PhytoScience - Article

Acne

 

What is Acne?


Acne is the term for plugged pores (blackheads and whiteheads), pimples, and even deeper lumps (cysts or nodules) that occur on the face, neck, chest, back, shoulders and even the upper arms.  Acne affects most teenagers to some extent.  However, the disease is not restricted to any age group; adults in their 20s - even into their 40s - can get acne.  While not a life threatening condition, acne can be upsetting and disfiguring.  When severe, acne can lead to serious and permanent scarring.  Even less severe cases can lead to scarring.

Causes

Three factors contribute to the formation of acne:

  • Overproduction of oil (sebum)
  • Irregular shedding of dead skin cells resulting in irritation of the hair follicles of your skin
  • Buildup of bacteria

Acne occurs when the hair follicles become plugged with oil and dead skin cells. Each follicle is connected to sebaceous glands. These glands secrete an oily substance known as sebum to lubricate your hair and skin. Sebum normally travels up along the hair shafts and then out through the opening of the hair follicle onto the surface of your skin. When your body produces an excess amount of sebum and dead skin cells, the two can build up in the hair follicle and form together as a soft plug.

This plug may cause the follicle wall to bulge and produce a whitehead. Or, the plug may be open to the surface and may darken, causing a blackhead. Pimples are raised red spots with a white center that develop when blocked hair follicles become inflamed or infected. Blockages and inflammation that develop deep inside hair follicles produce lumps beneath the surface of your skin called cysts. Other pores in your skin, which are the openings of the sweat glands onto your skin, aren't normally involved in acne.

It's not known what causes the increased production of sebum that leads to acne. But a number of factors {including hormones, bacteria, certain medications and heredity} play a role.

Contrary to what some people think, foods have little effect on acne. Acne also isn't caused by dirt. In fact, scrubbing the skin too hard or cleansing with harsh soaps or chemicals irritates the skin and can make acne worse.

Types of Acne


When you read about acne or other skin diseases, you encounter words or phrases that may be confusing. For example, the words used to describe the lesions of acne {comedo, papule, pustule, nodule and cyst} are understandable only if you know each word’s definition. It also is helpful to have a photo that is characteristic for each type of lesion.
Here is a brief summary of definitions of words used to describe acne, with accompanying photos. Let’s begin, though, with the definition of lesion, an all-purpose word:

Lesion: A physical change in body tissue caused by disease or injury. A lesion may be external (e.g., acne, skin cancer, psoriatic plaque, knife cut), or internal (e.g., lung cancer, atherosclerosis in a blood vessel, cirrhosis of the liver).

Thus, when you read about acne lesions you understand what is meant; a physical change in the skin caused by a disease process in the sebaceous follicle. Acne lesions range in severity from comedones (blackheads and whiteheads) to nodules and cysts. Here is a brief definition of acne lesions:

 

Comedo (plural comedones)


A comedo is a sebaceous follicle plugged with sebum, dead cells from inside the sebaceous follicle, tiny hairs, and sometimes bacteria. When a comedo is open, it is commonly called a blackhead because the surface of the plug in the follicle has a blackish appearance. A closed comedo is commonly called a whitehead; its appearance is that of a skin-colored or slightly inflamed "bump" in the skin.

The whitehead differs in color from the blackhead because the opening of the plugged sebaceous follicle to the skin’s surface is closed or very narrow, in contrast to the distended follicular opening of the blackhead. Neither blackheads nor whiteheads should be squeezed or picked open, unless extracted by a dermatologist under sterile conditions. Tissue injured by squeezing or picking can become infected by staphylococci, streptococci and other skin bacteria. The following photos are characteristic of acne with comedones:

 

 


Papule


A papule is defined as a small (5 millimeters or less), solid lesion slightly elevated above the surface of the skin. A group of very small papules and microcomedones may be almost invisible but have a "sandpaper" feel to the touch.

A papule is caused by localized cellular reaction to the process of acne. This photo shows papules and comedones on the face of an acne patient:


 

 


Pustule


A dome-shaped, fragile lesion containing pus that typically consists of a mixture of white blood cells,dead skin cells, andbacteria. A pustule that forms over a sebaceous follicle usually has a hair in the center.

Acne pustules that heal without progressing to cystic form usually leave no scars. This photo shows pustules, papules andcomedones on the face of an acne patient:



 


Macule


A macule is the temporary red spot left by a healed acne lesion. It is flat, usually red or red-pink, with a well defined border. A macule may persist for days to weeks before disappearing.

When a number of macules are present at one time they can contribute to the "inflamed face" appearance of acne. This photo shows the "red face" appearance of acne with macules:




Nodule


Like a papule, a nodule is a solid, dome-shaped or irregularly-shaped lesion. Unlike a papule,a nodule is characterized by inflammation, extends into deeper layers of the skin and may cause tissue destruction that results in scarring. A nodule may be very painful.

