Acne is a very common disease. People who have it tend to have similar kinds of questions about it and its treatment. This section addresses some of the common questions asked by people with acne. Please remember that your dermatologist is always the best source of specific information about your individual health issues, including acne.
WHAT YOU NEED TO
KNOW ABOUT ACNE IN
Acne is a very common disease. People who have it tend to have similar kinds of
questions about it and its treatment. This section addresses some of the common
questions asked by people with acne. Please remember that your dermatologist is
always the best source of specific information about your individual health issues,
Questions and Answer does follows:
1. What causes acne?
The causes of acne are linked to the changes that take place as young people
mature from childhood to adolescence (puberty). The hormones that cause physical
maturation also cause the sebaceous (oil) glands of the skin to produce more sebum
(oil). The hormones with the greatest effect on sebaceous glands are androgens
(male hormones), which are present in females as well as males, but in higher
amounts in males.
Sebaceous glands are found together with a hair shaft in a unit called a sebaceous
follicle. During puberty, the cells of the skin that line the follicle begin to shed
more rapidly. In people who develop acne, cells shed and stick together more so
than in people who do not develop acne. When cells mix with the increased
amount of sebum being produced, they can plug the opening of the follicle.
Meanwhile, the sebaceous glands continue to produce sebum, and the follicle
swells up with sebum.
In addition, a normal skin bacteria called P. acnes, begins to multiply rapidly in the
clogged hair follicle. In the process, these bacteria produce irritating substances
that can cause inflammation. Sometimes, the wall of the follicle bursts, spreading
inflammation to the surrounding skin. This is the process by which acne lesions,
from blackheads to pimples to nodules, are formed.
2. I wash my face several times a day. Why do I still get acne?
Many people still believe that acne is caused by dirty skin. The truth is, washing
alone will not clear up or prevent acne. Washing does, however, help remove
excess surface oils and dead skin cells. Many people use all kinds of products,
including alcohol-based cleansers, and scrub vigorously, only to irritate the skin
further and worsen their acne. Washing the skin twice a day gently with water and
a mild soap is usually all that is required. However, acne is actually caused by a
variety of biologic factors that are beyond the control of washing. For that reason,
you should use appropriate acne treatments for the acne.
3. Does stress cause acne?
Stress is commonly blamed for the development of acne. Stress can have many
physiologic effects on the body, including changes in hormones that may
theoretically lead to acne. In some cases the stress may actually be caused by the
acne lesions, not the other way around! If the acne is being treated effectively,
stress is not likely to have much impact on the majority of people.
4. I never had acne as a teenager. Why am I now getting acne as an
Usually, acne begins at puberty and is gone by the early 20s. In some cases, acne
may persist into adulthood. Such types of acne include severe forms that affect the
body as well as the face (which afflict males more than females) and acne
associated with the menstrual cycle in women. In other cases, acne may not present
itself until adulthood. Such acne is more likely to affect females than males.
There are several reasons for this. As females get older, the pattern of changes in
hormones may itself change, disposing sebaceous glands to develop acne. Ovarian
cysts and pregnancy may also cause hormonal changes that lead to acne. Some
women get acne when they discontinue birth control pills that have been keeping
acne at bay. Sometimes young women may wear cosmetics that are comedogenic-
that is, they can set up conditions that cause comedones to form.
5. What role does diet play in acne?
Acne is not caused by food. Following a strict diet will not, clear your skin. While
some people feel that their acne is aggravated by certain foods, particularly
chocolate, colas, peanuts, shellfish and some fatty foods, there is no scientific
evidence that suggests food causes or influences acne. Avoid any foods which
seem to worsen your acne and, for your overall health, eat a balanced diet-but diet
shouldn't really matter if the acne is being appropriately treated.
6. Does the sun help acne?
Many patients feel that sunlight improves their acne lesions and go to great lengths
to find sources of ultraviolet light. There is no proven effect of sunlight on acne. In
addition, ultraviolet light in sunlight increases the risk of skin cancer and early
aging of the skin. It is, therefore, not a recommended technique of acne
management, especially since there are many other proven forms of treatment for
acne. Moreover, many acne treatments increase the skin's sensitivity to ultraviolet
light, making the risk of ultraviolet light exposure all the worse.
