Understanding Acne-Part-II

Rosacea

Though often misdiagnosed as acne, rosacea is, in fact, not acne. Rosacea affects thousands of people in the U.S. alone, mostly those over the age of 30. It generally appears as a red rash confined to the cheeks, nose, forehead and chin. This redness is often accompanied by bumps, pimples, and skin blemishes--the reason it is so commonly mistaken for acne. Further, this redness is also linked to the fact that blood vessels may become more visible on the skin. Rosacea has been shown to be more prevalent in women than in men, but often if found in men it tends to be more severe. If you are seeking treatment and you think it may actually be rosacea, you need to be aware that the treatments differ quite a bit from those used in the care of acne vulgaris.

  Acne Mechanica

This form of acne is caused by external mechanical forces like constant pressure, constant and repeated friction, covered skin, and heat.  For those involved in sports, in the military or in high-activity jobs, this is nothing new as the condition is common with many athletes and in professions where factors like tight-fitting, even restrictive clothing is worn for extended periods of time. These sort of jobs may include certain kinds of factory work where an employee may be busy with repetitive tasks that may irritate the skin and lead to break outs.

For soldiers who must wear uniforms much of the time and may be carrying backpacks with straps that bite into the skin and cause friction with each step or straps on weapons that can also rub again the body this can become a real issue.

Operating in the extremes of temperatures that these soldiers often do can also often complicate existent acne by causing inflammation and further breakouts. 

Further examples of possible causes may include: 

Ø Wearing head bands that can rub the forehead and irritate the skin

Ø The kind of friction caused by physical contact with musical instruments for extended periods of time

Ø Wearing tight clothing period; whether it is blue jeans or types of undergarments made with synthetic materials

Even bra straps if they happen to fit snuggly against the skin

Acne Cosmetica

Often women who regularly wear make up or cosmetics find that they are getting breakouts on the forehead or cheeks. It may be what is called acne cosmetica. This form of acne is generally caused by the type of cosmetics that a person is using. 

Pomade Acne

When hairstyles change, it is not uncommon for teenagers and young adults to adopt new styles. But, sometimes a new style requires the use of a thick, oily hair cosmetic called pomade. Pomade is generally used when a hairstyle requires that curly hair be straightened or hair be molded into various shapes. 

One of the undesired effects of pomade use may be pomade acne. Pomade acne occurs on the scalp, forehead, and temples where pomade comes into contact with the skin. 

Most, if not all, pomades fall into the category of comedogenic – or pore clogging - cosmetics. The heavy oils used in pomades can clog skin, setting the stage for the formation of comedones. In addition, some of the other chemicals in pomades may irritate the skin, contributing to inflammation.

 Excoriated Acne

 The term excoriated means to scratch or abrade the skin. Now when we bring this term into the context of acne we have what is called excoriated acne. This type of acne is defined by the behavior of the person suffering from it. When such a person obsessively picks and scrapes at every pimple and blemish on their skin, they are said to have excoriated acne. Because of the excessive nature of the attention given to the sufferer’s skin, deep irritation can result as well as scarring. 

Though it may appear to others as a mild form of acne, without pustules or nodules, to the person dealing with it, this condition may be intolerable. This almost psychological urge to get rid of one’s skin lesions or blemish can become very damaging. As such, it is recommended that a dermatologist be sought for treatment. 

  Infantile Acne

This form of acne occurs in newborns and is concentrated on the nose and cheeks. It is caused by the hormonal changes that have occurred will the fetus was developing in the womb. Typically, the acne clears up in matter of weeks without treatment. 

However, infantile acne has a serious aspect that must be considered. If simple cleansing with mild soap and water will not clear the acne up then a mild topical agent (such as a prescription form of benzoyl peroxide for infants) helps both the current situation and prevents scarring. If this does not help, then a dermatologist may need to be consulted.

Things to note:

Ø Family History. Genetics might be a factor in the development of acne in the infant. Do the child’s parents or siblings have acne or did they have it in the past?

Ø Early hormone production. It may be that the infant has a condition that causes early production of sex hormones--especially androgen which is linked to acne. If this is the case, then medical help should be sought to avoid problems with the child’s development.

Ø Growth and developmental abnormalities. Acne at such an early stage in the child’s life could indicate developmental problems that might not show up until later. A pediatrician should be consulted to find out if this might be a possibility.

