What is acne and who gets it? What causes acne?

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1 Acne is cmmn and is usually treatable. Yu may need treatment fr several mnths t clear spts. Inflamed acne needs t be treated early t prevent scarring. Once the spts are gne, yu may need maintenance treatment fr several years t keep the spts away. What is acne and wh gets it? Acne is the cmmn cause f 'spts'. Mst peple with acne are aged between 12 and 25, but sme lder and yunger peple are affected. Acne usually affects the face but may als affect the back, neck, and chest. The severity can range frm mild t severe. Abut 9 in 10 teenagers develp sme degree f acne. Often it is mild. Hwever, it is estimated that abut 3 in 10 teenagers have acne bad enugh t need treatment t prevent scarring. Untreated acne usually lasts abut 4-5 years befre settling. Hwever, it can last fr many years in sme cases. What causes acne? Understanding nrmal skin Small sebaceus glands lie just under the skin surface. These glands make the 'il' (sebum) that keeps the skin supple and smth. Tiny pres (hles) n the skin allw the sebum t cme nt the skin surface. Hairs als grw thrugh these pres. During the teenage years, yu make much mre sebum than when yu were a child. This is due t the hrmne changes f puberty which stimulate the sebaceus glands. As a rule, the mre sebum that yu make, the mre greasy yur skin feels, and the wrse acne is likely t be. Sme peple make mre sebum than thers. Mild t mderate acne - blackheads, whiteheads, and small pimples Sme pres becme blcked ('plugged'). This is due t the skin at the tp f the pres becming thicker, cmbined with dead skin cells that are shed int the pres. Yu can see the 'plugs' that blck the tp f the pres as tiny spts knwn as cmednes (blackheads and whiteheads).

2 Nte: the black f the blackheads is due t skin pigment, and is nt dirt as sme peple think. In many cases, acne des nt prgress beynd this mild stage. Sme sebum may cllect under blcked pres. Yu can see this as small spts called pimples r papules. In sme cases, acne des nt prgress beynd this mild-t-mderate stage when yu can see a number f small pimples, blackheads, and whiteheads. Mderate t severe acne - larger spts and inflammatin Trapped sebum is ideal fr a bacterium (germ) called P.acnes t live and multiply. Small numbers f this bacterium nrmally live n the skin, and d n harm. Hwever, if a large number develp in the trapped sebum, the immune system may react and cause inflammatin. If inflammatin develps, it causes the surrunding skin t becme red, and the spts becme larger and filled with pus (pustules). In sme cases the pustules becme even larger and frm int small 'ndules' and cysts. Each inflamed spt will heal eventually. In sme cases the area f skin that was inflamed remains disclured fr several mnths after the inflammatin has gne (pst-inflammatry hyperpigmentatin). This is ften mre nticeable in darker skinned peple. Als, a small pitted scar is cmmnly left n the skin where there was an inflamed spt. These small scars ften d nt fade fully and are a marker in lder peple that they nce had inflamed acne spts. Rare causes f acne The descriptin abve is the cause f almst all cases f acne. Rarely, certain diseases in girls and wmen may cause acne, r make acne wrse. Fr example, plycystic vary syndrme, and cnditins that cause excess male hrmne t be made in the vary r adrenal gland. These cnditins cause ther symptms in additin t acne such as thinning f scalp hair, excess grwth f facial r bdy hair (hirsutes), and ther prblems. Anther rare cause f acne is expsure t halgenated hydrcarbns (chemicals that ccur in sme wrk places). What makes acne wrse? The prgestgen-nly cntraceptive pill may make acne wrse. In wmen, the hrmne changes arund the mnthly perid may cause a flare-up f spts. Thick r greasy make-up may, pssibly, make acne wrse. Hwever, mst make-up des nt affect acne. Yu can use make-up t cver sme mild spts. Nn-cmedgenic r il-free prducts are mst helpful fr acne prne skin types. Picking and squeezing the spts may cause further inflammatin and scarring. Sweating heavily r humid cnditins may make acne wrse. Fr example, ding regular ht wrk in kitchens. The extra sweat pssibly cntributes t blcking pres. Spts may develp under tight clthes. Fr example, under headbands, tight bra straps, tight cllars, etc. This may be due t increased sweating and frictin under tight clthing. Sme drugs can make acne wrse. Fr example, phenytin which sme peple take fr epilepsy, and sterid creams and intments that are used fr eczema. D nt stp a prescribed drug if yu suspect it is making yur acne wrse, but tell yur dctr. An alternative may be an ptin. Anablic sterids (which sme bdy-builders take illegally) can make acne wrse.

