What is acne?

Acne is a chronic, inflammatory skin disease that results in whiteheads, blackheads, pimples, cysts, and nodules. It is not dangerous, but it can leave skin scars.

Human skin has pores that connect to oil glands under the skin. Follicles connect the glands to the pores. Follicles are small sacs that produce and secrete liquid. The glands produce an oily liquid called sebum. Sebum carries dead skin cells through the follicles to the surface of the skin. A small hair grows through the follicle out of the skin.

Pimples grow when these follicles get blocked, and oil builds up under the skin.

They tend to appear on the face, back, chest, shoulders, and neck.

Skin cells, sebum, and hair can clump together into a plug. This plug gets infected with bacteria, and swelling results. A pimple starts to develop when the plug begins to break down.

Propionibacterium acnes (P. acnes) is the name of the bacteria that live on the skin and contributes to the infection of pimples.

What causes acne?

The cause of pimples is unknown. The process by which a pimple develops is highly intricate. Acne remains one of medical science’s great unsolved mysteries. Why does it come about? Why does it subside in some people and not others? There are certainly many more questions than there are answers.

Acne is a genetic disease. If your parents had acne, chances are you will as well.

A range of factors triggers acne, but the main cause is thought to be a rise in androgen levels. Androgen is a type of hormone, the levels of which rise when adolescence begins. In women, it gets converted into estrogen. Rising androgen levels cause the oil glands under the skin to grow. The enlarged gland produces more sebum. Excessive sebum can break down cellular walls in the pores, causing bacteria to grow.

Emotional and physical stress can also aggravate acne symptomes The mind and the body are connected. This is not Eastern philosophy, it is undisputable physical reality. Emotional stress affects our endocrine (hormone) system, disgestive system, respiratory system, immune system, and various other bodily systems. Over-taxing the body through an overly demanding exercise schedule or lack of sleep may also cause physical stress, which can adversely affect our bodily processes.

Other potential causes of acne: some medications that contain androgen and lithium, greasy cosmetics, hormonal changes, menstruation.

Acne myths:

”Only teens get acne”

So many adults now experience acne that some dermatologists refer to it as an "adult acne epidemic" Exactly why this occurs is unknown but 50% of adult men and 25% of adult women now experience adult acne at some point. The good news is that it is treated the same way in an adult as in a teen.

”Washing or scrubbing your face will help clear up acne”

Facial blemishes are not caused by dirt. Contrary to what you may have seen in commercials, pores do not get blocked from the top down due to "impurities." Rather, the walls of a pore stick together deep within the skin, starting acne formation. Far from preventing acne, frequent washing actually irritates pores, which can cause them to become clogged. A washcloth or any other cleansing device can add even more irritation. The best bet is to wash very gently with bare hands and only wash twice a day.

”The sun will help get rid of acne”

Don’t be afraid of the sun but try not to get burnt. 10-20 minutes per day of sun exposure for people with lighter skin and 20-30 minutes per day for people with darker skin may prove beneficial for acne symptoms, especially body acne. However, overly exposing your skin to the sun creates skin damage, which leaves the skin irritated. This irritation can result in more acne in the weeks following over exposure as the skin heals itself. If you notice a break out "out of the blue," ask yourself if you got sunburnt about two weeks ago. That may be the cause.

”Diet and acne are related”

Available scientific evidence does not yet support a compelling case. The bottom line is we need more research. We do know that people in some hunter/gatherer societies do not experience acne whatsoever across the entire population. This is in stark contrast to the widespread presence of acne throughout all modern society. It leaves us to ponder whether the indigenous people's unprocessed diet contributes to their acne-free skin or whether their clear skin is a result of genetics or some other factor. Discovering a dietary way of preventing acne may be a future reality. However, we may live so differently from our ancestors that it has become close to impossible to replicate our ancestral diet. Almost any diet will appear to work in the short term because as your body loses weight, insulin and other hormones react and acne tends to recede. Then, as body weight levels out or increases, acne symptoms tend to return. Any legitimately effective anti-acne diet should continue working after the initial weight loss period.

”You should never pop a pimple”

Popping a pimple responsibly is okay. If you search online, the vast majority of medical sources specifically warn against popping a pimple. However, this advice is never based on scientific evidence. While it is commonly agreed that attempting to pop pimples which are not yet ready and do not have a white or yellow center can cause the pimple to become more severe and potentially scar more severely, popping a zit which is ready and does in fact have a white or yellow center can actually eliminate the infection and initiate healing. Popping must be performed correctly to achieve the best result. Also, it is vital that popping never be combined with picking of the skin. Countless plastic surgeons who specialize in acne scar correction will tell you that picking the skin causes as much or more scarring than the initial acne lesion itself.

”Touching your face moves bacteria around and causes acne”

Bacteria on the surface of your skin has nothing to do with acne. It is the bacteria deep within your pores (Propionibacterium acnes) that are part of the acne formation process and not the bacteria on the surface of your skin. The reason it is important to leave your skin relatively untouched is because physically irritating the skin can cause breakouts and not because you are moving bacteria around.

”There is no cure for acne”

Accutane (isotretinoin) is curative for most people. Accutane (isotretinoin) provides long-term remission of acne symptoms in approximately 2/3 of people who take an adequate dosage (1mg/kg). Since "cure" is defined as "a complete or permanent solution or remedy," a strong case can be made that isotretinoin provides a cure for many people. However, since isotretinoin comes with such severe side effects, it is essential that anyone considering the drug enter into a careful decision-making process alongside a trusted physician.

How to treat acne?

Only three types of drugs have proven to be effective for the treatment of acne: antibiotics, benzoyl peroxide, and retinoids. Most people require at least one or two agents, depending on the severity of their acne.

Benzoyl peroxide : available as an over-the-counter product (for example Akneroxid gel) and by prescription (for example Duac gel), targets surface bacteria, which often aggravate acne. Irritation (dryness) is a common side effect.

Retinoids (vitamin A derivatives): treat blackheads and whiteheads, the first lesions of acne. The most common side effect is irritation. Most are available by prescription only.

Antibiotics: either topically applied to the skin (clindamycin, erythromycin), or taken orally (tetracycline and its derivatives) control surface bacteria and reduce inflammation in the skin. Antibiotics are more effective when combined with benzoyl peroxide or retinoids.

Treatment must continue until your body outgrows the disease, which the majority of people do for the most degree after adolescence. Aside from isotretinoin, there is no other oral or topical treatment for acne which produces long lasting remission of acne symptoms. However, ongoing treatment can get the skin completely clear and keep it that way for y

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