Drug-induced acne or acneiform eruption. It could be that the child has been exposed to certain medications that can cause acne or acneiform lesions. Examples of such drugs include corticosteroids and those that contain iodine.

Severe Acne

  

There are at least four types of acne that are recognized by many dermatologists and others in the medical field as severe regarding both the type of lesions that it produces on the body and long term effects it can have for the sufferer including scarring. This extreme acne affects more than just the body; it can affect every aspect of a person’s life. The pain and heartache of dealing with these potentially disfiguring forms of acne cannot be overemphasized but this does not take into account the emotional and psychological aspects that can lower quality of life and permanently destroy self-esteem. 

  Acne conglobata

Acne Conglobata is the most severe form of acne vulgaris. This form of extreme acne, generally characterized by the appearance of large and numerous nodules, often interconnected, along with widespread blackheads. Because theses lesions can become ulcerated, they can cause severe, irrevocable damage--even disfiguring scarring--to the skin. Acne conglobata is commonly found on the face, chest, back, buttocks, upper arms, and thighs. 

The age of onset for acne conglobata is usually between 18 and 30 years of age and it is more likely for males to get the condition than it is for females. It should also be noted that acne conglobata can stay active for many years, lying dormant until something causes it to resurface. As is true with all types of acne, the cause of acne conglobata is not known.

  Acne fulminans

This type of severe acne is actually an abrupt onset of acne conglobata that typically afflicts young men. The symptoms of the severe nodulocystic, often ulcerating acne, are readily apparent. As with normal cases of acne conglobata the lesions cover large portions of the extremities and the facial region, including the disfiguring scars that can eventually develop. Yet what makes acne fulminans unique in that it also includes fever symptoms, aching of the joints, particularly the knees and hips, and varying degrees of weight loss that depend upon the individual.

Gram-negative folliculitis

Gram-negative folliculitis is a form of extreme acne caused by an inflammation of the follicles that is caused by bacterial infection: This condition is characterized by pustules and cysts. It has been determined in some cases of the disorder that its development is caused by a complication resulting from a long-term antibiotic treatment of acne vulgaris. 

The reason that this form of acne is called “gram-negative” relates to the fact that gram is a type of blue stain used for laboratory testing for microscopic organism. Bacteria that do not stain blue are referred to as “gram-negative.” 

Like other forms of extreme or severe acne, gram-negative folliculitis is a rare condition, and we do not know whether it is more common in males or females as it has been documented in both.

  Pyoderma Faciale

This type of severe acne affects only females, usually between the ages of 20 to 40 years of age. It is characterized by large painful nodules, pustules and sores that may leave scarring. Forming abruptly, pyoderma faciale may occur on the skin of a woman who has never had acne before. Generally, this type of extreme acne is confined to the face, and though it usually does not last longer than a year, it can cause a great deal of damage in a very short time.

Natural Acne Remedies

  

The subject of natural or homegrown acne remedies is a broad one to cover as one must be able to separate the effective options from those that really amount to little more than old wives’ tales. Yet, with this said, someone searching for successful remedies for acne would be foolish to overlook the benefits of those natural remedies that have been passed on in families. These sorts of remedies based upon common sense practices or herbs are typically successful for most mild cases of acne. It is when these cases grow more severe that one should consult a physician or dermatologist.

For centuries, civilizations relied exclusively upon herbal and natural remedies for the treatment of every ailment. No, there were no convenient drive-up pharmacies to get a prescription for manufactured medications. In order to find ways to help treat sickness one had to venture into the woods and search for cures there. And for the most part, nature provided for these needs through the various herbs that were found to have medicinal value. 

The earliest physicians were nothing more than what we today call herbalists or at a certain point in time, apothecaries. Either way, the natural remedies they discovered were the basis for scientists who later found ways to create synthetic substitutes for these herbs and distill the innate properties down into a form that can be amplified or augmented by other elements.

A List of Common Natural Remedies

Hot/Cold Compresses - A chief natural remedy that is recommended more often than not is the usage of hot and cold wet towel compresses to reduce swelling and eliminate clogged pores--the major culprit in the production of acne.

