Beauty & Plastic Surgery Acne

Acne. Zits. Pimples. Blemishes. No matter
what you call them, acne can be distressing and annoyingly persistent.
Acne lesions heal slowly, and when one begins to resolve, others seem to
crop up.

Hormones likely play a role in the development of acne, making the
condition most common in teenagers. But people of all ages can get acne.
Some adult women experience acne due to hormonal changes associated
with pregnancy, their menstrual cycles, or starting or stopping birth
control pills.

Depending on its severity, acne can cause emotional distress and lead to
scarring of the skin. The good news is that effective treatments are
available — and the earlier treatment is started, the lower your risk of
lasting physical and emotional damage.

Symptoms

Acne typically appears on your face, neck, chest, back and shoulders,
which are the areas of your skin with the largest number of functional
oil glands. Acne can take the following forms:

* Comedones (whiteheads and blackheads) are created when the
openings of hair follicles become clogged and blocked with oil
secretions, dead skin cells and sometimes bacteria. When comedones
(kom-uh-DOE-neze) are open at the skin surface, they're called
blackheads because of the dark appearance of the plugs in the hair
follicles. When comedones are closed, they're called whiteheads —
slightly raised, skin-colored bumps.
* Papules are small raised bumps that signal inflammation or infection in the hair follicles. Papules may be red and tender.
* Pustules are red, tender bumps with white pus at their tips.
* Nodules are large, solid, painful lumps beneath the surface of the
skin. They're formed by the buildup of secretions deep within hair
follicles.
* Cysts are painful, pus-filled lumps beneath the surface of the skin. These boil-like infections can cause scars.

When to see a doctor
Acne usually isn't a serious medical condition. But you may want to seek
medical treatment from a dermatologist for persistent pimples or
inflamed cysts to avoid scarring or other damage to your skin. If acne
and the scars it may have left are affecting your social relationships
or self-esteem, you may also want to ask a dermatologist if your acne
can be controlled or if your scars can be diminished.


Causes

Three factors contribute to the formation of acne:

* Overproduction of oil (sebum)
* Irregular shedding of dead skin cells resulting in irritation of the hair follicles of your skin
* Buildup of bacteria

Acne occurs when the hair follicles become plugged with oil and dead
skin cells. Each follicle is connected to sebaceous glands. These glands
secrete an oily substance known as sebum to lubricate your hair and
skin. Sebum normally travels up along the hair shafts and then out
through the opening of the hair follicle onto the surface of your skin.
When your body produces an excess amount of sebum and dead skin cells,
the two can build up in the hair follicle and form together as a soft
plug.

This plug may cause the follicle wall to bulge and produce a whitehead.
Or, the plug may be open to the surface and may darken, causing a
blackhead. Pimples are raised red spots with a white center that develop
when blocked hair follicles become inflamed or infected. Blockages and
inflammation that develop deep inside hair follicles produce lumps
beneath the surface of your skin called cysts. Other pores in your skin,
which are the openings of the sweat glands onto your skin, aren't
normally involved in acne.

It's not known what causes the increased production of sebum that leads
to acne. But a number of factors — including hormones, bacteria, certain
medications and heredity — play a role.

Contrary to what some people think, greasy foods and chocolate have
little effect on acne. Studies are ongoing to determine whether other
dietary factors — including high-starch foods, such as bread, bagels and
chips, which increase blood sugar — may play a role in acne.

Acne isn't caused by dirt. In fact, scrubbing the skin too hard or
cleansing with harsh soaps or chemicals irritates the skin and can make
acne worse. Simple cleansing of the skin to remove excess oil and dead
skin cells is all that's required.


Risk factors

Hormonal changes in your body can provoke or aggravate acne. Such changes are common in:

* Teenagers, both in boys and girls
* Women and girls, two to seven days before their periods
* Pregnant women
* People using certain medications, including cortisone

Other risk factors include:

* Direct skin exposure to greasy or oily substances, or to certain cosmetics applied directly to the skin
* A family history of acne — if your parents had acne, you're likely to develop it too
* Friction or pressure on your skin caused by various items, such as
telephones or cell phones, helmets, tight collars and backpacks


Preparing for your appointment

If you have acne that's not responding to home and over-the-counter
treatments, make an appointment with your doctor. Early, effective
treatment of acne reduces the risk of scarring and of lasting damage to
your self-esteem. After an initial examination, your doctor may refer
you to a specialist in the diagnosis and treatment of skin conditions
(dermatologist).

Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

* Write down your key medical information, such as other conditions
with which you've been diagnosed and any prescription or
over-the-counter medications you're taking, including vitamins and
supplements.
* Write down key personal information, including any major stresses or recent life changes.
* Write down questions to ask your doctor. Creating your list of
questions in advance can help you make the most of your time with your
doctor.

Below are some basic questions to ask your doctor about acne. If any
additional questions occur to you during your visit, don't hesitate to
ask.

* What treatment approach do you recommend for me?
* If the first treatment doesn't work, what will you recommend next?
* What are the possible side effects of the medications you're prescribing?
* How long can I safely use the medications you're prescribing?
* How soon after beginning treatment should my symptoms start to improve?
* When will you see me again to evaluate whether my treatment is working?
* Is it safe to stop my medications if they don't seem to be working?
* Are there any self-care steps I can take to improve my symptoms?
* Do you recommend any changes to my diet?
* Do you recommend any changes to the over-the-counter products I'm
using on my skin, including soaps, lotions and cosmetics?

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to
answer them may reserve time to go over any points you want to talk
about in-depth. Your doctor may ask:

* When did you first develop acne?
* Does anything in particular seem to trigger an acne flare, such as stress or — in girls and women — your menstrual cycle?
* What medications are you currently taking, including
over-the-counter and prescription drugs as well as vitamins and
supplements?
* Are you sexually active, and if so, do you use birth control?
* In girls and women: Do you have regular menstrual periods?
* In girls and women: Are you pregnant, or do you plan to become pregnant soon?
* What types of soaps, lotions, hair products or cosmetics do you use?
* How is acne affecting your self-esteem and your confidence in social situations?
* Do you have a family history of acne?
* What treatments have you tried so far? Have any been effective?


Treatments and drugs

Acne treatments work by reducing oil production, speeding up skin cell
turnover, fighting bacterial infection, reducing the inflammation or
doing all four. With most prescription acne treatments, you may not see
results for four to eight weeks, and your skin may get worse before it
gets better.

Your doctor or dermatologist may recommend a prescription medication you
apply to your skin (topical medication) or take by mouth (oral
medication). Oral prescription medications for acne should not be used
during pregnancy, especially during the first trimester.

Types of acne treatments include:

* Over-the-counter topical treatments. Acne lotions may dry up the
oil, kill bacteria and promote sloughing of dead skin cells.
Over-the-counter (OTC) lotions are generally mild and contain benzoyl
peroxide, sulfur, resorcinol, salicylic acid or lactic acid as their
active ingredient. These products can be helpful for very mild acne. OTC
acne medications may cause initial side effects — such as skin
irritation, dryness and flaking — that often improve after the first
month of therapy.
* Topical treatments available by prescription. If your acne doesn't
respond to OTC treatments, you may want to see a doctor or
dermatologist to get a stronger prescription lotion. Tretinoin (Avita,
Retin-A, Renova), adapalene (Differin) and tazarotene (Tazorac, Avage)
are examples of topical prescription products derived from vitamin A.
They work by promoting cell turnover and preventing plugging of the hair
follicles. A number of topical antibiotics also are available. They
work by killing excess skin bacteria. Often, a combination of such
products is required to achieve optimal results. A number of benzoyl
peroxide and antibiotic combination medications are available, including
different dose combinations of benzoyl peroxide and clindamycin
(Benzaclin, Duac, Acanya) and benzoyl peroxide and erythromycin
(Benzamycin). Prescription topical treatments for acne may cause skin
side effects, such as stinging, burning, redness or peeling. Your doctor
may recommend steps to minimize these side effects, including using a
gradually increased dose, washing off the medication after a short
application or switching to another medication.
* Antibiotics. For moderate to severe acne, you may need a short
course of prescription oral antibiotics to reduce bacteria and fight
inflammation. Since oral antibiotics were first used to treat acne,
antibiotic resistance has increased significantly in people with acne.
For this reason, your doctor likely will recommend tapering off these
medications as soon as your symptoms begin to improve, or as soon as it
becomes clear the drugs aren't helping — usually, within three to four
months. In most cases, you'll use topical medications and oral
antibiotics together. Studies have found that using topical benzoyl
peroxide along with oral antibiotics may reduce the risk of developing
antibiotic resistance. Antibiotics may cause side effects such as an
upset stomach, dizziness or skin discoloration. These drugs also
increase your skin's sun sensitivity and may also reduce the
effectiveness of oral contraceptives.
*

