How to Get Acne Under
Control
(Scroll to the bottom of the page for
info on the best products for acne).
What causes acne?
Acne is a result of an imbalance of two or more
factors in skin physiology relating to the sebaceous
gland and duct system. When our body physiology
is working properly, small amounts of oil (called
sebum) are produced in the sebaceous glands
in the dermis or deeper part of the skin. These
sebaceous glands share a duct or tubule that
goes to the skin with a small hair. When either
too much oil is produced or blockage of the
tubule preventing the escape of oil occurs,
the net result is acne. The most common cause
of acne is an increased production of sebaceous
material due to hormone imbalance or side effects
of stress that cause an overproduction of sebaceous
material.
With the occurrence of acne, there
is usually also a related phenomenon called
retention keratosis. These two big words actually
refer to the lining cells of the sebaceous duct
not shedding properly and staying in place for
a longer period of time. This builds up like
rust in a pipe until the duct is closed or blocked.
When this happens, it sets events occurring
that proceed to inflammation or an irritation
underneath the surface of the skin. If one imagines
that the sebaceous duct were a small stream
that got plugged up, it causes a backup of everything
upstream from the direction of flow.
Another factor is the presence of several different
types of skin bacteria that normally don’t cause
problems. However, when trapped beneath the
skin, the bacteria begin to react chemically
with the sebaceous material causing it to break
down into free fatty acids. Free fatty acids
are quite irritating to the deeper structure
of the skin and result in inflammation.
The first signs are redness, firmness, swelling,
tenderness, and heat. On about the second or
third day of inflammation, white blood cells
increase in the area attempting to digest the
bacteria and rid the body of them. This results
in the formation of pustules and even more irritation
extending sideways beneath the surface of the
skin.
Does chocolate cause acne?
Eating chocolate, or for that matter any other
foods, does not cause acne. The only way chocolate
could cause acne would be perhaps to rub chocolate
on the skin until it clogs the pores causing
a mechanical blockage of the pore openings.
Some studies in the past indicated perhaps that
excess amounts of some iodine-containing foods,
such as shellfish, can influence the severity
of acne. This has been questioned by a number
of other recent studies, however. My recommendation
is to eat, drink and be merry in moderation
of all foods.
Does stress cause acne?
Stress does not cause acne per se. Stress does
stimulate our body enzyme and immune systems
to cause a stimulation of the oil glands. It
has been proven that lowering stress levels
certainly can help to decrease oil production,
and thus decrease the symptoms of acne.
Do fried foods cause acne?
Fried foods in excess certainly can cause us
to gain weight. However, fried foods have not
been shown to be related to causing acne. In
fact, there aren’t any specific foods that cause
acne.
Of course, skin health is directly related
to a well balanced diet, adequate rest and general
personal cleanliness. Many people have told
me that a good order of tasty french fries properly
cooked seemed to lower their stress level.
What part do hormones play in acne?
Hormones play an indirect but active part in
acne. The part they play is related to side
effects of the hormones, rather than a direct
effect. It’s interesting that the male hormones
(androgens) have a greater effect on skin oil
production (acne) than female hormones. This
said, it’s important to say that male hormones
and female hormones of the ovarian type are
very similar in their structural configuration.
One of the side effects of female hormones related
closely to the ovarian monthly cycle in women
is the stimulation of oil gland activity.
It’s impossible to change your hormones. However,
women do have access to some medications that
can actually balance the hormone events in the
monthly cycle. One very good product that has
been developed as a birth control pill was actually
developed to decrease the androgenic side effects
of the monthly cycle in women in order to control
acne. This product is Orthotricyclen.
Some of the benefits from using OrthoTrycyclen
include minimizing cramping and discomfort related
to the premenstrual cycle, as well as causing
more even transition in the phases of the monthly
cycle. Tricyclen minimizes the oil-producing
side effects from the female hormone shift.
Why is my acne worse before my period?
Very definite physiological and emotional changes
are associated with the changing in levels of
progesterone and estrogen which are the two
ovarian hormones related to menstrual cycles.
With the bouncing and changing concentrations
of these two hormones, the side effects also
bounce and change much like static in a car
radio that’s bouncing on a gravel road.
Actually, it is the androgenic side effects
of these hormones that create oil gland activity
in the skin and thus relate to monthly breakouts.
