Research Assessment #4

Date: ​October 20, 2017

Subject: ​ Dermatology

MLA Citation: ​ ​Nordqvist, Christian. “Acne: Causes, treatment, and tips.” ​Medical News Today​,

MediLexicon International, 23 June 2017, www.medicalnewstoday.com/articles/107146.php.

Analysis: ​ As I go deeper into Dermatology, I am reading more about the different types of skin

disorders. The most common skin disorder that dermatologist see is, acne. Acne affects people

regardless of age, gender, or race. For example, consider the following statistics: 60 million

Americans have active acne (20 percent of whom are adults); of the 85 percent of young adults

(between ages 11 and 30) who suffer from acne.

Acne occurs when hair follicles become clogged with oil and dead skin cells. The four

main factors that cause acne are, bacteria, dead skin cells, clogged pores and oil production.

Acne is a skin condition that causes spots and pimples, especially on the face, shoulders, back,

neck, chest, and upper arms. Acne normally occurs on these parts of the body because most oil

(sebaceous) glands are located there.The different types of acne dermatologists see are,

whiteheads (also known as a closed comedone), when a pore becomes clogged, closes and the

bulges out. When a pore becomes clogged but stays open and the toop darkens, you have a

blackhead, which is also known as an open comedone. Two other types of acne include pimples

and deeper lumps (cysts or nodules). When the walls of a pore become damaged, bacteria

(called Propionibacterium acnes, or P. acnes) and dead skin can work their way under the living

skin. This leaves you with a small, red infection called a pimple.

Teenagers and young adults are the age group most commonly affected by acne.

Around one in eight (80%) of 11 to 30-year-olds have acne at some point. In girls, acne is
commonest between the ages of 14 to 17. Boys most commonly have acne over the ages of 16

to 19 years. When I read more articles, I found out that 70% of teens have never sought medical

advice for their acne. A majority of teenagers have repeated episodes, where there skin will be

clear for sometime and then breakout. Also, they may experience flare-ups, and that’s when

they have acne without it clearing up and then it becomes worse, it may be triggered by stress,

a change in your diet, the products you use on your skin, or maybe a medical condition.

Stressing causes acne because, when you stress your body releases the hormone cortisol, and

the hormone signals the body to produce more oil, which cause the clogging of your pores.

Along with having acne, many people in this age group experience depression, social

withdrawal, decline in their work and school places, low self-esteem/body image, and many

more due to acne. Acne can often cause intense feelings of anxiety and stress, which can

sometimes make people become socially withdrawn. This combination of factors can lead to

depression. With social withdrawal, teens with acne may be victim to cruel taunts from other

teenagers. With the bullying of acne, teens may become depressed and it can be seen by the

lack of an appetite, mood swings feeling of unworthiness and many more signs. In today’s

society, there is an image that is perceived to be “perfect” and many people fall victim to

comparing themselves to famous people with “flawless” skin, mainly girls. Girls will start to wear

heavy makeup and style their hair a specific way to hide the acne. Having acne will make

people do things to make themselves less noticeable, like avoiding going to school, or calling in

sick to work. Acne can be cured over time and treatment, and as a dermatologist, I will support

my patients emotionally and physically, so they can feel better in their skin. One of the well

known medicine for acne is ​accutane which is a form of vitamin A. The purpose of it is to,

reduces the amount of oil released by oil glands in your skin, and helps your skin renew itself

more quickly. Using this drug has its ups and downs, such as causing severe, life-threatening
birth defects if the mother takes the medication during pregnancy. An up would be never having

acne after completing the treatment. This is a very helpful yet dangerous drug/treatment, and I

want to do more research on it.

Before I read about all these articles, I thought I knew so much about acne, but I did not.

I learned about the main skin disorder one may see working in dermatology, acne. Acne affects

a large number in the United States, from about 50-60 million people, between the ages of

11-30. I was shocked by the numbers. I also learned new way to to prevent and treat acne by

yourself. An example would be ​not scrubbing the skin or burst the pimples, as this may push the

infection further down, causing more blocking, swelling, and redness. For myself, when I see a

pimple, I take my electric facial brush and scrub that area harder than if I did not have a pimple

there. ​I now have a better understanding of what I need to do and how to do it. I hope to find out

my own ways and share them with my future patients.