7. What is the best way to treat acne?
Everyone's acne must be treated individually. If you have not gotten good results
from the acne products you have tried, consider seeing a dermatologist. Your
dermatologist will decide which treatments are best for you. For more information
about the types of acne treatments that are available, and for basic acne treatment
guidelines, please see Acne Treatments in the main part of AcneNet.
8. What kind of cosmetics and cleansers can an acne patient use?
Look for "noncomedogenic" cosmetics and toiletries. These products have been
formulated so that they will not cause acne.
Some acne medications cause irritation or pronounced dryness particularly during
the early weeks of therapy, and some cosmetics and cleansers can actually worsen
this effect. The choice of cosmetics and cleansers should be made with your
dermatologist or pharmacist.
Heavy foundation makeup should be avoided. Most acne patients should select
powder blushes and eye shadow over cream products because they are less
irritating and noncomedogenic. Camouflaging techniques can be used effectively
by applying a green undercover cosmetic over red acne lesions to promote color
9. Is it harmful to squeeze my blemishes?
Yes. In general, acne lesions should not be picked or squeezed by the patient. In
particular, inflammatory acne lesions should never be squeezed. Squeezing forces
infected material deeper into the skin, causing additional inflammation and
Scarring is best prevented by getting rid of the acne. Dermatologists can use
various methods to improve the scarring caused by acne. The treatment must
always be individualized for the specific patient. Chemical peels may be used in
some patients, while dermabrasion or laser abrasion may benefit others. It is
important that the acne be well controlled before any procedure is used to alleviate
The time for improvement depends upon the product being used, but in almost all
cases it is more a matter of weeks or months instead of days. Most dermatologists
would recommend the use of a medication or combination of medications daily for
4 to 8 weeks before they would change the treatment. It is very important for
patients to be aware of this time frame so they do not become discouraged and
discontinue their medications. Conversely, if you see no change whatsoever, you
might want to check with your dermatologist regarding the need to change
3. Would using my medication more frequently than prescribed speed
up the clearing of my acne?
No-always use your medication exactly as your dermatologist instructed. Using
topical medications more often than prescribed may actually induce more irritation
of the skin, redness and follicular plugging, which can delay clearing time. If oral
medications are taken more frequently than prescribed, they won't work any better,
but there is a greater chance of side effects.
4. My topical treatment seems to work on the spots I treat, but I keep
getting new acne blemishes. What should I do?
Topical acne medications are made to be used on all acne-prone areas, not just
individual lesions. Part of the goal is to treat the skin before lesions can form and
to prevent formation, not just to treat existing lesions. Patients are generally
advised to treat all of the areas (forehead, cheeks, chin and nose) that tend to break
out rather than just individual lesions.
5. My face is clear! Can I stop taking my medication now?
If your dermatologist says you can stop, then stop-but follow your dermatologist's
instructions. Many times patients will stop their medication suddenly only to have
their acne flare up several weeks later. If you are using multiple products, it may be
advisable to discontinue one medication at a time and judge results before
discontinuing them all at once. Ask your dermatologist before you stop using any
of your medications.
6. Does it matter what time I use my medication?
Check with your dermatologist or pharmacist. If you were taking one dose a day of
an antibiotic, you could probably take it in the morning, at midday or in the
evening, although you should pick one time of day and stay with it throughout your
treatment. With oral medications prescribed twice a day or three times a day, you
should try your best to spread out the doses evenly. Some antibiotics should be
taken on an empty or nearly empty stomach. For optimal results with topical
treatments, you should strictly follow your dermatologist's recommendations. For
example, if instructed to apply benzoyl peroxide in the morning and a topical
retinoid at bedtime, it is important to follow these directions strictly. If the two
were applied together at bedtime, for example, you could decrease the efficacy of
7. I have trouble remembering to take my oral medication every day.
What's a good way to remember? What should I do if I forget a dose?
This is a common problem. Many patients try to associate taking their medication
with a routine daily event such as brushing teeth or applying makeup. It also helps
to keep the medication close to the area where the reminder activity is carried out.
In most cases, if you miss a day of your oral treatment, do not double up the next
day; rather, get back to your daily regimen as soon as possible-but there may be
different instructions for different oral medications. Ask your dermatologist or
pharmacist about what to do if you miss a dose of your particular medication.
8. I have been using topical benzoyl peroxide and an oral antibiotic for
my acne and have noticed blue-black and brown marks developing on
my face and some discoloration on my body. The marks are especially
noticeable around acne scars and recently healed lesions. Is this a side
effect of medication and is it permanent?
