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Whether you call them blemishes, pimples, or zits, most of us experience mild acne at some point in our lives. More often a problem in the teen years, acne vulgaris, as it’s known medically, starts when skin pores become blocked by excess oil and dead skin cells. Some people have severe acne resulting in hundreds of pimples across the face, chest, and back, although many treatments can help.
- Cause :
There are different types of acne. The most common acne is the type that develops during the teen years. Puberty causes hormone levels to rise, especially testosterone. High hormones cause signal skin glands to start making more oil (sebum). Oil releases from the pores to protect the skin and keep it moist. Acne begins when oil mixes with dead cells and clogs the skin's pores. Bacteria can grow in this mixture. And if this mixture leaks into nearby tissues, it causes swelling, redness, and pus. A common name for these raised bumps is pimples.
See a picture of how pimples form :
Pimples form when dead skin cells mix with excess oil (sebum). This mixture plugs the pore, causing swelling. Bacteria can grow in the mix and lead to infection and pus.
It isn't just teens who are affected by acne. Sometimes newborns have acne because their mothers pass hormones to them just before delivery. Acne can also appear when the stress of birth causes the baby's body to release hormones on its own. Young children and older adults also may get acne.
A few conditions of the endocrine system, such as polycystic ovary syndrome and Cushing's syndrome, can lead to outbreaks of acne.
2-How to Treat Acne at Home
Treatment at home can help reduce acne flare-ups.
* Wash your face (or other affected skin) gently one or two times a day.
* Do not squeeze pimples, because that often leads to infections, worse acne, and scars.
* Use water-based skin care products that gently clean your skin. Avoid products such as milky cleansers, cold creams, lipsticks, and lip glosses that contain oils.
* Use over-the-counter medicated creams, soaps, lotions, and gels to treat your acne. Always read the label carefully to make sure you are using the product correctly.
Examples of some over-the-counter products used to treat acne include:
* Benzoyl peroxide (such as Brevoxyl or Benzac), which unplugs pores.
* Alpha-hydroxy acid, which dries up blemishes and causes the top skin layer to peel. You'll find alpha-hydroxy acid in some moisturizers, cleansers, eye creams, and sunscreens.
* Salicylic acid (Propa pH or Stridex), which dries up blemishes and causes the top skin layer to peel.
* Tea tree oil, which kills bacteria. You'll find tea tree oil in some gels, creams, and oils.
Other products that may help your overall skin condition include skin pore-cleaning strips. When you peel these sticky strips off your skin, dirt and/or makeup is removed by the strip.
You'll have better results if you follow the directions for using topical medicines. If you use a product too often, acne can get worse.
3-Medications Used to Treat Acne
Medicines can help manage the severity and frequency of acne outbreaks. A number of medicines are available. Your treatment will depend on the type of acne you have (pimples, whiteheads, blackheads, or cystic lesions). These medicines improve acne by:
* Unplugging skin pores and stopping them from getting plugged with oil (tretinoin, which is sold as Retin-A).* Killing bacteria (antibiotics).
* Reducing the amount of skin oil (isotretinoin).
* Reducing the effects of hormones in producing acne (certain oral contraceptive pills for women).
The best medical treatment for acne often is a combination of medicines. These could include medicine that you put on your skin (topical) and medicine that you take by mouth (oral).
Medication Choices
Treatment of acne depends on whether inflammation or bacteria are present. Some acne consists only of red bumps on the skin with no open sores (comedonal acne). Topical creams and lotions work best for this type of acne. But if bacteria or inflammation is present with open sores, oral antibiotics or isotretinoin may work better.
The most common types of medicines that doctors use to treat acne include:1
* Benzoyl peroxide, such as Brevoxyl or Benzac.
* Salicylic acid, such as Propa pH or Stridex.
* Topical and oral antibiotics, such as clindamycin, sulfacetamide, erythromycin, and tetracycline.
* Topical retinoid medicines, such as tretinoin (Retin-A), adapalene (Differin), and tazarotene (Tazorac).
* Azelaic acid, such as Azelex, a topical cream.
* Isotretinoin, an oral retinoid.
* Low-dose birth control pills that contain estrogen (such as Estrostep, Ortho Tri-Cyclen, or Yaz), which work well on moderate acne in women and for premenstrual flare-ups. Estrogen softens the effects of testosterone by lowering oil production.
* Androgen blockers, such as spironolactone. Androgen blockers can be useful in treating acne. These medicines decrease the amount of sebum (oil) made in your pores.
Medicine side effects In general, doctors prefer to use topical products for acne rather than oral antibiotics, which are more likely to have side effects. Oral antibiotic side effects can include:2, 3
* Yeast infections (women).
* Diarrhea.
What To Think About
If you are pregnant, talk to your doctor about whether you should take antibiotics for acne. Some antibiotics are not safe to take during pregnancy.
Over time, bacteria can become resistant to antibiotics, which means that the antibiotics are no longer effective at killing or controlling the bacteria causing the acne. This is called drug resistance. When this occurs, a different antibiotic may be used.
After acne is under control, you often need ongoing treatment to keep it from returning. This is the maintenance phase of treatment. Your doctor may suggest treatments other than antibiotics for long-term use, to avoid the risk of drug resistance.
Topical medicines usually have fewer and less serious side effects than oral medicines. But topical medicines may not work as well as oral medicines for severe acne.
