Understanding Acne and Its Causes
Other Types of Acne Lesions
After the Acne Goes Away: Spots and Scars
Who Gets Acne?
Causes of Acne
Myths About Acne
Review of Various Acne Treatments
Natural Supplements for Acne Treatment
Acne Treatment: The Choice is Yours

Understanding Acne and Its Causes
Acne is an inflammatory disease of the sebaceous or oil glands and hair follicles of the skin. It is characterized by plugged pores and outbreaks of lesions commonly known as pimples or zits. Acne can occur on the face, neck, back, chest, shoulder, and upper arm areas.

Affecting more than 17 million people in the United States, acne is the most common skin disease. For most people, acne is associated with adolescence - indeed, most young adults have acne. For some, however, acne can last well into adulthood. While it is not a life threatening condition, it can have significant emotional effects. Severe and even moderate acne can lead to permanent scarring.

What is acne?
In acne, the oil producing sebaceous gland produces excessive amounts of oily secretion, which drains into the hair follicle. This secretion, called sebum, hardens into a plug called a blackhead, which blocks the follicle opening. Blocked pores allowed bacteria called Propionibacterium acnes (P. acnes), which normally live on the skin, to grow in the trapped sebum and cause inflammation of the surrounding area.



Acne lesions (comedones or singular comedo) come in two basic forms - whiteheads and blackheads. A comedo that stays below the skin surface produces a white bump called a whitehead, whereas an open comedo that reaches the skin surface produces a black plug called a blackhead. The black color of the blackhead is not caused by dirt.

Neither whiteheads nor blackheads should be squeezed or "popped" without proper medical supervision under sterile conditions. This is because injured lesions can become infected and/or scarred.

Other Types of Acne Lesions

Sometimes acne lesions can turn into these various forms of lesions:

Papule
A papule is a small (less than 5 mm), inflamed solid lesion that appears as small, pink bumps on the skin. A group of small papules may not be visible to the eye, but can have a "sandpaper" feel and be tender to the touch.

Pustule (Pimple)
A pustule is a dome-shaped lesion filled with pus containing a mixture of white blood cells, dead skin cells, and bacteria. Often red at the base, a pustule that forms over a hair follicle usually has hair in the center. Normally, pustules that are resolved without turning into cysts do not leave any scars.

Nodule
Similar to a papule, a nodule is a dome-shaped or irregularly shaped lesion. However, a nodule is deeper than a papule, and can cause pain and/or scarring.

Cyst
A cyst is a deep and painful lesion filled with pus containing a mixture of white blood cells, dead skin cells, and bacteria. It is usually larger than a pustule and can lead to scarring. This condition is usually referred to as cystic acne.

After the Acne Goes Away: Spots and Scars

After the acne lesion goes away, sometimes you are left with:

Red Spot (Macula)
Red spots or maculae are usually flat, pinkish red in color at first, with a well-defined border. Untreated, maculae normally go away on their own after 4 to 6 months, and may change into a darker brownish red color before clearing up. Maculae typically disappear without any trace or scars.

You can speed up this process by using a topical application containing zinc (See ActivClear Acne Treatment for more info).

Post-Inflammatory Pigmentation
This form of pigmentation occurs at the site of the healed or healing acne, especially in people with darker skin tones. Some post-inflammatory pigmentation can last up to almost 2 years, especially with excessive sun exposure.

Acne Scars
Scars caused by injury to the skin tissue and the subsequent repair process. In cases of acne, especially deep acne, tissue injury is the result of the body's inflammatory response to the dead cells and bacteria in the plugged sebum.

In most cases, only nodule and cystic acne are associated with scarring. In people who are prone to scarring, however, common acne lesions may result in permanent scars.

There are two types of scars: those caused by increased tissue formation and those caused by loss of tissue.

In the first type, called keloids, skin injury from acne inflammation causes the cells to overproduce collagen, resulting in increased tissue formation. Typical keloid scars are a series of solid, irregular bumps about 1 to 2 mm in diameter. This form of scar is rare, and usually only affects people with a family history of keloid scarring.

A more common scarring associated with acne is that caused by tissue loss, such as the ice-pick scar. Usually occurring in the cheeks, ice pick scar forms when deep and shallow indentations or holes are left by acne.

