Understanding Acne-Part-I


What is acne? Certainly, most of us know what it is, simply because we have had to experience it at one time or another in our lives. But, in case a definition is needed, here is a short one. Acne is a dermatological term that includes clogged pores, pimples and lumps or cysts that occur on the face, neck, chest, back, shoulders, and upper arms. Acne occurs most commonly in teenagers, but is not limited to any age group, afflicting even adults in their forties. This disease has many varieties, and although none are life threatening, the more severe cases of acne can be disfiguring, leaving permanent scars on effected areas. 

The physical changes in body tissue - or lesions - which acne causes are described in five ways: comedos, papule, pustule, nodule and cyst. Further, these terms denote range or severity with comedo (also known as blackheads and whiteheads) at one end and nodules or cysts at the other. 

As stated above, acne is most common among teenagers, affecting teens between the ages 12 and 17. Usually, these mild cases are cleared up with over-the-counter treatments and the acne goes away by the early twenties. It also should be noted that although acne affects both girls and boys equally, there are some distinctions. Young men are more likely to have severe, long-term acne while women can have reoccurring or intermittent acne well into adulthood due to hormonal changes and cosmetics.

Now that we have summarized just what acne is, we can move on to the subject of this book. A guide to acne: what types are there, how to treat it, and current myths circulating about it. The hope is that the reader will come away having gained a clearer understanding of acne in its various forms, and how it can be combated against and to reduce its impact upon the lives of those suffering from it. This is by no means an exhaustive guide on the subject nor is it a clinical journal, but is at the very least, an introduction and a source upon which to do further study into the causes and cures of acne in all its forms.



Many of the problems facing those who are trying to deal with acne are the pervasive sources of misinformation out there regarding the causes of acne. Despite the numerous valid sources of information on and about acne that are now available, these myths persist and are passed on by word-ofmouth to those unfortunate enough to suffer from the disease.  Rather than finding solutions and treatments to alleviate the symptoms, problems are often compounded. Illadvised treatments based off these myths can have less than effective results and can often do further damage in the case of severe acne. 

In light of the influence that these myths can have on both understanding acne in general and the courses of treatment in particular, it would be wise to start with a quick overview of some of the more common myths that are out there, dispelling the misinformation with the truth about them. After this we can move on to the question of what the actual causes of acne might be.


Myth #1: Acne is caused by poor hygiene.

It doesn’t matter how often, how ritually, you scrub your face and other areas affected by acne; this has no bearing on either the status of current a breakout or the creation of new problems. In fact, this sort of rigorous regimen of washing and scrubbing can actually irritate skin and make the acne worse, not better.  Though you may have heard so from wellmeaning parents growing up or some other misinformed person, acne is not caused by poor hygiene.  This doesn’t mean that hygiene isn’t important. In fact, good hygiene can help reduce the effects of acne if used in conjunction with acne treatment products. Rather than frequent, harsh washing, it is generally recommended that you wash your face twice to three times a day with mild soap and then pat it dry - don’t scrub dry. 

  Myth #2: Acne is caused by diet.

“Don’t eat chocolate, it will give you pimples!” “They say that eating greasy foods can give you zits.” Most of you have heard these and other similar statements before, right? What they are saying, in effect, is that what you eat can cause acne. But, what they are saying isn’t true. It is a myth, one of the more popular ones actually, about the causes of acne. Extensive scientific research has been conducted, searching for possible correlations between one’s diet and a possible cause of acne, and have not found anything conclusive.

However, each of us is different. Some people notice that breakouts are worse after eating certain foods--and the kinds of food differ with each person. For example, some people may notice breakouts after eating chocolate; while others have no effects with chocolate. Instead, they notice breakouts occurring after they drink too much coffee or caffeine. These are just examples but they might be worth heading. If there is some sort of food or drink that might be affecting your acne, then cut back and see if that helps.

  Myth #3: Acne is caused by stress.

Stress is not a direct cause of acne but it is true that some types of stress can cause the body to produce a hormone called cortisol, which can irritate existing acne. Indirectly, some medication that we take to alleviate or control extreme stress or emotional problems like depression can be factors in the production of acne. In fact, some medicines have acne listed as a possible side effect. 
  Myth #4: Acne will go away on its own.

This is generally not true and acne needs treatment in order to be cleared up. With the selection of acne treatment products available today there is no reason not to investigate and find what has the best results for those concerned. In some cases, a dermatologist should be consulted and other forms of treatment can be pursued. 
          
  Myth #5: Tanning clears up skin.

In fact, this has the reverse effect. At first it may seem that the latest bake in the tanning bed or sunbathing has improved your complexion, but in fact the tan may only have masked or covered the acne. In reality, the sun can make the skin dry and irritated and this can lead to more breakouts. On another note, if you do tan, make sure that you are using a sunscreen that doesn’t contain oils and other chemicals that might clog up your pores and cause acne to get worse. (Look for noncomedogenic or nonacnegenic on the label.)
  Myth #6: Popping Zits Will Make Them Go Away
Faster

Again, though this seems true, it is another myth. Rather than speeding up the process of healing, this action actually prolongs the situation as popping the whitehead caused the bacteria inside to be pushed deeper into the skin, which allows more infection to grow, and ultimately leads to scarring. 