Drinking Water - This natural remedy for acne is simple enough. The premise behind it the idea that if you drink a sufficient amount of water per day, typically 7-8 glasses of water a day, your body is cleansed of elements of toxicity that can actually contribute to the development and spread of acne. It also should be noted, that many natural remedies not only recommend to merely drink plain old ordinary water, but actually adding herbal ingredients by boiling fenugreek seeds and corn into the water.

Oils and Juices - Though it can seem odd, the benefits of using natural substances like almond oil - which can actually help with the removal of acne scars - cannot be ignored. Apricot juice helps to alleviate the presence of cysts by cutting through them. 

Ø Cucumber juice - Used as a topical application, either alone or combined with carrot juice, alfalfa or lettuce.

Ø Citric fruit juices - These types of juices, such as lemon juice, serve as a natural exfoliate, removing dead skin cells which might cause clogging of the pores. You should allow it to dry on the face for approximately 10 minutes before rinsing it away with cool water.

Fenugreek leaves - This remedy provides great prevention of breakouts and involves taking the fenugreek leaves, crushing them, and making a paste out of them.  You should then apply it to infected areas every night, then wash it away the following morning with warm water.

Honey Mask - Because honey has naturally occurring antibacterial qualities it is often applied to the face as a mask, killing surface bacteria. Typically, the mask should be applied once or twice weekly depending upon the results of usage. 

Distilled white vinegar - Apply the vinegar as a topical solution, letting it sit on the infected area for at least 5-10 minutes. Then rinse it thoroughly with cool water. Often the vinegar can be a little too strong so it is recommended that you dilute it, though not too much.

Make-up or Cosmetic Usage - Simply put, this is a common sense remedy for acne. Just avoid using these products because more than likely the chemicals and oils used to manufacture them will clog the pores, which, in turn, leads to more breakouts.

  Further Remedies

Beyond the common natural remedies for acne, there are a few other interesting options available and worth mentioning at this time.

Diet and vitamin supplements - Unlike former days, when the diets of civilizations included only naturally occurring food from the ground, the usage of fertilizers and pesticides has taken a toll on the nutrient content of much of the food that we eat. Add to this the fact that our food is further manipulated by chemical preservatives and you have some further explanations for the occurrences of some acne breakout. To combat this, observing a proper and balanced diet and taking a hearty multi-vitamin can actually go a long way towards preventing certain bio-chemical conditions which provide fertile ground for acne. 

Echinacea and Oregon grape - These herbs are both useful for boosting the body’s immune system and also combating many forms of acne-causing bacteria. 

Vitamin A - Used in large quantities, vitamin A has actually been used to successfully treat some severe forms of acne. But it must be clear that if you plan to use vitamin A as a possible remedy you should consult a physician because, if used in large enough doses, it can be toxic.
Zinc - This vitamin, if added to one’s diet, can actually aid in the healing of acne lesions and help in the prevention of scarring.

Over-the-Counter Acne Remedies

  

There are many types of over-the-counter treatments for acne.  When dealing with acne, most people run to the local pharmacy and buy some sort of over-the-counter medication on the basis of recommendations from their friends or perhaps even television ads.  Yet despite friendly suggestions, it is a good idea to consult with a physician before using any kind of over-the-counter medication.  Even though acne is generally a benign condition, a doctor or dermatologist can advise you on what the best course of treatment might be as well as provide further suggestions based on the particular kind of acne you may be suffering from.

Considering the fact that a large number of acne treatment products are available, it can be hard to choose which one to try.  You should not rely strictly upon the advice of friends or family because what may work for one person may not work for another.  Further, you should have some background knowledge about the active ingredients in various acne medications, so you can make a better-informed choice.

One of the most popular ingredients in acne medications is benzoyl peroxide.  Found in gels and ointments, it helps by combating the bacteria that generally help cause acne.  It is also useful for removing dead skin cells that accumulate on the surface of the skin.  It is these dead skin cells which combine with sebum to create blackheads and whiteheads.

Benzoyl peroxide has been proven to be safe and effective in combating lesions.  It can also be used as a means of acne prevention once a breakout has cleared up by keeping the skin free from acne causing bacteria.  The only side effect associated with this ingredient is dry skin, and this can be avoided by decreasing the frequency that it is applied on the skin.