Isotretinoin. For deep cysts, antibiotics may not be enough.
Isotretinoin (Accutane) is a powerful medication available for scarring
cystic acne or acne that doesn't respond to other treatments. This
medicine is reserved for the most severe forms of acne. It's very
effective, but people who take it need close monitoring by a
dermatologist because of the possibility of severe side effects.
Isotretinoin is associated with severe birth defects, so it can't be
safely taken by pregnant women or women who may become pregnant during
the course of treatment or within several weeks of concluding treatment.
In fact, the drug carries such serious potential side effects that
women of reproductive age must participate in a Food and Drug
Administration-approved monitoring program to receive a prescription for
the drug.

Isotretinoin commonly causes side effects such as dry eyes, mouth,
lips, nose and skin, as well as itching, nosebleeds, muscle aches, sun
sensitivity and poor night vision. The drug may also increase the levels
of triglycerides and cholesterol in the blood and may increase liver
enzyme levels.

In addition, isotretinoin may be associated with an increased risk
of depression and suicide. Although this causal relationship has not
been proved, doctors remain on alert for these signs in people who are
taking isotretinoin. If you feel unusually sad or unable to cope while
taking this drug, tell your doctor immediately.
* Oral contraceptives. Oral contraceptives, including a combination
of norgestimate and ethinyl estradiol (Ortho-Cyclen, Ortho Tri-Cyclen),
can improve acne in women. However, oral contraceptives may cause other
side effects — such as headaches, breast tenderness, nausea and
depression — that you'll want to discuss with your doctor. The most
serious potential complication is a slightly increased risk of heart
disease, high blood pressure and blood clots.
* Laser and light therapy. Laser- and light-based therapies reach
the deeper layers of skin without harming the skin's surface. Laser
treatment is thought to damage the oil (sebaceous) glands, causing them
to produce less oil. Light therapy targets the bacteria that cause acne
inflammation. These therapies can also improve skin texture and lessen
the appearance of scars. More research is needed to understand the most
effective use of light and laser therapies in acne treatment, and
experts currently recommend these approaches as stand-alone therapy only
in people who can't tolerate approved acne medications. These therapies
may be uncomfortable and may cause temporary skin problems that mimic a
severe sunburn.
* Cosmetic procedures. Chemical peels and microdermabrasion may be
helpful in controlling acne. These cosmetic procedures — which have
traditionally been used to lessen the appearance of fine lines, sun
damage and minor facial scars — are most effective when used in
combination with other acne treatments. They may cause temporary, severe
redness, scaling and blistering, and long-term discoloration of the
skin.

Acne scar treatment
Doctors may be able to use certain procedures to diminish scars left by
acne. These include fillers, dermabrasion, intense light therapy and
laser resurfacing.

* Soft tissue fillers. Collagen or fat can be injected under the
skin and into scars to fill out or stretch the skin, making the scars
less noticeable. Results from this acne scar treatment are temporary, so
you need to repeat the injections periodically.
* Dermabrasion. Usually reserved for more severe scarring,
dermabrasion involves removing the top layer of skin with a rapidly
rotating wire brush. Surface scars may be completely removed, and deeper
acne scars may appear less noticeable. Dermabrasion may cause
pigmentation changes for people with darker skin.
* Microdermabrasion. This newer acne scar treatment involves a
hand-held device that blows crystals onto skin. These crystals gently
abrade or "polish" the skin's surface. Then, a vacuum tube removes the
crystals and skin cells. Because just the surface cells are removed, the
skin isn't damaged. However, results are subtle and scars may still be
noticeable, even after several sessions.
* Laser, light source and radiofrequency treatments. In laser
resurfacing, a laser beam destroys the outer layer of skin (epidermis)
and heats the underlying skin (dermis). As the wound heals, new skin
forms. Less intense lasers (nonablative lasers), pulsed light sources
and radiofrequency devices don't injure the epidermis. These treatments
heat the dermis and cause new skin formation. After several treatments,
acne scars may appear less noticeable. This means shorter recovery
times, but treatment typically needs to be repeated more often and
results are subtle.
* Skin surgery. A minor procedure (punch excision) cuts out
individual acne scars. Stitches or a skin graft repairs the hole left at
the scar site.