Who Gets Acne?

Acne is found in people of all races and ages. Almost all adolescents and young adults develop acne - indeed, nearly 85% of people between the ages of 12 and 24 have acne. For most, acne goes away by the time they reach their thirties. However, for some, acne can develop well into adulthood.

Acne affects young men and women about equally. However, young men are more likely to suffer from more severe and longer lasting forms of acne. Young women are more likely to suffer from intermittent acne caused by hormonal changes associated with their menstrual cycles or from acne caused by cosmetics.

Causes of Acne

Although the exact cause of acne is not known, it is thought that one or more of the following factors are involved in causing acne:

Genetics
The predisposition to acne is inherited from either parents - that is, you are more likely to suffer from acne if one or both of your parents also suffered from acne.

Hormones
The increase in the production of male sex hormones called androgens in young men and women during puberty is thought to cause the sebaceous glands to enlarge and produce excess sebum. The oily sebum often forms hardened plugs that lead to acne.

For women, pregnancy, menstruation or period, starting or stopping taking birth control pills, can cause drastic changes in hormonal levels and lead to acne breakouts. For some women, elevated hormone levels tend to make them breakout 2 to 7 days before their period.

Prescribed Medicines
Certain drugs, such as androgens, lithium (for psychological conditions), and barbiturates (to control seizures), can cause acne. Usually, the acne only lasts as long as the drugs are taken.

Cosmetics
For some, cosmetics or makeup can plug pores or cause follicles to stick together and thereby cause acne.

Stress
Although the experts disagree on whether stress actually causes acne, it certainly can aggravate existing acne conditions. In particular, severe stress or prolonged emotional tension, can make acne worse.

Humidity and Environmental Pollutants
High humidity as well as environmental irritants such as pollution can make acne worse.

Physical Irritations
Acne condition can worsen if the skin is rubbed hard, or pustules are picked and squeezed. Handling of acne with unwashed hands can also introduce bacteria, which can get inside the acne lesion and cause infections.

Friction from collars, backpacks, or helmets worn too tightly can also cause acne to flare up.

It is important to keep in mind that the causes of acne above are not absolutes - different individuals are susceptible to different causes (or combination of causes) of acne. Furthermore, factors cause acne in some people may only aggravates existing acne conditions in others.

There are a lot of myths about acne. Here are some of them:

Myth: Acne is caused by poor hygiene
Acne is not caused by dirt on your face and blackheads are not black because of dirt. However, clogged pores due to oils and dirt may cause acne-prone skin to breakout.

Although good hygiene is a must for healthy skin, washing your face too many times or scrubbing too hard can actually irritate your skin and cause acne.

Instead, you should wash your face twice a day with mild facial soap and pat dry - not rub - with a clean towel.

Myth: Washing your face more wil get rid of acne
Because acne is not caused by dirt or poor hygiene, you cannot get rid of it by washing your face alone, let alone washing it many times. As we said above, washing your skin too frequently can lead to more - not less- acne. This is because frequent washing causes your skin to dry out. This, in turn, leads your skin's sebaceous glands to secrete more oily sebum, which can cause acne.

Myth: Chocolate, peanuts, and greasy food cause acne
Some people swear that eating chocolate, pizza, or greasy french fries cause them to break out. Scientific studies, however, failed to link acne to any specific diet.

Nevertheless, eating a proper balanced diet is a key consideration in remaining healthy - and healthy skin is less prone to acne breakouts.

Myth: Getting a tan can get rid of acne
Sunbathing will not cause your pimples to go away, although the tan may make the redness of your acne less noticeable. In fact, too much sun is bad for your skin and may lead to more serious health risks, such as skin cancer.

Myth: Popping your pimple is the best way of getting rid of acne
Actually, improper popping or squeezing of acne can lead to infections and/or scarrings.

Myth: There is nothing you can do about acne - you just have to let acne run its course
For many people, acne is only a temporary condition that goes away as they grow up. But there is no need to wait years for your acne to get better. There are steps that you can take to get rid of acne and shorten the time it takes for red spots to go away.