  Myth #7:  Only Teenagers get acne.

The truth is that about 25% to 30% of all people between the ages 25- 44 have active acne. So the idea that acne is only a problem for teens is yet another myth. 

After covering these myths, it is important to note, that these are not all of the myths that are out there, circulating in the popular health magazines and on the Internet. No, not by a long shot. There are dozens more where these came from.
The reason for their inclusion in this book is to help you, the reader, understand that the topic of acne has grown more complicated as new sources of information, both good and bad, have become available and that one must be very careful about researching the topic and deciding what sources to trust.
For the Parents of Teens with Acne
  
Acne has affected all of us at one time or another.  If you are a parent with teenage children you will be reminded of what a toll dealing with acne can have on their lives. Acne can affect your child’s self image as well as overall social life and in severe cases can lead to depression and withdrawal. You should let your teenager know that you are available and that you are willing to help him or her with their acne. Talking about your own experiences may help them relate and quite possibly, give them a broader perspective on the condition. Even if they don't want to talk about it, dealing with acne is one of their major concerns. Consequently, your teenager is trying everything he or she can to control the acne.  

As adults, we know that acne will not last forever, that it will usually clear up in time if given attention and treated appropriately. Yet this is only a small comfort to teenagers who are currently suffering from embarrassment and discomfort from breakouts of acne. Talking with your teenager about acne can be difficult because they might be embarrassed by their appearance and would sooner just pretend it wasn’t an issue. The key is to be supportive and understanding. At the same time, parents must be more than moral support to their children. They need to be a source of information and advice about how to treat acne as well.

One of the most effective ways is to learn as much as possible about the various types of acne and how it can be treated. Simply doing this can go a long way in providing more effective guidance for your children when confronted with decisions related to their acne treatment.  You will be able to help them in the selection of acne medications and perhaps determine whether or not it is an appropriate time to consult with a dermatologist.  

Do not assume that just because you happened to have acne as a teen that you know everything about it. Things have changed since then. Advances in scientific research on acne related matters continually unearth new information. Also, new medications as well as new methods of acne treatment have been developed so that the most common acne conditions can be remedied quickly.  Because there are such a variety of approaches, knowing what is available will aid you in deciding what the best option may be for your child.
What Really Causes Acne?
  
It must be stated at the beginning that an exact cause of acne is unknown. Despite the endless research that has been done to date, nothing has ever been isolated as a primary cause for the development of acne. Keeping this in mind though, doctors and researchers have at least come to some conclusions as to what sort of risk factors are involved and ultimately contribute to acne’s development. According to some researchers, the primary causes are hormones and genetics, but this cannot account for every case. No, in some instances, factors like medication, types of cosmetics, and certain aspects of personal hygiene (i.e. methods of cleansing skin) are more likely to create the conditions for acne’s formation. Environment, too, can be a catalyst. Those working with chemicals or who are exposed to oils and greases, have a greater chance of getting acne because the materials themselves can clog pores. 

Hormones

With the onset of puberty, the human body starts to produce hormones called androgens or male sex hormones, increasing in both boys and girls. These androgens cause the enlargement and over stimulation of the sebaceous glands which are found in the hair follicles or pores of the skin. The extra sebum or oil that the sebaceous glands produce mixes with dead skin cells and bacteria on the skin's surface and this blocks pores. Within the blocked pore, the bacteria multiply and cause inflammation. All of this leads to the lesions that are associated with acne.
Teenagers are the most common sufferers of acne, purely because of the hormonal shifts that are associated with puberty. Current figures indicate nearly 85% of people will develop acne at some point between the ages of 12 and 25.
It is also important to note that the hormonal changes associated with both the menstrual cycle, pregnancy, and even menopause have been shown to be culprits in the creation of acne. Also, when women are either beginning or ending their usage of birth control, the hormonal fluctuations that can occur at this time can cause acne in some women. 
Furthermore, fluctuations in the hormones of adults, both men and women, can cause spikes in the production of sebum in the sebaceous glands. This opens wide the range of those susceptible to acne, due to hormonal changes.

  Genetics

Another factor is heredity or genetics. Many researchers now believe that the tendency to develop acne can be inherited from parents. In studies conducted by a number of scientists, links have been found between those presently suffering from acne and the presence of acne in their family history. Strictly speaking though, acne is not an inherited disease, at least not in the medical sense of the word. However, it is also true that acne is much more common in children of parents who have had or still have acne than those who do not. While the research is still ongoing, there is no doubt the research will continue to yield new results and perhaps, deeper genetic causes might be unearthed.

Other Factors

Medication 

As was stated before, the side effects of certain drugs can cause acne. Examples can include: barbiturates, antidepressants, anti-anxiety medication, lithium and certain forms of steroids. 