Isotretinoin (such as Sotret) and tazarotene (Tazorac) can have serious side effects. Women who take isotretinoin or tazarotene need to use an effective birth control method, to avoid having a baby with serious birth defects. The U.S. Food and Drug Administration (FDA) has announced that the companies that make isotretinoin have a program to register doctors who prescribe isotretinoin and the people who take it. The program is to ensure that women taking this medicine understand the risk of birth defects, take precautions to avoid pregnancy, and know what to do if they become pregnant. If your doctor suggests that you take isotretinoin, you must be registered with iPLEDGE in order to get the drug. You can get more information and register at www.ipledgeprogram.com or by telephone at 1-866-495-0654.
The FDA’s Center for Drug Evaluation and Research division has also warned that isotretinoin (such as Sotret) may be linked with depression, psychosis, and, in rare cases, suicidal thoughts or attempts. The link between this medicine and depression is not clear and is being watched very closely. Talk to your doctor about the side effects of isotretinoin to decide whether it is right for you. If you are taking isotretinoin and feel depressed, see your doctor for treatment.
Acne: Should I Take Isotretinoin for Severe Acne?
Get the facts
* Take isotretinoin to clear up severe acne.
* Use other treatments for your acne. This may include over-the-counter or prescription medicines.
If you aren't sure whether you need treatment beyond home care, see Click here to view a Decision Point. Acne: Should I see my doctor?
Key points to remember
* Acne will improve over time for most people. For some people, though, acne is harder to treat.
* You may want to take isotretinoin if:
o You are bothered by severe acne that doesn't get better after several months of using other medicines.
o A parent or sibling had severe acne with scarring.
o Your acne causes anxiety, low self-esteem, or depression.
* You may not want to take isotretinoin if:
o You can control your acne with other medicines or treatments.
o There is any chance that you could become pregnant.
o You or members of your immediate family (parent, brother, or sister) have a history of severe depression.
What is isotretinoin?
Isotretinoin (Amnesteem, Claravis, or Sotret) is a powerful medicine for severe acne that cannot be cleared up with other medicines. It is related to vitamin A. Most people need to take it for 3 to 6 months.
This medicine unclogs skin pores and shrinks oil glands. It can reduce the scars and emotional pain of severe acne. But this medicine can have severe side effects.
What are the risks of taking this medicine?
Isotretinoin can cause side effects. The most serious side effects occur in women who are pregnant or get pregnant while taking it. They may have a miscarriage, or their infant may be born with severe birth defects. Other serious side effects are rare.
The U.S. Food and Drug Administration (FDA) warns that this medicine has been linked with depression, psychosis, and, in rare cases, suicidal thoughts or suicide attempts. The link between this medicine and depression is not clear, and it is being watched very closely. Talk with your doctor to decide if this medicine is right for you or your child. See your doctor if you or your child takes isotretinoin and has signs of depression.
Most people who take this medicine have some of the less serious side effects. These include dry skin, dry mouth, chapped lips, nosebleeds, dry eyes, and trouble wearing contact lenses. These side effects usually are not a big problem and can be treated with moisturizers, artificial tears, and other products. If you have dry eyes while taking this medicine, you may have to wear glasses instead of contact lenses. Your skin also could sunburn more easily, so make sure to use sunscreen.
This medicine can raise the level of certain fats (triglycerides) in your blood. So you may be more likely to get health problems such as heart disease. For this reason, you need to have your triglyceride levels checked before you start this medicine and every 4 to 6 weeks while you are taking it. You also need blood tests to make sure that the medicine isn't harming your liver.
Headaches and muscle or joint pain are less common side effects that most people can treat with over-the-counter pain medicine. Muscle and joint pain are more common in people who exercise often.
Why might your doctor recommend this medicine?
Your doctor might recommend this medicine if:
* You have severe acne that has not improved with other treatments.
* You feel bad about yourself because of your acne.
* You are not pregnant or planning on getting pregnant soon.
Compare your options
Take isotretinoin Take isotretinoin
What is usually involved?
* You take a pill every day for 3 to 6 months.
* You have blood tests every 4 to 6 weeks to check your liver enzymes and the level of certain fats.
* Because the medicine can cause birth defects or miscarriage, women must use two forms of birth control while they are taking it and for at least 1 month after they stop taking it.
What are the benefits?
* Your acne may get much better or go away. In 80 out of 100 people, this medicine clears up severe acne or makes it much better. 1
* It can prevent scarring from severe acne.
* If acne comes back, it may be much less severe than before you took the medicine.
* You may feel better about how you look if the medicine clears up your acne.
What are the risks and side effects?
* It may not work for you. It doesn't clear up severe acne or make it much better for 20 out of 100 people.1
* You cannot take it if you are pregnant or want to get pregnant soon. It can cause birth defects and miscarriages.
* It has been linked with depression and suicidal thoughts.
* Less serious side effects are dry skin, dry eyes, and chapped lips. You may get sunburned more easily than before if you don't wear sunscreen.
* It can raise the level of fats in your blood.
* This medicine is expensive.
Don't take isotretinoin Don't take isotretinoin
What is usually involved?
* Keep washing your face with soap or other cleansers. You also may use over-the-counter acne lotions.
* You can use other prescription pills or creams.
What are the benefits?
* You don't have the risk of the medicine's serious side effects, such as depression and birth defects and miscarriage.
* You don't have less serious side effects, such as dry skin, dry eyes, and chapped lips.
* You don't have to use two forms of birth control, which is required for women who use this medicine.
What are the risks and side effects?
* Home care might not control your acne.
* Your acne could get worse, causing more scarring.
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