First, you should always practice good skin hygiene and wash your face twice a day with warm water and mild facial soap. Be sure to avoid overly drying your skin, since this will only encourage your skin's natural oil and sebum production.

Avoid physically irritating your skin - such as hard rubbing, wearing your collar or hat too tightly. Also avoid using cosmetics that clog your pores - instead, look for non-acnegenic or noncomedogenic makeups.

For those with severe acne problems, a visit to your dermatologist may be in order. These doctors specialize in skin conditions and diseases, and would be able to give you prescription-only acne medicine if needed.

There are many acne relief products available today, including prescribed medicine, natural supplements, and topical creams. Which one is right for you? Read on:

OTC and Prescription Drugs for Acne Treatment
Dermatologists or doctors that specialize in treating skin diseases and conditions often prescribe either oral or topical over-the-counter and prescription medicine for treating acne. These medicines include:

Over-The-Counter (OTC) Topical Creams and Washes
Topical medicine is applied directly to pimples or acne lesions or to the entire affected area. Common over-the-counter or OTC creams that are available without prescriptions include those containing benzoyl peroxide, salicylic acid, resorcinol, or sulfur.

Benzoyl peroxide is an antiseptic that kills P. acnes, the bacteria that causes acne infection. Salicylic acid, resorcinol, and sulfur help breakdown whiteheads and blackheads. Salicylic acid can also reduce the shedding of follicle and sebaceous gland cells.

OTC acne creams are usually recommended to those with mild acne conditions and may take up to 8 weeks to show improvement. In some people, these creams can cause side effects such as skin irritation, burning, and redness. Fortunately, the side effects are usually temporary and disappear by themselves once the medicine is no longer used.

Some ingredients, such as salicylic acid and benzoyl peroxide, have also been made available as daily washes for those with mild acne.

Prescription Topical Creams
For more moderate cases of acne, topical medicines containing antibiotics, adapalene, azelaic acid, benzoyl peroxide, and tretinoin are often used.

Antibiotics and azelaic acid are used to help get rid of bacteria and reduce inflammation. Tretinoin and adapalene are a form of vitamin A called retinoids, which work by reducing the formation of acne lesions (comedones) and opening up existing comedones to allow other topical medicines to enter the follicles.

Prescription topical creams often have side effects such as stinging, burning, peeling, discoloration, scaling, redness, and severe dryness of the skin. In some people, skin may look worse before improvement can be seen within 4 to 8 weeks.

Prescription Oral Medicines
For patients with severe forms of acne, doctors often prescribe oral antibiotics - sometimes in combination with topical creams. Common oral antibiotics include tetracycline, minocycline, doxycycline, clindamycin, and erythromycin.

Although generally safe, oral antibiotics sometimes can have side effects such as dizziness and lightheadedness, upset stomach, increased susceptibility to sunburn, and changes in skin color. For pregnant women and children, tetracycline is not prescribed as it may cause teeth discoloration. Tetracycline and minocycline may also decrease the effectiveness of birth control pills.

If their acne conditions do not improve with the antibiotics above, dermatologists may prescribe isotretinoin - a strong form of retinoid or vitamin A that can reduce the size of oil glands and diminish oil and sebum production.

While effective, isotretinoin can have serious side effects, including birth defects, dryness in the eye, mouth, lips, nose, and skin; itching, nosebleeds, susceptibility to sunburn, muscle aches, and poor night vision. Isotretinoin can also cause changes in liver function and in triglyceride and cholesterol levels, thus requiring regular blood checks before and during treatment.

Because of these potential side effects, isotretinoin should never be used without proper dermatologist supervision.

Hormone Therapy
Some acne in women are caused by hormonal changes. These acne can be caused by elevated hormone levels prior to menstruation or by excessive androgen (male sex hormone - yes, women do normally produce small amounts of these hormones) production.

For these acne, doctors can prescribe specific drugs. Low-dose estrogen birth control pills can help reduce the androgens produced by the ovaries, whereas low-dose corticosteroids can be used to suppress androgens produced by the adrenal glands. Anti-androgen drugs, such as spironolactone, can be used to reduce excessive oil and sebum production. Such drugs, however, have the potential side effects of irregular period, breast tenderness, fatigue, and headache.