 Acne: Causes, treatment, and tips

Acne is a skin condition that causes spots and pimples,especially on the face, shoulders, back,

neck, chest, and upper arms.

It is the most common skin condition in the United States (U.S.), affecting up to ​50 million
Americans yearly.

It commonly occurs during ​puberty​, when the sebaceous glands activate, but it can occur at any
age.

The glands produce oil and are stimulated by male hormones produced by the adrenal glands in
both males and females.

At least ​85 percent​ of people in the U.S. experience acne between the ages of 12 and 24 years.

Contents of this article:

1. What is acne?
2. Causes
3. Types
4. Over-the-counter treatment
5. Treating moderate to severe acne
6. 15 tips for managing acne

Fast facts on acne

Here are some facts about acne. More detail is in the main article.

● Acne is a skin disease involving the oil glands at the base of hair follicles.
● It affects 3 in every 4 people aged 11 to 30 years.
 ● It is not dangerous, but it can leave skin scars.
● Treatment depends on how severe and persistent it is.
● Risk factors include genetics, the menstrual cycle, ​anxiety​ and ​stress​, hot and humid
climates, using oil-based makeup, and squeezing ​pimples​.

What is acne?

Acne is a chronic, inflammatory skin disease that results in whiteheads, ​blackheads​, pimples,
cysts​, and nodules. It is not dangerous, but it can leave skin scars.

Human skin has pores that connect to oil glands under the skin. Follicles connect the glands to
the pores. Follicles are small sacs that produce and secrete liquid.

The glands produce an ​oily liquid​ called sebum. Sebum carries dead skin cells through the
follicles to the surface of the skin. A small hair grows through the follicle out of the skin.

Pimples grow when these follicles get blocked, and oil builds up under the skin.

They tend to appear on the face, back, chest, shoulders, and neck.

Skin cells, sebum, and hair can clump together into a plug. This plug gets infected with bacteria,
and swelling results. A pimple starts to develop when the plug begins to break down.

Propionibacterium acnes (P. acnes)​ is the name of the bacteria that live on the skin and
contributes to the infection of pimples.

Research ​suggests​ that the severity and frequency of acne depend on the strain of bacteria. Not
all acne bacteria trigger pimples. One strain helps to keep the skin pimple-free.

Causes
A range of factors triggers acne, but the main cause is thought to be a rise in androgen levels.

Androgen is a type of hormone, the levels of which rise when adolescence begins. In women, it
gets converted into ​estrogen​.

Rising androgen levels cause the oil glands under the skin to grow. The enlarged gland
produces more sebum. Excessive sebum can break down cellular walls in the pores, causing
bacteria to grow.

Some ​studies suggest​ that genetic factors may increase the risk.

Other causes ​include​:

● some medications that contain androgen and lithium

● greasy cosmetics
● hormonal changes
● emotional stress
● menstruation

Types

Acne pimples ​vary​ in size, color, and level of pain.

The following types are possible:

● Whiteheads: These remain under the skin and are small

● Blackheads: Clearly visible, they are black and appear on the surface of the skin
● Papules: Small, usually pink bumps, these are visible on the surface of the skin
● Pustules: Clearly visible on the surface of the skin. They are red at their base and have
pus​ at the top
● Nobules: Clearly visible on the surface of the skin. They are large, solid, painful pimples
that are embedded deep in the skin
 ● Cysts: Clearly visible on the surface of the skin. They are painful and filled with pus.
Cysts can cause scars.

Over-the-counter treatment

Treatment depends on how severe and persistent the acne is.

Mild acne

Mild acne can be treated with over-the-counter (OTC) medications, such as gels, soaps, pads,
creams, and lotions, that are applied to the skin.

Creams and lotions are best for sensitive skin. Alcohol-based gels dry the skin and are better for
oily skin.

OTC acne remedies ​may contain​ the following active ingredients:

● Resorcinol: helps break down blackheads and whiteheads

● Benzoyl peroxide: kills bacteria, accelerates the replacement of skin, and slows the
production of sebum
● Salicylic acid: assists the breakdown of blackheads and whiteheads and helps reduce
inflammation​ and swelling
● Sulfur: exactly how this works is unknown
● Retin-A: helps unblock pores through cell turnover
● Azelaic acid: strengthens cells that line the follicles, stops sebum eruptions, and
reduces bacterial growth​. There is cream for acne, but other forms are used for
rosacea​.