3 Sme myths and wrngly held beliefs abut acne Acne is nt caused by pr hygiene. In fact, excessive washing may aggravate acne and make it wrse. Diet has little r n effect n acne. Fr example, there is n evidence that chclate, sweets, r fatty fds cause acne r make acne wrse. Stress des nt cause acne. Acne is nt just a simple skin infectin. The cause is a cmplex interactin f changing hrmnes, sebum, vergrwth f a nrmally harmless bacteria, inflammatin, etc, (described abve). Yu cannt 'catch' acne - it is nt cntagius. Acne cannt be cured by drinking lts f water. There is n evidence t say that sunbathing r sunbeds will help t clear acne. Sme peple believe that acne cannt be helped by medical treatment. This is nt true. Treatments usually wrk well if used crrectly. Skin care fr peple with acne D nt wash mre than nrmal. Twice a day is nrmal fr mst peple. Use a mild sap and lukewarm water. (Very ht r cld water may wrsen acne.) D nt scrub hard when washing acne-affected skin. D nt use abrasive saps, cleansing granules, astringents, r exfliating agents. Use a sft wash-clth and fingers instead. Excess washing and scrubbing may cause mre inflammatin, and pssibly make acne wrse. Antiseptic washes are heavily advertised, but are unlikely t make any difference. Yu cannt clean ff blackheads. The black tip f a blackhead is actually melanin (skin pigment) and cannt be remved by cleaning r scrubbing. Sme tpical acne treatments (described belw) may dry the skin. If this ccurs, use a fragrance-free, water-based misturiser cream. D nt use intments r il-rich creams as these may clg pres. What are the treatment aims and ptins fr acne? The aim f treatment is t clear spts as much as pssible, and t prevent scarring. There are different types f treatment that wrk in different ways. A dctr r pharmacist will advise, and the treatment they advise will ften depend n the severity and type f yur acne. Treatments can be 'tpical' (treatment that yu apply t the skin), and/r tablets. Yu may prefer nt t treat mild acne which is nt inflamed. That is, if yu just have blackheads, whiteheads and mild pimples. Mild acne is cmmn, and usually ges in time withut scarring. Hwever, inflamed acne can scar. If yu develp inflammatin (redness, red spts, pustules, etc) then it is best t treat early t prevent scarring. Treatment will usually clear mst spts if yu use it prperly. Hwever, n treatment will clear yur skin perfectly. Tpical preparatins fr acne Varius gels, ltins, and creams are used t treat acne. Different preparatins wrk in different ways. The fllwing briefly describes the different types. Hwever, always read the leaflet in the packet, because such things as 'hw t apply it', and 'precautins' vary between different preparatins. One general pint is that yu shuld apply tpical treatments t all the affected area f skin, and nt just t each spt.

4 Benzyl perxide This is a cmmn tpical treatment. It has three actins - it kills bacteria, reduces inflammatin, and helps t unplug blcked pres. Therefre it ften wrks well t clear inflamed spts and helps t clear blackheads and whiteheads. Yu can buy benzyl perxide at pharmacies withut a prescriptin. It cmes in different brand names and strengths - there is a 2.5%, 4%, 5%, and 10% strength. Benzyl perxide: Wrks best if yu wash the skin minutes befre using. May bleach hair, bed-linen, r clthes that cme int cntact with it. Cmmnly causes mild skin irritatin. If yur skin des becme irritated then stp using it until the irritatin ges. Then try again with a lwer strength, r reduce the time it is left n yur skin befre washing ff. T prevent skin irritatin, the fllwing may help. Use the lwest strength at first. In many cases the 2.5% preparatin wrks just as well as the 10% preparatin, but causes the least irritatin. If yu wish t increase the strength, d it gradually. Use a water based preparatin (rather than an alchl based ne). Apply nce daily at first, and wash ff after several hurs. Gradually increase the length f time left n the skin. Aim t put n twice-daily when yu get used t it. Retinids These are gd at unplugging blcked pres. They include adapalene, tretinin, and istretinin which cme in varius brand names. They als have sme effect n reducing inflammatin. Therefre, ne is ften used early n in acne t help t unblck pres and t treat blackheads r whiteheads (cmednes) and mildly inflamed spts. Yu need a prescriptin fr all retinid preparatins. When yu use a tpical retinid: Yu may develp sme skin redness and skin peeling. This tends t settle ver time. The spts smetimes get a little wrse befre imprving. Yur skin may be mre sensitive t sunlight. Therefre, it is best t apply at night and wash ff in the mrning. A sun prtectin cream may als help if yu are ut in the sun. The mst cmmn side-effects are burning, irritatin, and dryness. Therefre, yu may be advised at first t use a lw strength, less frequent applicatins, and fr a shrter duratin. Yu shuld nt be pregnant, r intend t becme pregnant, as there is a slight risk f harm t unbrn babies. Discuss cntraceptin with yur dctr if necessary. Tpical antibitics There are varius tpical antibitic preparatins. They reduce the number f bacteria and reduce inflammatin. Hwever, they have little effect n unplugging blcked pres. S, they are usually gd at treating inflamed acne, but blackheads and whiteheads may remain. Yu need a prescriptin t get a tpical antibitic. They may cause mild irritatin, but generally cause less side-effects than the ther tpical preparatins. Azelaic acid This is an alternative that mainly wrks by unplugging blcked pres. S, like retinids, it is gd at clearing blackheads and whiteheads. It has sme effect n reducing inflamed acne t, but prbably nt as much as antibitics r benzyl perxide. Hwever, it may cause less skin irritatin than benzyl perxide.