In women that have irregular periods, both in
time and flow, and those who may have premenstrual
cramps and pain, there is a medication which
is useful. It’s useful in controlling those
symptoms, as well as often has a remarkable
effect on calming breakouts even to the point
of elimination.
That medication is actually a birth control
pill designed to give a regular and gradual
transition of hormone concentrations of estrogen
and progesterone. It does this in a manner that
has far fewer androgenic (male hormone) side
effects than found in natural ovarian hormones
or previously available birth control pills.
Ortho Tricyclen is taken as a birth control
pill, but actually was designed for the control
of acne. Ortho Tricyclen is a prescription drug
but may be obtained through your Gynecologist,
Family Physician, or Dermatologist.
Who gets acne?
From a medical standpoint, one who gets acne
has a combination of factors working in concert.
Two or more factors can cause a condition based
on the anatomy and physiology of the skin itself
to promote an inflammatory response that we
call acne.
The factors include:
-
Increased oil – either production by the
sebaceous glands or added (in makeup etc.)
-
Retention Keratosis - skin cells that
are not shed properly and plug sebaceous
ducts
-
Trapped bacteria under the skin’s surface
– normally present and harmless as they
are on the surface.
-
By and large, genetics can play a part
in acne in that our genetic blueprint does
influence thickness of skin, oily tendencies
of the skin and basic hormone responses.
However, just because one’s parent or another
family member has acne, does not necessarily
mean that you or I will have acne.
It most often occurs in the teenage years,
but may appear a few days after birth. This
is more often related to increased activity
in the hormone processes within the skin. Older
persons can develop adult acne, sometimes from
different causes. Still basic factors of plugging
an oil gland result in the development of an
inflammatory process.
Will acne cause scarring?
Any chronic wound or delayed healing process in
the skin will cause scarring, whether it be from
a surgical wound with complications, an embedded
splinter that takes days, weeks or months to work
its way out, or an acne pustule that cannot heal.
If I have acne now, can
I minimize permanent scarring?
Although you may may already have some permanent
scarring present from the past, you should be
able to minimize any new scarring. The key things
to remember are:
-
As soon as a new breakout lesion begins,
start to control its progression by administering
acne medication.
-
Don’t pick or squeeze.
-
Use the Reversion
Acne Control System twice daily.
-
Remember that fluid filled or pustule
lesions cannot heal until the fluid is
gone. This may require an antibiotic,
a chemical peel, or even mechanical extraction
by a skin care professional.
-
Get plenty of rest and drink 8 glasses
of water each day.
-
Before going to bed, apply a small drop
of Reversion
Antimicrobial wash to each lesion and
LEAVE IN PLACE ALL NIGHT.
-
Start taking an oral antibiotic early
if pustular lesions develop and persist
for more than 2-3 days.
I'm 30 -- why acne now?
It is becoming more and more common for young
women who had no problem during teen years to
develop acne between age 30-35. There are probably
many reasons. One significant reason is related
to the use of birth control pills.
Birth control pills utilize two hormone groups
that are synthetically made to mimic the ovarian
cycle/ovulation processes that are normally
at work only during pregnancy. Specifically,
birth control pills trick the ovaries into thinking
the lady is already pregnant and ovulation does
not occur. These synthetic hormones in most
birth control pills have strong Androgenic (male
hormone) side effects on sebaceous gland production
of oil in the skin.
Another possible reason for the 30 year-old
onset of acne might relate to hormone adjustments
after a pregnancy, nursing a child, or simply
experiencing the stressful lifestyle so prevalent
today with all the demands and time limits we
impose on ourselves.
Men may still have acne symptoms at age 30,
but it is unlikely that acne will develop then
for the first time. We are all still subjected
to stress, and men may skip the gentle cleansing
of facial areas after sports, etc., so acne
can still be a problem.
When can I expect my acne to go away?
Although acne is not as predictable as the weather,
it certainly is as unpredictable as the weather
can be. By this I mean acne can seemingly for
no reason at all cease and never return. More
than likely, if you have acne at this time and
you’re in an age transition when male or female
hormones are still changing randomly and haphazardly,
your acne will go away when hormone levels become
more consistent.