Lifestyle and home remedies

You can avoid or control most acne with good basic skin care and the following self-care techniques:

* Wash problem areas with a gentle cleanser. Products such as facial
scrubs, astringents and masks generally aren't recommended because they
tend to irritate skin, which can worsen acne. Excessive washing and
scrubbing also can irritate skin. If you tend to develop acne around
your hairline, shampoo your hair frequently.
* Try over-the-counter acne lotion to dry excess oil and promote
peeling. Look for products containing benzoyl peroxide or salicylic acid
as the active ingredient.
* Avoid irritants. You may want to avoid oily or greasy cosmetics,
sunscreens, hairstyling products or acne concealers. Use products
labeled "water-based" or "noncomedogenic." For some people, the sun
worsens acne. Additionally, some acne medications can make you more
susceptible to the sun's rays. Check with your doctor to see if your
medication is one of these, and if so, stay out of the sun as much as
possible and anytime you have to be in the sun, use sunscreen that
doesn't clog your pores.
* Watch what touches your face. Keep your hair clean and off your
face. Also avoid resting your hands or objects, such as telephone
receivers, on your face. Tight clothing or hats also can pose a problem,
especially if you'll be sweating. Sweat, dirt and oils can contribute
to acne.
* Don't pick or squeeze blemishes. Picking or squeezing can cause
infection or scarring. If you need aggressive treatment, see your doctor
or dermatologist.

Alternative medicine

Research suggests that over-the-counter (OTC) gels containing 5 percent
tea tree oil may be an effective treatment option for mild to moderate
acne. Tea tree oil may take longer to work than do OTC products with
benzoyl peroxide as the active ingredient, and may cause mild skin
irritation in some people.

Other studies suggest that taking the following supplements may help treat acne:

* Zinc
* Guggul
* Brewer's yeast

More research is needed to understand the potential role of these and other dietary supplements in the treatment of acne.

Always talk with your doctor before trying a natural remedy. Dietary
supplements can cause side effects and may alter the safety and
effectiveness of certain medications.


Prevention

Once your acne improves or clears, you may need to continue your acne
medication or other treatment to prevent new acne breakouts. In some
cases, you might need to use a topical medication on acne-prone areas,
continue taking oral contraceptives or attend ongoing light therapy
sessions to keep your skin clear. Talk to your doctor about how you can
prevent new eruptions.

You can also prevent new acne breakouts with self-care measures, such as
washing your skin with a gentle cleanser and avoiding touching or
picking at the problem areas. Other acne-prevention tips include:

* Wash acne-prone areas only twice a day. Washing removes excess oil
and dead skin cells. But too much washing can irritate the skin. Wash
areas with a gentle cleanser and use oil-free, water-based skin care
products.
* Use an over-the-counter acne cream or gel to help dry excess oil.
Look for products containing benzoyl peroxide or salicylic acid as the
active ingredient.
* Avoid heavy foundation makeup. Choose powder cosmetics over cream products because they're less irritating.
* Remove makeup before going to bed. Going to sleep with cosmetics
on your skin can clog tiny openings of the hair follicles (pores). Also,
be sure to throw out old makeup and clean your cosmetic brushes and
applicators regularly with soapy water.
* Wear loosefitting clothing. Tightfitting clothing traps heat and
moisture and can irritate your skin. Also, whenever possible, avoid
tightfitting straps, backpacks, helmets or sports equipment to prevent
friction against your skin.
* Shower after exercising or doing strenuous work. Oil and sweat on your skin can trap dirt and bacteria.