What is acne?

By Philip S. Chua, M.D., FACS, FPCS

What is acne?

Acne is a skin disease caused by blocked follicles, which are tiny canals that connect the oil glands of the skin to the pores (small holes), through which sebum (oily liquid, which carries dead skin cells) exits the skin. When the follicles are plugged, sebum is trapped and get infected, causing acne or pimples develop when the plug starts to break down. The areas most commonly affected are the face, back, shoulders, and neck.

What are the types of acne?

There are 6 varieties: Whitehead, which are small and confined under the skin; Blackheads, which are obvious, black in color, and appear on the skin; Papules, usually small pink bumps on the skin; Pustules, red at their base and have pus at the top; Nobules, large, solid pimples, embedded deep in the skin and are painful; and, Cysts, painful, filled with liquid pus, and prone to cause scarring.

What causes pimples?

This is an unsettled medical question. Scientists think a rise in the level of a class of hormone, called androgen, which naturally happens during adolescence, induces the oil glands under the skin to grow and produce more oil. This leads to a greater amount of sebum produced, which break down the cell walls in the skin pores. This ultimately becomes a fertile medium for bacteria to grow, causing infection. Genetic predisposition to acne formation is also suspected to play a role. Medications containing androgen and lithium, and greasy cosmetics, may also cause pimples to form. Because of hormonal changes, pregnant women may also be prone to develop acne. Poor personal hygiene promotes bacterial infection.

Does masturbation cause pimples?

No. This common perception is a myth. Increase in androgen (testosterone) increases the sex urge among adolescents, and also induces pimple formation as explained earlier. Their similar prevalence in this age group is purely coincidental, both being hormonal. While ejaculation or orgasm releases the hormonal ?tension,? it does not lower the hormonal level and it does not minimize, lessen, or make the pimples less severe.

Does application of alcohol help?

While alcohol is a disinfectant, it is also harsh to the skin, besides causing severe dryness, especially of the face. The use of alcohol itself, off the shelf, is discouraged. And so with the use of early morning baby  urine, tea, vinegar, wine, or fruit juices, laundry/kitchen detergents, all a myth, without any scientific basis, ineffective, and may even be harmful.

What can aggravate acne?

The following factors make acne worse: poor hygiene, eating stress and anxiety, squeezing acne, oil-based makeup, menstrual cycle, use of greasy hair products (cocoa or coconut butter), and, hot and humid environment.

What can one do to treat acne?

A healthy low-fat, low-cholesterol diet, greatly helps. Personal hygiene is an important weapon against pimples. Daily shower and frequent hand-washing are essential habits. Since hands and fingers have bacteria most of the time, not touching or scratching the face, and not squeezing the pimples, will minimize infection and scarring. The face should be washed with mild soap at least twice a day. Do not scrub the face or areas with pimples. Hair must be shampooed to remove sebum and skin residue.

Eyeglasses should be cleaned regularly. For make-up, use only nonacnegenic (nonceomedogenic) and do not go to bed with makeup on.

Most of the people with acne have the mild form, which can be initially managed with over-the-counter topical medications for acne applied to the areas involved.

What are these OTC anti-acne drugs?

Majority of these topical medications for acne contain any of the following active ingredients in the forms of cream, gels, pads, lotion, or soaps: Resorcinol, a crystalline phenol that is also used for treating psoriasis, eczema and dandruff. It breaks down whiteheads and blackheads.

Benzoyl peroxide, a white crystalline peroxide used in bleaching flour, fats, or oils, which works as peeling agent, stimulating new skin formation, cleaning the pores, thus cutting down the bacterial count.

Salicylic acid,also used as fungicide, anti-dandruff in shampoos, and in making aspirin, perfumes and dyes, this white crystalline substance stimulates the epidermis to shed skin more easily, preventing pores from getting plugged, and stimulating new cells to grow.

Sulfur with an action not well understood, elemental sulfur is know to oxidize slowly to sulfurous acid which has a mild reducing and antibacterial actions. It helps break down whiteheads and blackheads.

Retin-A -containing an acid form of Vitamin A, called Tretinoin or all-trans retinoic acid (ATRA), this drug ‘combats’ aging of the skin and also acts as a chemical peel. Tretinoin is also used in the treatment of acute promyelocytic leukemia.

‘Azelaic acid,a saturated dicarboxylic acid naturally present in barley, wheat and rye, this acid cleans up free radicals, fortifies cells that line the follicles, stops oil eruptions, slows down bacterial proliferation, and lessens inflammation. This is also good for dark skin patches on the face called melasma.

Some oral contraceptives, which control the overactive oil glands of the skin, have been found to be effective for women with acne.

When is a dermatologist needed?

Use of any of those medications listed may cause skin irritation, redness, and burning. It is best to use the lowest strength. The side-effects usually cease after continued applications. If they persist, or if the trial with OTC drugs does not show improvement after a couple of weeks, or, if the acne is very severe to begin with, consultation with a dermatologist is recommended. The skin specialist may additionally prescribe oral or topical antibiotics, like Erythromycin and Tetracycline, Clindamycin, or Sulfacetamide to reduce the population of Propionibacterium acne, the bug commonly found in blocked follicles of the skin where the pimples are.

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