Acne (Pimples, Blackheads, Whiteheads, Acne Vulgaris)

Excess oil in the skinBlackheadsWhiteheadsPapulessmall pink bumps that may be tender to the touchPimplesinflamed, pus-filled bumps that may be red at the base (also called pustules)Noduleslarge, painful, solid lumps that are lodged deep within the skinCystsdeep, inflamed, pus-filled lumps that can cause pain and scarring DiagnosisThe doctor will examine the areas of your skin with the most sebaceous glands like the face, neck, back, chest, and shoulders. If your acne is severe, you may be referred to a dermatologist, a skin specialist. TreatmentThere are several over-the-counter and prescription medications for acne. They may be applied directly to the skin (topical medication), taken by mouth (oral medication), or injected into the acne cysts or pustules.Acne may require a combination of treatments but, most acne does not require surgery. Some treatments may take several weeks to work. Your skin may actually appear to get worse before it gets better. MedicationsOver-the-counter topical medicinesinclude cleansers, creams, lotions, and gels. Their goal is to reduce the amount of oil and/or bacteria in the pores. They may contain one or more of the following ingredients: Benzoyl peroxideSalicylic acidSulfurResorcinolPrescription topical medicinesinclude cleansers, creams, lotions, and gels to reduce the amount of oil and/or bacteria in the pores. They include: Benzoyl peroxideSalicylic acidSulfurResorcinolAntibiotics, such as clindamycin (Cleocin T), erythromycin, tetracyclineTretinoin (Retin-A, Avita)Adapalene (Differin)Azelaic acid (Azelex)Tazarotene (Tazorac) Prescription oral medicine include antibiotics, medications for hormone-related acne, and vitamin A derivatives called retinoids. They are generally used for moderate to severe cases of acne.

Oral Antibioticsaimed at controlling the amount of bacteria in pores, including: ErythromycinTetracyclineDoxycyclineMinocyclineClindamycinAmpicillinCephalosporinsTrimethoprim-sulfamethoxazoleOral medicationsaimed at controlling androgen levels, including: Birth control pills SpironolactoneOral retinoidsaimed at reducing the size and secretions of sebaceous glands. Only for severe cases of cystic acne.The main drug is isotretinoin (Accutane). It must not be taken by women who are pregnant or who may become pregnant, because of the risk of serious birth defects. ProceduresIntralesional corticosteroidsthe injection of a steroid preparation directly into the cyst. This treatment is mostly used for large, cystic acne lesions.Acne surgeryspecialized (comedo) extractors are used to open, drain, and remove contents of acne lesions. Repeated sessions maybe required. Acne scar revisionthese are procedures done to minimize acne scars. Scar revision procedures include: Chemical peelsthe application of glycolic acid and other chemical agents to loosen blackheads and decrease acne papulesDermabrasion"sandpapers" the skin to smooth it outScar excisionuses a tiny punch tool or a scalpel to remove scarsCollagen fillersfill the pits of scars with a collagen substanceLaser resurfacinga laser is used to remove scars and tighten underlying skinRisks associated with scar revision and surgery include scarring and infection. Talk with your doctor or surgeon about the risks and benefits of the procedure.

Prevention It can be difficult to prevent acne from occurring, because it can be difficult to control the factors that cause it. But there are some things you can do to keep your acne from getting worse: Gently wash your face with mild soap and warm water twice a day (no more than twice) to remove excess oil. Scrubbing or washing too often can make acne worse. When washing your face: Use your hands rather than a washclothUse mild soap rather than a harsh acne cleanserAllow your face to thoroughly dry before applying any topical preparationsDon't pick at or squeeze blemishes.Use lotions, soaps, and cosmetics labeled noncomedogenic. This means it won't clog your pores.Use topical acne treatments only as directed. Using them more often could make your condition worse.Recognize and limit emotional stress.Wear sunscreen year-round. This is especially important if you are using medications, which can make your skin more sensitive to the sun. RESOURCES: The Acne Resource Center Onlinehttp://www.acne-resource.org/ The American Academy of Dermatologyhttp://www.aad.org/ CANADIAN RESOURCES: Canadian Dermatology Associationhttp://www.dermatology.ca/ Dermatologists.cahttp://www.dermatologists.ca/ References:

What is acne? American Academy of Dermatology website. Available at: http://www.skincarephysicians.com/acnenet/index.html. Accessed June 4, 2008. Questions and answers about acne. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/hi/topics/acne/acne.htm. Accessed June 4, 2008. Last reviewed November 2007 by Ross Zeltser, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.