Acne vulgaris, or plain pimples, has been plaguing mankind for thousands of years. Although acne is often referred to as “teenage acne,” this is misleading, for it is not a sign of maturation, like growing a beard or breast development. While it is true that more than 80 percent of adolescents develop some form of acne, it is also true that nearly 95 percent of the population will suffer from acne at some point in their adult lives. In fact, contrary to popular belief, acne is a disease that some people do not outgrow. Moreover, some people reach adulthood before suffering from acne. Regardless of the age of onset, acne is usually treated in the same way.
Acne severity ranges from the occasional appearance of a few isolated pimples, or “zits,” to widespread breakouts that may leave scars on face, chest, and back. When persistent or severe, acne can be the source of embarrassment and much needless psychological distress and loss of self-esteem. If improperly treated or left untreated, it can lead to permanent scarring and disfigurement. Even acne scars can—and often do—remain lifelong sources of emotional distress.
The cause(s) of acne is unknown, though genetic (hereditary) and hormonal factors are believed to play significant roles. With the onset of puberty, men and women begin to secrete increased amounts of sex hormones, including male hormones (androgens), which are believed to be important in acne development. Precisely because men secrete greater amounts of male hormones, they tend to have more severe cases of acne than women. This increased hormone production is also believed to be responsible at least in part for the oily skin of which many acne sufferers also complain. And racial factors seem to play a role, too: Whites tend to have more severe acne than blacks.
While stress is not a cause of acne, nervous tension and physical stresses often play important roles in triggering or aggravating it. I always warn my patients that emotional stress, such as boyfriend-girlfriend problems, marital difficulties, illness or death in the family, or physical stresses, such as menstruation (especially during the week before the period), fevers, sore throats, and hive and allergy attacks, may cause acne to flare up or worsen. At the same time, I reassure my patients that their condition will usually improve once the stressful episode has passed.
Acne vulgaris is quite distinctive. It typically consists of four types of blemishes: papules (pimples), pustules (“pus-heads”), closed comedones (whiteheads), and open comedones (blackheads). In more serious cases deep cysts and pock-mark scars can also be seen. The four types of blemishes may not be present at the same time; lesions may occur alone or in combination. Acne vulgaris differs in a number of ways from acne rosacea, which it may resemble at first glance to the untrained eye.
Acne begins within hair follicles, which everyone has on his or her face, chest, and back, Under ordinary circumstances, secretions from the sebaceous glands within the follicles travel up the follicle and are released onto the surface of the skin through the pores. In acne, a small mass of cells called a microcomedo plugs the opening to the pores. A blackhead results when the top of the plug is exposed to the skin surface. (The color of the blackhead is caused by the dark pigment in your skin and oxidation of the exposed plug; it is not caused by dirt.)
A whitehead is formed when the plug rests below the skin surface and does not open onto it. Whitehead formation is a crucial step in acne development. Oils and debris accumulate within the clogged pore. Trapped below the surface, they are then broken down into highly irritating substances by otherwise harmless (noninfectious) bacteria known aspropionobacterium acnes. Finally, like a balloon bursting from overexpansion, the follicle ruptures and spills its irritating contents into the surrounding skin, heightening the inflammation and creating the papules, pustules, and cysts so familiar to the acne sufferer. When the inflammation spreads deep within the skin, cysts are formed. When normal tissue is destroyed, permanent scars result.
Acne can range from mild to severe, and dermatologists use a convenient and more precise way of grading its severity. Grade I (mild acne) consists only of whiteheads and/or blackheads. Grade II (moderate acne) consists of blackheads, whiteheads, and small pimples with minimal inflammation, usually confined to the face; grade III (severe acne) consists of blackheads, whiteheads, and deep, inflamed pimples. Finally, grade IV (very severe acne) is characterized by scarring, deeper cysts, and many pustules on the face, chest, and back.
Unfortunately, there is still no cure for acne. However, many fine treatments are available to control its manifestations. I always tell my acne patients on their first visit that my job is to make them look as though they don’t have a problem until a true acne cure is found, or until they “outgrow” this problem. For many people home treatment with a few OTC medications is all that is necessary. For more severe problems, or those that do not respond to simple therapy, I suggest you consult with a dermatologist as soon as possible.
Let’s begin by exploding a few common myths about acne.
Acne is not a disease of dirt, so overscrubbing your skin with harsh soaps, acne soaps, or abrasive cleansers is unnecessary. In fact, it can make your skin worse. Scrubbing may dry it out so much that it will burn or sting when you apply real acne medications. Gentle cleansing with a mild, soapless soap, such as Lowila cake, is all that is usually needed to remove oil, cosmetics, and dirt buildup.
Foods do not cause acne. Acne is neither caused nor made worse by chocolates, fried foods, colas, nuts, potato chips, candy, ice cream, pizza, or other kinds of junk foods. As a rule, I don’t recommend eating these foods, which are unhealthy for the rest of your body, particularly your heart and blood vessels, but you need not avoid them for the sake of your skin.
However, foods high in iodine—shellfish, kelp, seaweed, iodized salt, and mineral supplements containing iodine—have been linked to acne flare-ups. If you have an acne problem, you should consume these items in moderation or, if possible, eliminate them entirely from your diet.
The sun is not necessarily your best friend in the war against acne. While it is true that sun exposure “dries up” pimples and that a tan helps to mask persistent blemishes, the sun may also precipitate a flare-up of acne. Ultraviolet rays not only thicken the horny layer of the skin and contribute to plugging the pores, but also can damage the openings of the pores, which leads to blockage. It is then an easy step to the development of whiteheads, which usually appear about four to six weeks after sun exposure.
GENERAL TIPS FOR SELF-HELP
- Use mild soaps and don’t overwash or overscrub your skin.
- Avoid abrasive sponges or washcloths.
- Use only oil-free moisturizers, oil-free or gel foundations, and powder or gel blushes.
- Don’t pick, squeeze, or pop your pimples.
- When in doubt, or if your problem is severe, seek professional help.
- Restrict astringents to occasional and sparing use.
It is important to reemphasize here that vigorous scrubbing, the use of harsh soaps (and so-called acne soaps), and the use of washcloths or polyester scrub brushes, in a misguided attempt to wash away or dry up acne, leads to dry, chapped, flaking skin— skin that is too dry and tender to withstand the often slightly drying side effects of most antiacne topicals. The notion of scrubbing away at acne is so ingrained in many people that when their skin does grow dry and chapped from overwashing, they choose to give up using their medications rather than cut back on washing.
Without question, certain cosmetics, particularly heavy, oily makeups, aggravate acne by clogging pores. Dermatologists call this condition acne cosmetica. At one time, many doctors advised patients with acne to avoid using any makeups at all. Nowadays this need no longer be the case. However, when choosing cosmetics, be sure to look for oil-free or water-based formulations and specifically for products advertised as noncomedogenic (i.e., noncomedone forming, nonacne forming). These have been tested by daily application to the skin of a rabbit’s ear for several weeks to determine whether or not they cause acne. Allercreme, Almay, Clinique, Dermage, and Revlon produce noncomedogenic cosmetics for people with oily or acne- prone skin.
Excerpted from Super Skin–A Leading Dermatologist’s Guide to the Latest Breakthroughs in Skin Care, by Nelson Lee Novick, M.D.