Other Treatments for Acne
Some dermatologists may offer other treatments of acne, including popping the pimple (under very specific and sterile conditions) during office visits and cortisone injections to reduce the size and pain of inflammed acne lesions.

Treatment of Acne Scars
Although prevention of acne scars is the goal of all acne treatment methods, once scarring has occured, there are a couple of possible treatments:

Laser Treatment
Laser is often used either to smooth the skin layer or to tighten the underlying tissue and "push" out depressed scars.

Dermabrasion
Dermabrasion is a surgical procedure where scars are "sanded" by rotary abrasives. It can be performed by qualified doctors to reduce the appearance of acne, but may not be very effective for ice-pick and deep scars.

In a small percentage of people, dermabrasion actually makes their skin worse and may cause temporary or permanent discoloration.

Microdermabrasion
In microdermabrasion, instead of a hand held machine, aluminum oxide crystals are used to remove skin. This procedure is gentler than dermabrasion and takes only the surface layer of skin. However, multiple procedures may be needed before improvement can be seen.

Dermaplaning
Deep acne may require dermaplaning, where skin is "shaved" by use of an oscillating blade.

Collagen Injection
Collagen can be used to "fill out" and stretch certain types of acne scars. The effect of collagen injection is temporary, lasting about 3 to 6 months, and are usually not effective for ice-pick and deep scars.

Skin surgery
In this procedure, deep ice-pick scars are excised or "punched" out, and the resulting hole is filled by either a skin graft or just sutured. In certain cases, skin grafts are needed to replace an area badly affected by acne.

It is important to note that the prescribed medicines and surgical procedures above should only be performed by qualified dermatologists.

The use of herbal and natural ingredients are becoming increasingly popular for acne treatment. Advances in scientific purification and investigations into the active ingredients of many herbs have helped make natural supplements a promising source of treatment for many health conditions, including acne.

Below are some of herbal supplements and their uses in treating acne:

Vitamin A
There is evidence that when taken orally, vitamin A can successfully treat severe acne. However, large quantities of this vitamin is required. Vitamin A derivatives, such as isotretinoin and retinoid creams, have also been successfully used for acne treatment.

Vitamin B3
Vitamin B3 or niacinamide gel has been shown to be an effective acne treatment. In a double-blind clinical study, a treatment of 4% niacinamide gel applied twice daily was shown to be as effective as antiobiotic clindamycin in acne treatment.

Vitamin B5
Studies have suggested that vitamin B5 or panthotenic acid can reduce the amount of oily sebum in your skin. It has been suggested that vitamin B5 is required by your body's natural enzymes to break down oil.

Other studies have also suggested that deficiency in vitamin B5 can also cause acne.

Zinc
Clinical studies have shown that an oral zinc supplement is as effective in clearing acne as antibiotics. In one study, 30 mg of zinc taken twice a day was shown to reduce acne conditions within 12 weeks of treatment.

In cream form, zinc can also be used in concert with the antibiotic erythromycin or by itself to treat acne breakouts (see below).

In addition to oral supplements, natural and herbal ingredients in cream form can also be used effectively for acne treatment. Some of these ingredients are:

Tea Tree Oil
Tea tree oil is a solution derived from the leaves of the Australian tea tree plant (Melaleuca alternifolia). The leaves of the tea tree plant have traditionally used as an antiseptic.

Studies have shown that tea tree oil has antibacterial and antifungal properties, and that it can be successfully used to treat acne and fungal infections, as well as to promote wound healings.

In a single-blind, randomized clinical trial on 124 patient, 5% tea-tree oil application on mild to moderate acne was found to be just as effective as 5% benzoyl peroxide lotion. Both were shown to reduce the numbers of inflamed and non-inflamed acne lesions. Tea tree oil, however, was found to have fewer side effects, such as skin irritation and dryness, than benzoyl peroxide.

Zinc
Topical zinc cream has been shown to reduce oily sebum production and may help the body's immune system in warding off bacterial infections in acne.

Zinc is also a required element in tissue repair and rebuilding. It helps your skin heal after acne and contributes to the elimination of red spots often left by acne. Zinc can also help prevent scarring.