It is not possible to make general statements about side effects of medications that
apply to individual cases. A dermatologist should be consulted. The facial marks
and body discoloration described by the patient in this case do fall within the range
of side effects of some antibiotics.
Unique patterns of pigmentation are sometimes seen in acne patients treated with
certain oral antibiotics-particularly minocycline. The pigmentation patterns that
appear may include:
* Localized blue-black or brown marks in and around acne scars and in areas of
previous acne inflammation
* A "muddy skin" appearance that may cover much of the body
* Diffuse brownish pigmentation of the feet and lower legs.
The pigmentation side effect gradually disappears after the therapy is discontinued.
Any side effect of a medication should be noted by the patient and brought to the
attention of the physician. While most side effects are temporary they should be
discussed with the physician and monitored.
1. My doctor is prescribing a topical retinoid for my acne. He said a
retinoid is a substance related to vitamin A. If the drug is related to
vitamin A, shouldn't vitamin A dietary supplements be helpful in
getting rid of acne?
Dietary vitamin A is essential to good health, especially vision. It has healthful
effects in the skin. Large doses of vitamin A for the treatment of acne is not
recommended on grounds of safety. The retinoids and retinoid-like substances used
as topical treatments for acne are prepared especially for their potent effect on the
shedding of cell lining in the sebaceous follicle. Their use should be monitored by
Dietary vitamin A has multiple health effects in the human body. Vitamin A is
essential for good vision. Extreme vitamin A deficiency can result in blindness,
usually accompanied by dry, scaly skin. Vitamin A overdose that far exceeds the
Recommended Dietary Allowance (RDA) of 5,000 IU can have effects nearly as
catastrophic. Extreme vitamin A overdose can cause the skin to blister and peel-an
effect first seen in early North Pole explorers who nearly died after eating polar
bear liver that has an extraordinarily high vitamin A content.
Topical retinoids are usually prescribed as a treatment for moderate to severe acne.
Side effects are chiefly dermatologic, including redness, scaling and dryness of the
skin, itching and burning. These side effects can usually be managed by adjustment
of the amount and timing of retinoid applied to the skin. Dose adjustment must be
discussed with the dermatologist who prescribed the treatment.
2. Are there any acne treatments specifically for people with dark
skin? Are there any treatments specifically harmful to dark skin?
There are no acne treatments specifically for use on dark skin. Acne treatments are
generally as safe and effective on dark skin as on light skin. Some treatments for
acne scars may cause temporary lightening of dark skin.
Acne is a common skin disease that has the same causes and follows the same
course in all colors of skin.
Very dark or black skin may be less well-moisturized than lighter skin. Topical
anti-acne agents such as benzoyl peroxide that have a drying effect on the skin
should be used under the supervision of a dermatologist. Benzoyl peroxide also is a
strong bleach and therefore must be applied carefully to avoid inadvertent
decolorization of a patch of hair, towels or clothing.
Darker skin has a tendency to develop post-inflammatory hyperpigmentation
(excessive skin darkening at places where the skin was inflamed). Severe
inflammatory acne may result in dark spots. The spots resolve over time; a
dermatologist may be able to recommend cosmetic measures to make the spots less
apparent until they resolve. Some acne treatments, such as topical retinoids and
azelaic acid, may also help fade the discoloration.
Removal of acne scars by dermabrasion or chemical peeling may cause temporary
lightening or darkening of dark skin in the areas of treatment. Scar treatment
should be discussed with a dermatologist or dermatologic surgeon before it is
Alterations of melanin (dark pigments that give the skin its color) pigmentation
such as vitiligo and melasma are not related to acne, but they may be present
simultaneously with acne. The diagnosis and treatment of melanin pigmentation
disorders such as vitiligo requires a dermatologist with knowledge and experience
in treating these conditions.
3. Is acne that appears for the first time in adulthood different from
acne that appears in adolescence?
Acne has a specific definition as a disease of sebaceous follicles. This definition
applies to acne that occurs at any age. However, it may be important to look for an
underlying cause of acne that occurs for the first time in adulthood.