5 Cmbinatins Sme preparatins cntain a mixture f ingredients. Fr example, benzyl perxide plus an antibitic, r a retinid plus an antibitic. These may wrk better than either ingredient alne. Tablets that can treat acne Antibitic tablets Antibitics wrk by killing bacteria that cntribute t the cause f acne. They als have a direct effect f reducing inflammatin. Antibitics usually wrk well t clear inflamed acne spts, and any surrunding skin inflammatin. Hwever, they have little effect n unplugging blcked pres (which yu can see as blackheads and whiteheads). S, if yu nly have mild acne with just blackheads and whiteheads, yu are better ff using a tpical treatment that unblcks pres. If yu have a lt f blackheads and whiteheads as well as inflamed acne spts, yu may be advised t use a tpical treatment such as benzyl perxide in additin t taking an antibitic tablet. Always read the leaflet that is in the packet f antibitics. Things such as precautins and pssible side-effects vary between different antibitics. The fllwing are sme general pints. Tetracycline based antibitics are the mst cmmnly used antibitics t treat acne. These include: xytetracycline, tetracycline, dxycycline, lymecycline and mincycline. Children under 12 years shuld nt take tetracycline based antibitics. D nt take tetracycline based antibitics if yu are pregnant, breastfeeding, r intend t becme pregnant. Discuss cntraceptin with yur dctr if necessary. Fd and milk affects the absrptin f xytetracycline r tetracycline. Therefre, take these tablets n an 'empty stmach', between meals, with a glass f water, (nt milk). Dxycycline, lymecycline and mincycline can be taken with fd. Wmen taking 'the pill' shuld use additinal cntraceptive precautins (such as cndms) during the first three weeks f taking antibitics. Other antibitics that are smetimes used include erythrmycin and trimethprim. Yu may be advised t take ne f these if ne f the abve has nt wrked well, r is unsuitable. The pill (a hrmne treatment) The cmbined ral cntraceptive pill ('the pill') may help sme wmen if their acne seems t be partly related t their hrmne changes. Fr example, acne that began r became wrse in adulthd, r if acne seems t flare up arund the time f a perid. It is the estrgen part f the pill that is thught t help. A variant f the cmbined pill called c-cyprindil (trade name f Dianette) may be especially useful where a sensitivity t andrgen hrmne is thught t be making acne wrse. Fr example, fr wmen with excess facial hair grwth in additin t acne. C-cyprindil cntains a cmbinatin f an estrgen plus cyprterne (an anti-andrgen). Istretinin tablets Istretinin greatly reduces the amunt f sebum that yu make by the sebaceus glands. It wrks very well, and usually clears spts even in severe cases. Hwever, it is nrmally used nly n the advice f a specialist after ther treatments have been tried first. This is because there is a risk f serius side-effects with istretinin tablets.

6 Hw lng is treatment needed? Whatever treatment is used, it is nrmal t take up t fur weeks fr there t be any nticeable imprvement in the skin. There is ften a gd respnse t treatment by six weeks. Hwever, it can take up t fur mnths (smetimes lnger) fr maximum respnse t a treatment, and fr the skin t be generally free f spts. The mst cmmn reasn fr a treatment failure is because sme peple think that treatment is nt wrking after a cuple f weeks r s, and give up. Therefre, persevere with any treatment fr at least six weeks befre deciding if it is wrking r nt. If there is n imprvement after six weeks f taking a treatment regularly and crrectly, d nt despair. Adding in anther treatment, r a change t a different r mre pwerful treatment will usually be advised, and is likely t wrk. Althugh treatment can usually clear mst spts, n treatment will make yur skin perfect, and the dd spt may remain. Will acne return after treatment? Once the spts have cleared, acne cmmnly flares up again if yu stp treatment. Therefre, after the spts have gne r are much reduced, it is cmmn t carry n with a 'maintenance' treatment t prevent acne frm flaring up again. It is cmmn t need maintenance treatment fr 4-5 years t keep acne away. This is typically until the late teens r early 20s. In a small number f cases, acne persists int the 30's, r even later. Fr these peple it is pssible t cntinue t treat the skin t keep it under cntrl. Maintenance treatment is usually with either benzyl perxide r a tpical retinid. These can bth be used indefinitely. The dse used t prevent spts frm returning is ften lwer than that used t treat acne. Fr example, ne applicatin t the skin every ther day with a lw strength preparatin may be sufficient t keep spts frm returning. It is nt usual t use tpical antibitics r antibitic tablets as maintenance treatment nce the spts have cleared. This is because lng-term use f antibitics can lead t resistance f germs t the antibitics. Als, azelaic acid, anther tpical treatment, is nly licensed fr treatment perids f six mnths. Als, it is best nt t take 'the pill' lng term slely t prevent acne. Therefre, if at first yu are treated with an antibitic, azelaic acid r 'the pill', yu may be advised t switch t benzyl perxide r a tpical retinid fr maintenance treatment. Further help and advice The Acne Supprt Grup PO Bx 9, Newquay, Crnwall, TR9 6WG Tel: Web: & EMIS and PIP 2006 Updated: June 2006 PRODIGY Validated