It is advisable to start with the lowest strengths, as some preparations can cause skin irritation,
redness, or burning on first use.
These side effects normally subside after continued use. If not, see a doctor.

Treating moderate to severe acne

A skin specialist, or dermatologist, can treat more severe cases.

They may prescribe a gel or cream similar to OTC medications but stronger, or an oral or topical
antibiotic​.

Corticosteroid injection

If an acne cyst becomes severely inflamed, it ​may rupture​. This can lead to scarring.

A specialist may treat an inflamed cyst by injecting a diluted corticosteroid.

This can help prevent scarring, reduce inflammation, and speed up healing. The cyst will break
down within a few days.

Oral antibiotics

Oral antibiotics ​may be prescribed​ for up to 6 months for patients with moderate to severe acne.

These aim to lower the population of ​P. Acnes​. The dosage will start high and reduce as the
acne clears.

P. acnes​ can become resistant to the antibiotic in time, and another antibiotic is needed. Acne is
more likely to become resistant to topical rather than oral antibiotics.

Antibiotics can combat the growth of bacteria and reduce inflammation.

Erythromycin and tetracycline are commonly prescribed for acne.

Oral contraceptives

Oral contraceptives can help control acne in women by suppressing the overactive gland. They
are commonly used as long-term acne treatments.

These may not be suitable for women who:

● have a blood-clotting disorder

● smoke
● have a history of ​migraines
● are over 35 years old

It is important to check with a ​gynecologist​ first.

Topical antimicrobials

Topical antimicrobials also aim to reduce ​P. acnes​ in patients with moderate to severe acne.
Examples are clindamycin and sodium sulfacetamide.

The dermatologist may prescribe a topical retinoid.

Topical retinoids are a derivative of ​vitamin​ A. They unclog the pores and prevent whiteheads
and blackheads from developing.

Examples​ of topical retinoids prescribed in the U.S. are adapalene, tazarotene, and tretinoin.

Isotretinoin
This is a strong, oral retinoid, used for the treatment of severe ​cystic acne​ and severe acne that
has not responded to other medications and treatments.

It is a strictly controlled medication with potentially serious side effects. The patient must sign a
consent form to say that they understand the risks.

Adverse effects include dry skin, dry lips, nosebleeds, fetal abnormalities if used during
pregnancy, and mood swings.

Patients who take isotretinoin must avoid vitamin A supplements, as these could lead to vitamin
A toxicity.

15 tips for managing acne

Here are ​some tips​ for looking after skin that has acne or is prone to it.

1. Wash your face no more than twice each day with warm water and mild soap made
especially for acne.
2. Do not scrub the skin or burst the pimples, as this may push the infection further down,
causing more blocking, swelling, and redness.
3. Avoid popping pimples, as this makes scarring likelier.
4. A specialist can treat a pimple that requires rapid removal for cosmetic reasons.
5. Refrain from touching the face.
6. Hold the telephone away from the face when talking, as it is likely to contain sebum and
skin residue.
7. Wash hands frequently, especially before applying lotions, creams, or makeup.
8. Clean spectacles regularly as they collect sebum and skin residue.
9. If acne is on the back, shoulders, or chest, try wearing loose clothing to let the skin
breathe. Avoid tight garments, such as headbands, caps, and scarves, or wash them
regularly if used.
10. Choose makeup for sensitive skin and avoid oil-based products. Remove makeup
before sleeping.
 11. Keep hair clean, as it collects sebum and skin residue. Avoid greasy hair products,
such as those containing cocoa butter.
12. Avoid excessive sun exposure, as it can cause the skin to produce more sebum.
Several acne medications increase the risk of ​sunburn​.
13. Use an electric shaver or sharp safety razors when shaving. Soften the skin and beard
with warm soapy water before applying shaving cream.
14. Avoid anxiety and stress, as it can increase production of cortisol and adrenaline, which
exacerbate acne.
15. Try to keep cool and dry in hot and humid climates, to prevent sweating.

Acne is a common problem. It can cause severe embarrassment, but treatment is available, and
it is effective in many cases.