Another ingredient commonly found in a majority of acne medications is salicylic acid.  This prevents acne by clearing up dead skin cells that are accumulating too quickly and clogging the pores.  If the medication you are using contains salicylic acid you should continue to use it after the skin has cleared up to prevent future outbreaks of acne.  The only side effects associated with salicylic acid are dry, irritated skin.

  Other ingredients

Besides the more common ones, there are other ingredients you may see in acne medication such as resorcinol and sulphur.  Resorcinol causes the top layer of skin to peel and the dead skin cells that clog the pores are similarly affected.  It is often combined with sulphur.  Although it is not known how exactly sulphur affects acne conditions, it has continued to be used effectively even after more than 50 years.  (Sulphur is often combined with other ingredients besides resorcinol like salicylic acid and benzoyl peroxide.)  

Of all the ingredients that have been listed which are effective in fighting acne or preventing its outbreak, benzoyl peroxide is probably the most versatile.  It can be used in cleansing liquids or bars, as well as lotion, cream, and gels which are applied directly on the skin.  The cleansing products are used once or twice a day, while the creams and lotions can be used as needed.  They should be applied on the skin around the acne as well as the pimples themselves for overall effectiveness.  Also, you should try to avoid getting benzoyl peroxide in the eyes, mouth or nose, as it will cause irritation or inflammation.

Turning to Prescriptions

Generally, mild and moderate forms of acne can be treated with over-the-counter medications, but with severe cases the only recourse is to seek treatment from a dermatologist. In many cases, the doctor will recommend a prescription medicine to deal with the condition. It also should be noted that these kinds of medication can be more effective even when dealing with moderate acne than what is typically available over-the-counter. 

There are two types of prescription acne medications - oral and topical.

Antibiotics

Commonly used to fight acne, antibiotics can be taken orally or as a lotion.  Topical prescription medications may include ingredients such as zinc or retinoids. The most common antibiotic used for treating acne is tetracycline.  It is used to kill the bacteria responsible for acne and also reduces inflammation.  Treatment may take several weeks or even months to be effective and it is important to continue using antibiotics even after the acne has cleared up.  A common side effect associated with tetracycline is increased sensitivity to sun light resulting in bad sunburns if the patient stays in the sun too long.  Further side effects may include dizziness, hives, and upset stomach.

Women who are taking tetracycline may be susceptible to an increase in incidences of vaginal yeast. 

  Ointments and topical solutions

Antibiotic ointments actually have fewer complications than oral antibiotics.  Like oral antibiotics, topical treatments are rather effective in killing bacteria that cause acne. If you use these ointments with other topical treatments like benzoyl peroxide the bacteria may not develop resistance to the antibiotics. This increases the level of prevention that you will experience. 

  Retinoids

Retinoids are a form of acne medication that is derived from vitamin A and can be applied directly to the skin typically in the form of lotions or creams.  Topical retinoid medications are useful for treating blackheads and whiteheads by helping to open clogged pores. 

Oral retinoids are used to treat the more severe forms of acne, because they have a better chance of dealing breakouts and lesions which don't respond to other treatments.  Oral retinoids cause the upper layer of the skin to peel thereby opening pores.  They also cause the body to produce less sebum – the substance which causes oily skin.

As with many other types of prescription strength medication, a number of serious side effects are associated with oral retinoids.  They can also cause liver damage and depression, so regular medical attention is needed to make sure the patient is not being adversely affected by retinoid treatment. It is not unheard of for this kind of medication to cause birth defects if mothers are taking them when pregnant, so females should consult their doctor if pregnant, or suspect pregnancy.

Other medications

Birth control pills are sometimes effective in treating acne in women.  They change hormone levels in the body and can reduce the acne causing effects of testosterone.

Surgical Options

  

Often, when every avenue of medicinal treatment is exhausted, it becomes time for sufferers of persistent acne or more severe acne to seek alternative treatment methods. A dermatologist can help discuss the different treatments currently available including treating acne with laser therapy or acne surgery. 

If you are considering the possibility of treating acne with laser therapy or surgery, you must take care to fully evaluate each of the processes, including the number of required treatments, the consequent costs, and the potential side effects of the treatment. It's also important that you select a process that is designed to deal with reducing the presence of acne - and not acne scarring. 