Heavy or oily costmetics  

In the case of certain cosmetics, their ingredients can affect the structure of hair follicles and lead to over-production of sebum, which in turn clogs the pores.

Over-abrasive cleansing 

Astringent facial products can dry the skin out and also causes the body to overproduce sebum to compensate.  The use of harsh exfoliators can damage existing spots and spread infection.

  Flare Up Factors

There are also a number of other factors which can cause existent acne to flare up and create more problems. A small list of some of these factors is included in the following pages so that our picture of acne becomes clearer and we shall, hopefully, obtain a greater understanding of the causes and elements that make this disorder such an inconvenient and uncomfortable thing to endure. 

Pressure from helmets or hats, backpacks, tight clothing

If there is pressure against the skin, as is the case when wearing hats, and helmets, or when a backpack is pressing down against shoulders, then the potential for irritation and acne breakouts are real. Either friction, as is true when someone is wearing tight clothing, or pressure as in the aforementioned hat or helmet, can go a long way towards affecting the pores and causing acne to flare up.

Environmental irritants

If a person works in a garage or in a factory, certain chemicals present in such environments can actually cause acne flare-ups, if not lead to its appearance. Oils, for instance, when brought in contact with skin over a long period can clog up pores, or at least irritate the skin. 
Pollution can have much the same effect upon the skin, clogging pores and creating infections. 

Heavy scrubbing of skin

Picking or squeezing blackheads and/or whiteheads can cause the infection to move deeper into the skin and which will lead to scarring.

Diet

While no foods actually have been linked to the cause of acne, it is proven that certain foods can be responsible for acne flare-ups.

Types of Acne


  Acne Vulgaris 


Acne vulgaris is another name for common acne. This is the type of acne that mainly affects adolescents but may persist and become more severe as one reaches adulthood.

Mild to Moderate acne vulgaris is characterized by the following lesions:

Whiteheads


Whiteheads result when a pore is completely blocked, trapping sebum, bacteria, and dead skin cells, causing a white appearance on the surface. Whiteheads have a shorter life span than blackheads. 

Blackheads


Blackheads result when a pore is only partially blocked, allowing some of the trapped sebum, bacteria, and dead skin cells to slowly drain to the surface. The dark color associated with its appearance is not caused by dirt. Rather, it is a reaction of the skin's own pigment, melanin, reacting with the oxygen in the air. As a whitehead has a short life cycle, a blackhead is a firmer structure, and can often take a long time to clear.

Papules 
Papules are inflamed, red, tender bumps with no head.

Pustules 

A pustule is similar to a whitehead, but is inflamed, and appears as a red circle with a white or yellow center. (This is what is commonly called a “zit.”)
Severe acne vulgaris can be distinguished by the presence of nodules and cysts:

Nodules 

As opposed to the lesions mentioned above, nodular acne consists of acne spots which are much larger, can be quite painful and can sometimes last for months. Nodules are large, hard bumps under the skin's surface. Scarring is common. Absolutely do not attempt to squeeze such a lesion. You may cause severe trauma to the skin and the lesion may last for months longer than it normally would have left untouched.

Cysts 

An acne cyst is often similar in appearance to a nodule, but it is pus-filled, and has been described as having a diameter of 2 inches or more across and is often very painful. Again, scarring is common with cystic acne. Squeezing an acne cyst may cause a deeper infection and more painful inflammation which will last much longer than if you had left it alone. 

  Adult Acne


Adult acne is a form of acne vulgaris that can affect adults over 30 years of age. Those who had no problems with acne as a teenager have found that they are having breakouts. But because acne is normally associated with the hormonal fluctuations that occur during puberty, its appearance in an adult should be investigated to determine the underlying causes--especially if it appears for the first time in adulthood.  

The following are at least three reasons why acne appears after 30 years of age:

Ø Often the acne that one had as an adolescent resurfaces later in adulthood. It is not always clear why this happens, but it is one reason for its presence in adults. 

Ø In women, acne often reappears during pregnancy where there had been no activity for months, if not years. This could also be true in the case of woman during their menstrual period. 

Ø Thirdly, acne can appear in adults for the first time who have never had it before. Now with this third reason, it might be more obvious that something unusual is going on and it might be wise to talk to a dermatologist or at least your family physician.

With some reasons established, we can now mention some of the possible causes of adult acne:

Medication. As has been stated previously, some medications can induce acne. Anabolic steroids, antiepileptic medications, anti-tuberculosis drugs rifampin and isoniazid, lithium and medications that contain iodine.

Ø Chronic physical pressure on the skin. Whether chaffing from wearing a helmet or carrying a backpack, such pressure against the skin can lead breakouts.
(See acne mechanica)

Ø Chlorinated industrial chemicals. Working in certain types of industrial environments can cause acne-like symptoms or even chloracne, an occupational skin disorder caused by prolonged exposure to chemicals like chlorinated dioxins. 

Metabolic changes. With changes in the body’s hormonal balance, such as those present during pregnancy or menstruation can produce acne in adults. 

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