Acne is a common skin condition producing pimples on the face and upper torso. It’s caused by an interaction between skin oils, bacteria, and hormones. This results in inflammation of hair follicles. This condition occurs mainly on the face, back, shoulders and upper chest. It’s characterized by pimples, pus-filled cysts, and sometimes pus-filled abscesses. An abscess is larger and deeper than a cyst.
The middle of the skin is called the dermis. There are sebaceous glands in the dermis that secrete an oily substance called sebum. The sebaceous glands are attached to hair follicles. Sebum and dead skin cells pass up from the sebaceous gland and the hair follicle through the pores out to the surface of the skin.
When dead skin cells, dried sebum, and bacteria clog the hair follicles and block sebum from leaving through the pores the result is
. If the blockage is incomplete a blackhead develops. This is also called an open comedone. If the blockage is complete a whitehead, or closed comedone, develops.
The blocked sebum-filled hair follicle promotes overgrowth of the bacteria Propionibacterium acnes. This bacteria is normally present in the hair follicles. The skin is irritated by the substances that are produced by the breakdown of sebum by Propionibacterium acnes. The resulting inflammation and infection is the acne pimple and if the infection worsens cysts and abscesses form.
This condition ranges from mild to very severe. The mild form produces only a few noninflamed blackheads or a moderate number of small, mildly irritated pimples. The mild form usually doesn’t leave scars.
Affected areas should be gently washed once or twice a day with mild soap. Goat’s milk soap is a good mild soap. Heavy frequent scrubbing, abrasive or antibacterial soap, or alcohol pads are of no extra benefit. They just serve to irritate the skin more.
The mild form is treated with topical drugs that either kill bacteria, or dry up or unclog pores. Examples include benzoyl peroxide, salicylic acid, resorcinol, or sulfur. If topical antibacterials don’t work other topical drugs can be prescribed by your doctor; the most common being tretinoin. Never use benzoyl peroxide and tretinoin together, because benzoyl peroxide inactivates tretinoin.
The severe form is treated by the use of oral antibiotics. Minocycline is the most effective. The other most common antibiotics are tetracycline, doxycycline, and erythromycin. In the most severe cases oral isotretinoin is the best treatment. It’s the only drug that can potentially cure this condition. Isotretinoin can have very serious side effects. It can harm a developing fetus. In the U.S. there are stringent measures that must be followed when filling a prescription. Patients must be registered and females must use strict contraceptive measures so they don’t become pregnant.
This condition occurs mainly during puberty. This is when the sebaceous glands are stimulated by increased hormone levels resulting in excessive sebum production. It’s the androgen hormones, like testosterone that is the main culprit. When you reach early to mid 20s, the hormone production stabilizes and this condition generally disappears.
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