For instance, during pregnancy, oftentimes
acne breakouts become more prominent and suddenly
after pregnancy seem to disappear. This again
is related to hormonal changes related to normal
body physiology.
Most patients that suffer from acne as teenagers
can expect acne to certainly become less active
in their mid to late 20’s as the stresses of
life in general become more regulated and less
emotionally severe.
Do all ethnic groups battle
acne?
Persons in every ethnic group may have acne.
The genetic component is still in effect. Each
parent’s family tree will have some effect in
a specific persons acne. Significant factors
still relate to whether or not the person’s
skin is oily and the thickness of skin. Other
factors such as sun exposure, makeup and skin
care products used may influence breakouts as
well.
Blue eyed, lighter complexion
persons usually have thinner and more dry skin
as a rule. That group probably has less acne
problems than some other groups.
What are the pros and cons of Accutane
and other prescription drugs?
Prescription drugs may be necessary to control
acne in some cases. Accutane is a very serious
drug that acts by interfering with the cells
that actually produce skin oil. In several studies
it has been able to cut oil production by 80%.
Unfortunately, because Accutane is taken internally,
it affects many other cells in the body. It
often will cause mucosal surfaces to become
dry, cracked and even to bleed. This includes
lips, mouth, eyes, vaginal, and urinary tract
linings.
Accutane has caused significant birth defects
during pregnancy from taking only one dose!
For this reason, the FDA mandates that pregnancy
testing be done for any female of childbearing
age before starting usage of Accutane and at
intervals during usage.
Accutane can also have significant harmful
effects on the liver, and liver function tests
must be done monthly while taking the drug.
These tests, along with visits to the doctor's
office and the cost of the drug itself, may
cost $400-$1200 for 2-3 months use. Even with
all of these negative effects, Accutane is still
useful for some patients to control the worst
cases of acne and to prevent deep scarring.
Retin-A is chemically akin to Accutane but
is used topically on the skin for acne as well
to repair sun damage. It does not have the same
degree of health concern problems such as birth
defects but it still has troublesome side effects
such as irritation, itching, redness, and flaking
of the skin area where used. It also is by prescription
only, but useful with some cases of acne.
Antibiotics taken orally may be of great benefit
when taken for 2-3 weeks to control very pustular
acne breakouts. They should not be taken continuously
for long periods. Topically applied antibiotics
such as Cleocin Tea or erythromycin liquids
are almost surely to cause a development of
resistant bacteria on the skin that will make
acne control more difficult.
Prescription drugs have a place in acne treatment
for some cases. They are costly, always have
side effects, and should be used only when less
drastic measures have not been successful in
controlling acne.
Fortunately, the Reversion
Acne Control System is very effective in controlling
the majority of acne problems in nearly all
patients and is able to do this in the least
costly way.
Are any kind of
"masks"
helpful to dry the oiliness of the skin?
Charcoal masks have been reported by some to
be helpful in decreasing oiliness. Oatmeal masks
likewise may be quite helpful. The key is not
to attempt to reach a “no oil” state. This will
always cause the body to try to produce more
oil and a never-ending cycle will occur in the
oil production cells.
What is salicylic acid?
Salicylic acid is an organic acid. A form of
it was originally discovered by American Indians
in the bark and leaves of certain trees. That
particular form of salicylic acid was acetyl
salicylic acid. It was known and passed down
for generations that when that bark was chewed,
headaches or other inflammatory processes actually
became improved. We know acetyl salicylic acid
today as the drug aspirin.
The salicylic acid used for acne treatment
is actually a higher concentration than would
be found in nature. Its usefulness in acne control
is that it promotes exfoliation of the skin
surface cells, and in particular the cells lining
the sebaceous ducts. Topical application of
salicylic acid on a daily basis in low (1-2%)
concentration promotes regular, even exfoliation
that minimizes the plugging of follicles.
In more concentrated forms (15-20%), salicylic
acid acts as a peeling agent. This is normally
reserved for application by an aesthetician,
nurse or physician in an office setting to unroof
blackheads, whiteheads or pustules. This allows
a more rapid removal of the foreign material
so that scarring does not occur. Jessner’s Peel
is a solution of three different peeling agents
including 14% Salicylic Acid. Jessner peels
greatly enhance the clearing up of acne lesions.
What does "non-comedogenic"
mean?
