What is Acne?

Acne Vulgaris is a hair follicle and sebaceaous gland disease where the follicle has become blocked, trapping sebum (oil) and bacteria below the skin's surface. It is characterized by a combination of painful papules in areas where these glands are most concentrated: the face, neck, and upper body. In severe cases, lesions coalesce to form deep cysts and interconnecting sinus tracts in the deeper layers of the skin, causing extensive scarring.

normal follicle acne follicle

Who Has Acne?

80% to 90% of high school students will experience acne. 10% of those will continue to suffer with it into their 20s and 30s. Acne also affects more than 17 million adult Americans. 6% of females and 8% of males in their 50s and older still suffer from acne.

What Causes Acne?

Sebum is a key factor in acne formation. Several factors influence the sebum production and drainage process.

• Hormones. Androgens stimulate sebum production in the sebaceous glands. Stress, fatigue, and hormonal changes contribute to increased androgen production.
• Plugged Pores. Keratinization moves tough keratin proteins toward the skin's surface. When these cells block the normal flow of sebum, blackheads and whiteheads (comedones) occur. Resulting bacterial growth can lead to inflammation and acne.
• Skin Pathogens. The bacteria involved in acne are Proprionobacterium acnes and Propriononbacterium granulosum. Both produce fatty acids that contribute to abnormal keratinization and an inflammatory response.

Other causative factors include genetic factors, environmental influences, some medications and cosmetics, stress, fatigue, and picking at lesions. Years of study have not shown any association between acne and diet. Excessive scrubbing and cleansing will not remove trapped oil and bacteria and can actually further irritate the skin.

Acne Treatments and Possible Side Effects

Common acne treatments, both prescription and over-the-counter, have side effects users should be aware of. These range from serious potential side effects like depression and birth defects to minor side effects like dry skin. Below is a list of the most popular acne treatments and their documented potential side effects.

Treatment Action Side Effects

Accutane (oral) For severe acne, - Severely dry skin, lips, mouth, nose
(Isotretinoin) reduces oil production - Sensitivity to sunlight
- Inflammation of the bowel and gums
- Nausea and diarrhea
- Abnormal menstrual cycles
- Severe birth defects
- Depression

Oral Antibiotics Kills bacteria - Gastrointestinal upset
(Erythromycin, Tetracycline, including diarrhea
Minocycline, Doxycycline) - Increased sun sensitivity
- Yeast infections
- Allergic reactions
- Long-term use can result
in resistance

Oral Contraceptives Reduces sebum by - Mood swings
balancing hormones - Fluid retention
- Increased risk of blood clots,
stroke, heart attack

Topical Antibiotics Kills bacteria - Allergic reactions
(Clindamycin, Tetracycline, - Short-term effectiveness
Erythromycin) - Bacteria becomes resistant

Benzoyl (topical) Kills bacteria - Bleaches skin and clothing
- Skin irritation and dryness
- Redness, stinging,
sensitivity to sunlight

Retinoids (topical) Opens follicles - Skin irritation and dryness
(Retin-A, Avita, Differin, - Dryness of lips, mouth, nose, eyes
Tazorac) - Temporary skin discoloration
- Increased sun sensitivity

Mild Fruit Acids (topical) Opens follicles - Skin irritation, redness, peeling
(Salicylic or Glycolic Acid) - Mild drying can be corrected with
moisturizer