Guide to Understanding and Treating Acne

People often make facetious remarks about "spotty teenagers", but when you are a sufferer of acne, it is definitely no joke. Many of them are told that it's "normal" and that they'll "grow out of it". This may be true, but in the meantime it can be an unpleasant condition to live with and can impact every area of a sufferer's life, causing an enormous amount of stress, loss of self-esteem and even depression. The good news is that it generally clears up and it is treatable.

What is Acne?

Acne is a condition that occurs on the face, neck, shoulders, back, chest and upper arms that can affect children from the age of 12. It is most common in adolescents and young adults, but a few people will suffer from it throughout life and some people may experience it for the first time as a mature adult. He peak incidence of acne is seen in females aged 14-17 years and males aged 16-19 years.

Acne occurs when the sebaceous glands become overactive and produce excess oil, which acts as a nutrient for a bacteria called P. acnes (Propionibacterium acnes), which lives on the skin. The sebum excess causes the bacteria to multiply and produce free fatty acids, which block the follicular duct and lead to spots that we know as whiteheads and blackheads. Other skin lesions can form as follows:

" Papules: These are inflamed lesions that usually appear as small, pink bumps on the skin, which can be tender to the touch
" Pustules: Pus-filled lesions that may be red at the base
" Nodules: Large, solid and painful lesions that are lodged deep within the skin
" Cysts: Also lodged deep in the skin, these painful, pus-filled lesions can cause scarring

What Causes Acne?

There are many myths surrounding acne. It is not due to lack of hygiene or eating too many fatty foods or chocolate and it cannot be "caught" from someone else. Although the exact cause is not known, the main causes are believed to be:

" Hormones: At puberty, hormones known as androgens increase in both males and females. These hormones trigger the sebaceous glands to begin producing oil. Overactive glands cause an over-production of oil, which leads to acne in some people. Hormonal changes related to pregnancy or the use of birth control pills are also factors
" Hereditary factors: Family history plays a part in whether you are likely to develop acne. If either of your parents were sufferers, then you have a higher risk of developing it yourself
" Certain drugs: Certain drugs are known to cause acne e.g. androgens, corticosteroids and lithium

What Makes Acne Worse?
" Squeezing or picking the spots: This forces oil from the sebaceous glands into the surrounding normal skin, causing redness and swelling
" Vigorous scrubbing of the skin: Acne is not caused by dirty skin and harsh scrubbing can actually make the condition worse
" Cosmetics: Makeup, creams and hair products
" Overuse of harsh cleansing products
" Contact irritants: Objects that come into contact with the skin can cause further irritation e.g. hair and head wear, back packs, shirt and jumper collars
" Certain medications
" Menstruation
" Environmental factors: pollutants, humid weather

Treating Acne

There is no one treatment for acne, since each sufferer will have different requirements and varying degrees of acne severity. However, virtually all cases of acne can be treated effectively, bearing in mind that this will not happen overnight. The possible avenues that can be taken are:

Topical Treatments (External application of creams, lotions and gels)

Topical therapy is often suitable for people with mild to moderate acne and includes the following:
" Benzoyl peroxide: This is the most effective over the counter treatment and comes in varying strengths and is recommended for acne that is non-inflammatory
" Adapalen Gel
" Tretinoin (Retin-A)
" Topical antibiotics: These may be used for pustular acne in combination with other medications

Oral Medicines

Oral antibiotics are effective in treating inflammatory acne. They work by curbing the growth of bacteria and by having an anti-inflammatory effect. They may be recommended where other treatments have failed, where topical treatments are not suitable, or where the acne affects areas that are hard to reach with creams e.g. back or shoulders.
" Accutane: This is an extremely strong chemical, which is taken in pill form. It should only be used for severe cystic acne that has not responded to other, milder treatments. Accutane should never be taken by anyone trying to conceive, or during pregnancy, since it can cause severe or fatal abnormalities in the unborn child

Natural Remedies

Some prefer to take the gentler, non-invasive route and look to alternative remedies to help alleviate the unpleasant symptoms of acne. As with other remedies, these may work for some people and not for others. Some of the recommended remedies include:

" Emu Oil: Emu Oil has been used for thousands of years by the Aborigines of Australia to treat a range of conditions including wounds, burns, acne and eczema. Emu Oil is an effective anti-inflammatory, non-comedogenic (does not clog pores) and hypo-allergenic, suitable for all skin types

" Manuka Oil: The Manuka Tree has long been valued for its healing properties by the Maori people of New Zealand. Manuka Oil has powerful antibacterial, antifungal and anti-inflammatory properties

" Tea Tree Oil: Tea tree oil comes from the leaves of an Australian plant. When crushed and distilled, the leaves produce a 100% natural oil that has antiseptic and antibacterial properties. It is also a fungicide and a mild solvent

Treating Acne Scarring

There are numerous procedures that can be used to correct acne scars, depending on the type and extent of the scarring. Each procedure has its own risks and benefits and several procedures can be combined for maximum effect. Cosmetic surgery is usually very effective, but it is costly and not everyone would wish to opt for such invasive procedures.

There are three types of scarring caused by acne:

" Icepick Scars: These are narrow scars tapering to a point, giving the skin a pitted appearance like the surface of an orange and making the skin appear as though it has been punctured with an icepick

" Boxcar Scars: Boxcar scars are round or oval-shaped depressions that have sharp vertical edges

" Rolling Scars: Rolling scars occur when normal skin is attached to the underlying tissues. This causes an undulated appearance

Possible treatments include:

" Laser Resurfacing: Laser resurfacing works by burning away the top layers of skin. As the skin heals, it is replaced with new, fresher-looking skin. Icepick scars are usually too deep to correct with laser resurfacing, nor will it work on rolling scars, but this treatment is suitable for shallow boxcar scars

" Dermal Fillers: There are numerous types of fillers that can be injected into the scars. This has the effect of raising the surface of the skin and "filling out" the scars. Dermal fillers are not permanent, since the substance injected e.g. collagen will eventually be metabolized by the body, so further treatments will be necessary

Surgical correction of scars includes procedures such as:

" Punch Excision: The scar is removed with a punch tool and the edges sutured together. The new scar that is form eventually fades and will certainly not be as noticeable as the original acne scar. This procedure is most effective on deep scars

" Punch Elevation: The base of the scar is removed using a punch tool (as above), but the walls of the scar are left intact. The base is then lifted to the surface of the skin and secured with sutures, skin glue or steri strips. This is recommended for use on deep boxcar scars with normal bases

" Punch Excision with Skin Graft Replacement: After the scar has been excised with the punch tool, the gap is filled with a skin graft, which is usually taken from behind the ear. Because the color and texture of the skin may differ, skin resurfacing is recommended approximately 4-6 weeks after the grafting procedure

" Subcutaneous Incision or Subcision: This is a technique used to break up the fibrous bands that causes rolling scars

Conclusion

After treating acne with any medication, particularly Tretinoin (Retin-A), it is particularly important to wear a good sunscreen, since the skin's sensitivity is increased.

In addition to the remedies listed above, appropriate concentrations of Alpha-Hydroxy Acids (AHAs) and Beta-Hydroxy Acid (BHA) that are at the appropriate pH level will also help renovation of the skin.
If you are on medication, don't forget to take it every day. However, it does take time for skin to adapt to new medication, so if you find that your skin is becoming dry or irritated, then try using it every other day.
Finally, remember that it can take 3-6 weeks to see a marked improvement and that you may have to try several medications before you find one, or a combination of therapies, that suits you.

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