Actually, to describe what non-comedogenic means
would require an explanation of what comedogenic
means. A comedone is a plugged sebaceous follicle
with sebaceous material, epithelial cell debris
like a small logjam that prevents this material
from getting to the external surface of the
skin and being removed.
Non-comedogenic refers to substances that, when put on the
skin, have minimal or no effect in plugging the oil glands.
Look for this label description on products such as makeup,
foundation, and moisturizers. This nearly always relates to
a very low oil content in these products and the formulation
of them allow very easy removal with gentle cleansing.
If I stop using acne medication, will the acne return?
The factors in life that predispose one to breakouts and acne
probably will remain essentially unchanged. If an acne medication
has been successful in controlling breakouts and then is no
longer used, the acne certainly won’t instantly return. However,
over time the factors and conditions may become optimum again
for acne breakouts. Unless other changes occur in life some
of those skin condition factors may cause acne to return.
The good news is that those medications that had worked well
in controlling acne should work well again if acne returns.
If we look at what is causing the acne inflammatory process
and its relation to a clogged duct or a clogged pore, we get
a picture of events trying to occur that can’t occur.
By this I mean that if acne persists for several weeks as a
pustule or infected area that cannot heal because of fluid being
trapped under the skin, the probability of scarring increases.
It is for this reason that dermatologists actually extract comedones
or sebaceous plugs in follicles. This is done in order to open
the outlet for debris to exit the skin. In cases of deep acne
cysts, actually incising and draining may be necessary to minimize
future scarring.
Certainly controlling acne in its early stages to prevent the
formation of fluid-filled pockets is the best way to prevent
permanent scarring from acne.
Is acne contagious?
Acne is a skin condition and certainly is not contagious to
your friends or family or any other person. However, if you
pick or squeeze an acne lesion with your fingernails and then
scratch another area, you can contaminate a non-infected sebaceous
duct with bacteria-infected material and cause a new lesion
to arise. Using the general principles of washing both hands
and face on a regular basis and not picking at acne lesions
will decrease the likelihood of new acne lesions developing.
Does touching my face make acne worse?
The act of touching one’s face during breakouts does not make
acne worse, especially if hands are clean. In fact, touching
your face with warm water and a gentle cleanser actually improves
acne and the overall health of skin. Squeezing or picking at
acne lesions definitely will make them worse, larger, more difficult
to eliminate, and much much more likely to leave permanent scarring.
Can using a dirty washcloth cause acne?
Using a dirty washcloth should not cause one to have acne if
it is not already present. However, if one has acne and then
repeatedly uses the same unclean washcloth for washing, it very
likely may cause the spreading of new breakouts or the worsening
of those present.
These conditions make an ideal culture medium for bacteria
from the skin which remain in the washcloth to multiply overnight.
The next time the dirty cloth gets used we are re-infecting
our acne breakouts!
Will sun exposure help acne?
Small amounts of sunlight exposure to skin certainly is healthy.
Sunlight is necessary for certain vitamins to function, such
as Vitamin D. If any aspect of the spectrum of sunrays has a
helpful nature to acne, it would be bands close to the ultraviolet
spectrum of light. For this reason, dermatologists have tried
in the past to improve acne using sun lamps for the ultraviolet
exposure.
One problem with the exposure of the skin to ultraviolet
light, however, is that ultraviolet light causes a damaging
effect to the skin itself. For this reason, ultraviolet light
therapy for acne has not been as popular in recent years as
it was some years ago.
Another negative effect of sunlight on the skin
is that sunlight itself can cause an increased production of
skin oils which may actually make acne worse.
Does acne occur anywhere else besides
the face?
Because acne is not a disease but a condition that exists in
sebaceous glands, it is possible for it to occur anywhere on
the body surface that has sebaceous glands. Obviously, there
are some areas void of these oil glands, such as the palms,
the soles of the feet and, interestingly enough, eyelid skin.
These areas have sweat glands, but they are eccrine or water
glands rather than sebaceous or oil glands.
Acne mechanica is a condition that occurs with
athletes especially, such as football players in the hot summer
months that wear shoulder pads or clothing that rubs continually
on skin that is exposed to dust, perspiration, etc. Traditional
acne does commonly occur on the chest, the back, arms and legs.
Here are some more acne medications, treatments and
cover-ups with good reputations:
|