Current understanding of the causes of acne vulgaris is described in the Main Text
section Why and how acne happens. In brief summary, acne vulgaris develops
when excessive sebum production and abnormal growth and death of cells in the
sebaceous follicle result in plugging of follicles with a mixture of sebum and
cellular debris and formation of comedones (blackheads and whiteheads). Bacteria
in the follicles-chiefly Propionibacterium acnes, the most common bacterial
colonist of sebaceous follicles-may contribute to the inflammation of acne by
release of metabolic products that cause inflammatory reaction. The pathogenic
events, which cause disease, in the sebaceous follicle are believed to be due in
large degree to changes in levels of androgenic (male) hormones in the body-a
circumstance usually associated with growth and development between ages 12
4. Some acne investigators believe that although this understanding is generally
correct, there is more yet to be learned about the causes of acne vulgaris.
Acne that appears after the age of 25-30 years is (1) a recurrence of acne that
cleared up after adolescence, (2) a flare-up of acne after a period of relative quiet-
for example, during pregnancy, or (3) acne that occurs for the first time in a person
who had never previously had acne.
Acne that occurs in adulthood may be difficult to treat if there are multiple
recurrences. Some patients with severe recurrent acne have undergone repeated
courses of treatment with the potent systemic drug isotretinoin.
Acne flares in association with pregnancy or menstruation are due to changes in
Acne that appears for the first time in adulthood should be investigated for any
underlying cause. Drugs that can induce acne include anabolic steroids (sometimes
used illegally by athletes to "bulk up"), some anti-epileptic drugs, the anti-
tuberculosis drugs isoniazid and rifampin, lithium, and iodine-containing drugs.
Chlorinated industrial chemicals may induce the occupational skin disorder known
as chloracne. Chronic physical pressure on the skin-for example, by a backpack
and its straps, or a violin tucked against the angle of the jaw and chin-may induce
so-called acne mechanica. Some metabolic conditions may cause changes in
hormonal balance that can induce acne.
Some lesions that appear to be acne may be another skin disorder such as
folliculitis-infection and inflammation of hair follicles-that require different
treatment than acne. Acne that appears for the first time in adulthood should be
examined and treated by a dermatologist.
5. My 15-year-old daughter has what I would describe as a very mild case of acne.
She has made it much worse by constant picking and squeezing. She looks in the
mirror for hours, looking for some blackhead or blemish she can pick or squeeze.
Does she need psychological counseling?
Excessive picking and squeezing of otherwise mild acne is a condition called
excoriated acne, seen most often in young women. A dermatologist may provide
The typical person with excoriated acne is a person-often a young women-who is
so distressed with her appearance due to acne that she literally tries to "squeeze the
acne out of existence." The acne is often very mild, but the person's face may
constantly be covered with red marks from squeezing, and open sores where
lesions have been picked open.
The word excoriate means to scratch or abrade the skin. Excoriated acne is a
medically recognized condition that should be discussed with a dermatologist.
Occasionally giving in to a temptation to squeeze a blackhead is not defined as
excoriated acne. Hours in front of a mirror, squeezing and picking every blemish,
is a definition of excoriated acne. A dermatologist may be able to counsel the
patient regarding a course of treatment in which the patient can participate, but
keep "hands off."
6. Can the rate of secretion or the composition of sebum be altered by diet? If it
can, shouldn't alteration of diet be considered a treatment for acne?
Diet has never been proven to have a role in the cause or treatment of acne. Dietary
manipulation may have a role in the treatment of some scaling diseases of the skin,
but not in the treatment of acne.
Dietary cause is one of the most persistent myths about acne. Foods, such as
chocolate or greasy foods, do not cause acne, but certain foods seem to make some
people's acne worse. The following can bring on or worsen it:
*An increase in male hormones found in both males and females
No food has been shown to be effective in preventing or treating acne. A healthy
diet is, of course, necessary for good general health.
7. Shouldn't I just try to eliminate sebum from my body?
No. When it isn't blocked in your pores, sebum helps keep your skin healthy.
8. Why does acne usually start at puberty?
No one knows for certain. What is known is that the sebaceous glands that produce
sebum get much larger at puberty than they were before.
9. Why does the skin around a pimple turn red?
This redness is caused by the body's inflammatory response. Inflammation is a sign
that your immune system is working to fight an infection. However, the
inflammatory response doesn't always work perfectly, and can even be the cause of
10. If my skin turns red, does that mean that I'm going to have scars?
Usually, no. Even when there will be no permanent scar, the aftereffects of the
inflammatory response can leave the skin red for months, sometimes for more than
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