  Acne Surgery

Acne surgery involves making an incision into the affected area and draining the clogged matter. The process for blackheads and whiteheads doesn't actually involve surgery, but is often performed by a nurse, esthetician or dermatologist. A small, pointed blade is used to first open the comedone and then gently work the material out using a comedone extractor.

Severe cysts can be drained and removed by a procedure known as excisional surgery. The procedure should be performed in a sterile environment to reduce the risk of spreading bacterial infection and should only be performed by trained professional. If the cysts are not carefully extracted, they can develop serious infection and create scarring.  

  Forms of Physical Treatment

Exfoliation

This form or treatments involves removing the top layer of skin either chemically or with some sort of abrasive.  Chemical peels are usually done with salicylic acid or glycolic acid.  These work by destroying a microscopic layer of skin cells to unclog pores and remove the build-up of dead cells.  The same effect can be achieved by using an abrasive cloth or liquid scrub.  

Comedo Extraction

In this procedure, an anesthetic cream is applied to the immediate area of breakout. Then the comedones (blackheads and white heads) are extracted using a pen-like instrument which opens the top to allow the removal of dead skin cells and sebum from the follicle.  The procedure is usually followed by an application of antibiotic cream. 

Drainage

With many forms of severe acne, cysts can form under the skin and become very painful--even disfiguring. Often, the smaller cysts can be treated with cortisone injections which will flatten the lesion in a few days.  But for larger cysts the only alternative available might be to have them drained and then surgically removed.  Drainage can help relieve the pain associated with cysts and also reduce the chance of scarring.  It is important not to try to drain cysts by yourself because of the risk of infection, which could lead to permanent scarring.

  Using A Laser to Treat Acne

Laser treatments involve the use of varying wavelengths that are aimed directly at the affected area of the skin. These wavelengths pulsate against the skin and destroy overlylarge sebaceous glands and acne lesions. Laser treatments remove the damaged outer layers of skin so that new cell growth can be initiated. The laser technician varies the intensity of the laser as necessary to effectively treat the area. 

Despite all of the benefits, there is still considerable debate surrounding the effectiveness of laser therapy. Yes, it has been shown to be effective in improving the skin's appearance, but as with most of the other available acne treatments, there are some side effects. For example, patients can experience red, burned skin after treatment that can last for weeks. Individuals with dark-colored skin can end up with skin discoloration after laser treatments.  Finally, the skin’s appearance can be uneven if the laser is applied inconsistently.

Exfoliation

This form or treatments involves removing the top layer of skin either chemically or with some sort of abrasive.  Chemical peels are usually done with salicylic acid or glycolic acid.  These work by destroying a microscopic layer of skin cells to unclog pores and remove the build-up of dead cells.  The same effect can be achieved by using an abrasive cloth or liquid scrub.  

Comedo Extraction

In this procedure, an anesthetic cream is applied to the immediate area of breakout. Then the comedones (blackheads and white heads) are extracted using a pen-like instrument which opens the top to allow the removal of dead skin cells and sebum from the follicle.  The procedure is usually followed by an application of antibiotic cream. 

Drainage

With many forms of severe acne, cysts can form under the skin and become very painful--even disfiguring. Often, the smaller cysts can be treated with cortisone injections which will flatten the lesion in a few days.  But for larger cysts the only alternative available might be to have them drained and then surgically removed.  Drainage can help relieve the pain associated with cysts and also reduce the chance of scarring.  It is important not to try to drain cysts by yourself because of the risk of infection, which could lead to permanent scarring.

Using A Laser to Treat Acne

Laser treatments involve the use of varying wavelengths that are aimed directly at the affected area of the skin. These wavelengths pulsate against the skin and destroy overlylarge sebaceous glands and acne lesions. Laser treatments remove the damaged outer layers of skin so that new cell growth can be initiated. The laser technician varies the intensity of the laser as necessary to effectively treat the area. 

Despite all of the benefits, there is still considerable debate surrounding the effectiveness of laser therapy. Yes, it has been shown to be effective in improving the skin's appearance, but as with most of the other available acne treatments, there are some side effects. For example, patients can experience red, burned skin after treatment that can last for weeks. Individuals with dark-colored skin can end up with skin discoloration after laser treatments.  Finally, the skin’s appearance can be uneven if the laser is applied inconsistently.