This story was originally published Feb 03, 2016
First of a two-part column
The medical term for acne is “acne vulgaris.” Acne is the most common skin disorder in the United States and the number-one reason patients visit a dermatologist.
Approximately 50 million Americans suffer from acne. Over 80 percent of all teenagers battle acne.
Unfortunately, acne is not a teenage disorder. In fact, acne can occur at any stage of life. Over 35 percent of adult women over the age of 30 report struggling with acne. There are often significant physical and psychological side effects that come from suffering from acne, such as scarring, low self-esteem, anxiety and depression.
Advice from the Internet and from friends and family can often lead legitimate acne information-seekers astray. Here we will discuss and explain the causes, complications, and treatment options of acne from the knowledge base of a board-certified dermatologist and skin specialist.
Causes of acne
There are six key players when it comes to the formation of acne:
- Excess oil (sebum) production
- Clogged pores
- Trigger foods
Many areas of our skin contain glands that produce oil, also known as “sebum.” The face, neck, chest and back are areas that contain a large number of these oil glands. There are many advantages of sebum. These include protection and even mild immune protection.
The oil travels to the surface of the skin via tubes commonly called pores. The inside of pores contain skin cells. These skin cells sometimes become sticky and clump. The clump can plug the pore, producing a small bump.
The medical term for a plugged pore is a “comedone.” If the contents become oxidized and turn dark, the lesion is termed an “open comedone,” commonly called a “blackhead.” Without oxidation or darkening, the lesion is called a “closed comedone” or “whitehead.”
Comedones are the precursors to acne. When oil is produced behind the plugged pore, a nodule develops. This attracts bacteria. Bacteria release substances called “free-fatty-acids,” which cause extreme inflammation. Inflammation produces redness, bumps, and pustules, the clinical manifestation of what we call “acne.”
Oil production and the ability of skin cells lining the inside of pores to stick together and plug the pores are under the influence of hormones. That is why acne occurs in adolescence when hormone levels start to change. It is also why situations that influence hormone levels like stress, medications and menstruation can make acne worse.
The level of sensitivity to hormonal changes is based on genetics and heredity. That is why some people suffer more with acne than others.
Foods are not a significant contributor to acne, except some foods may be personal triggers for some people. These include greasy foods, chocolate, and a diet high in dairy, especially skim milk. If you find that your acne flares up, on a regular basis, after ingestion of these foods or any others, then it would be wise to minimize them in your diet.
Some topical cosmetic products can exacerbate acne and should also be avoided when identified. These include make-ups and hair-care products where the hair comes in contact with the forehead, shoulders and back. Use “non-acnegenic” skin-care products when possible. Also, sports equipment can apply pressure on the skin and clog pores, leading to acne.
Acne treatment options
Now that we have discussed the six key players in the cause of acne, we can use any or all of these as targets to modify in treating acne. Most acne treatments will take four to eight weeks to see a significant improvement.
Contrary to popular TV commercials, there really are no overnight treatments for acne. Most acne treatments require ongoing treatment for continued success. While waiting for an acne treatment to work, it can be tempting to manipulate or squeeze acne lesions to make them go away faster. Dermatologists do not recommend squeezing acne lesions. Manipulating acne lesions can make the situation worse and cause permanent scarring.
The treatment of acne can use topical treatments or systemic treatments. Sometimes a combination of both treatments may be used. These treatments may include over-the-counter products or prescription products from a doctor or dermatologist.
Next week: Specific acne treatment options, skin-care tips, and scar treatments.
Charles E. Crutchfield III, MD is a board-certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.