acne, such as dermatologists, should prescribe isotretinoin.

Acne is a skin disorder that leads to an outbreak of lesions called pimples or “zits.” The most common form of the disease in adolescents is called acne vulgaris. Antiacne drugs are the medicines that help clear up the pimples, blackheads, whiteheads, and more severe forms of lesions that occur when a teen has acne.
Different types of antiacne drugs are used for different treatment purposes, depending on the severity of the condition. For example, lotions, soaps, gels, and creams containing substances called benzoyl peroxide or tretinoin may be used to clear up mild to moderately severe acne. Isotretinoin (Accutane) is an oral drug that is prescribed only for very severe, disfiguring acne.

Acne is caused by the overproduction of sebum during puberty when high levels of the male hormone androgen cause excess sebum to form. Sebum is an oily substance that forms in glands just under the surface of the skin called sebaceous glands. Sebum normally flows out hair follicles onto the skin to act as a natural skin moisturizer. The glands are connected to hair follicles that allow the sebum, or oil, to empty onto the skin through a pore.

Sometimes the sebum combines with dead, sticky skin cells and bacteria called Propionibacterium acnes (P. acnes) that normally live on the skin. The mixture of oil and cells allows the bacteria to grow in the follicles. When this happens, a hard plug called a comedo can form. A comedo is an enlarged hair follicle. It can appear on the skin as a blackhead, which is a comedo that reaches the skin’s surface and looks black, or as a whitehead, which is a comedo that is sealed by keratin, the fibrous protein produced by the skin cells and looks like a white bump.

In addition, pimples can form on the skin. Types of pimples include:
• papules, which are small, red bumps that may be tender to touch
• pustules, which are pus-filled lesions that are often red at the base
• nodules, which are large, painful lesions deep in the skin
• cysts, which are painful pus-filled lesions deep in the skin that can cause scarring

Pimples form when the follicle is invaded by the P. acnes bacteria. The damaged follicle weakens and bursts open, releasing sebum, bacteria, skin cells, and white blood cells into surrounding tissues. Scarring happens when new skin cells are created to replace the damaged cells. The most severe type of acne includes both nodules and cysts.

Acne cannot be cured, but antiacne drugs can help clear the skin and reduce the chance of scarring. The goal of treating moderate acne is to decrease inflammation and prevent new comedones from forming. Benzoyl peroxide and tretinoin work by mildly irritating the skin. This encourages skin cells to slough off, which helps open blocked pores. Benzoyl peroxide also kills bacteria, which helps prevent whiteheads and blackheads from turning into pimples. Isotretinoin shrinks the glands that produce sebum. It is used for severe acne lesions and must be carefully monitored because of its side effects. Antibiotics also may be prescribed to kill bacteria and reduce inflammation.

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