Nodular acne is a severe form of acne that may not respond to therapies other than isotretinoin - Acne Treatments

 


 

 


Cyst


A cyst is a sac-like lesion containing liquid or semi-liquid material consisting of white blood cells, dead cells, and bacteria. It is larger than a pustule, may be severely inflamed, extends into deeper layers of the skin, may be very painful, and can result in scarring.

Cysts and nodules often occur together in a severe form of acne called nodulocystic. Systemic therapy with isotretinoin is sometimes the only effective treatment for nodulocystic acne.

Some acne investigators believe that true cysts rarely occur in acne, and that (1) the lesions called cysts areusually severely inflamed nodules, and (2) the term nodulocystic should be abandoned. Regardless of terminology, this is a severe form ofacne that is often resistant to treatment and likely to leave scars after healing. The photo above and to the right show nodular, cystic acne:



Who gets acne?


Close to 100% of people between the ages of twelve and seventeen have at least an occasional whitehead, blackhead or pimple, regardless of race or ethnicity. Many of these young people are able to manage their acne with over-the-counter (nonprescription) treatments. For some, however, acne is more serious. In fact, by their mid-teens, more than 40% of adolescents have acne severe enough to require some treatment by a physician.

In most cases, acne starts between the ages of ten and thirteen and usually lasts for five to ten years. It normally goes away on its own sometime in the early twenties. However, acne can persist into the late twenties or thirties or even beyond. Some people get acne for the first time as adults.

Acne affects young men and young women about equally, but there are differences. Young men are more likely than young women to have more severe, longer lasting forms of acne. Despite this fact, young men are less likely than young women to visit a dermatologist for their acne. In contrast, young women are more likely to have intermittent acne due to hormonal changes associated with their menstrual cycle and acne caused by cosmetics. These kinds of acne may afflict young women well into adulthood.

Acne lesions are most common on the face, but they can also occur on the neck, chest, back, shoulders, scalp, and upper arms and legs. Acne also has significant economic impact. Americans spend well over a hundred million dollars a year for nonprescription acne treatments, not even taking into account special soaps and cleansers. But there are also the costs of prescription therapies, visits to physicians and time lost from school or work.

Prevention

Once your acne improves or clears, you may need to continue your acne medication or other treatment to prevent new acne breakouts. In some cases, you might need to use a topical medication on acne-prone areas, continue taking oral contraceptives or attend ongoing light therapy sessions to keep your skin clear. Talk to your doctor about how you can prevent new eruptions.

You can also prevent new acne breakouts with self-care measures, such as washing your skin with a gentle cleanser and avoiding touching or picking at the problem areas. Other acne prevention tips include:

  • Wash acne-prone areas only twice a day. Washing removes excess oil and dead skin cells. But too much washing can irritate the skin. Wash areas daily with a gentle cleanser and use oil-free, water-based skin-care products.

  • Use an over-the-counter acne cream or gel to help dry excess oil. Look for products containing benzoyl peroxide or salicylic acid as the active ingredient.

  • Avoid heavy foundation makeup. Choose powder cosmetics over cream products because they're less irritating.

  • Remove makeup before going to bed. Going to sleep with cosmetics on your skin can clog tiny openings of the hair follicles (pores). Also, be sure to throw out old makeup and clean your cosmetic brushes and applicators regularly with soapy water.

  • Wear loosefitting clothing. Tightfitting clothing traps heat and moisture and can irritate your skin. Also, whenever possible, avoid tightfitting straps, backpacks, helmets or sports equipment to prevent friction against your skin.

  • Shower after exercising or doing strenuous work. Oil and sweat on your skin can trap dirt and bacteria.

Treatment

Acne treatments work by reducing oil production, speeding up skin cell turnover, fighting bacterial infection, reducing the inflammation or doing all four. With most prescription acne treatments, you may not see results for four to eight weeks, and your skin may get worse before it gets better.

Your doctor or dermatologist may recommend a prescription medication you apply to your skin (topical medication) or take by mouth (oral medication). Oral prescription medications for acne should not be used during pregnancy, especially during the first trimester.

Types of acne treatments include:

  • Topical treatments. Acne lotions may dry up the oil, kill bacteria and promote sloughing of dead skin cells. Over-the-counter lotions are generally mild and contain benzoyl peroxide, sulfur, resorcinol, salicylic acid or lactic acid as their active ingredient. These products can be helpful for very mild acne. If your acne doesn't respond to these treatments, you may want to see a doctor or dermatologist to get a stronger prescription lotion. Tretinoin (Avita, Retin-A, Renova) and adapalene (Differin) are examples of topical prescription products derived from vitamin A. They work by promoting cell turnover and preventing plugging of the hair follicles. A number of topical antibiotics also are available. They work by killing excess skin bacteria. Often, a combination of such products is required to achieve optimal results.

  • Antibiotics. For moderate to severe acne, prescription oral antibiotics may be needed to reduce bacteria and fight inflammation. You may need to take these antibiotics for months, and you may need to use them in combination with topical products.

  • Isotretinoin. For deep cysts, antibiotics may not be enough. Isotretinoin (Accutane) is a powerful medication available for scarring cystic acne or acne that doesn't respond to other treatments. This medicine is reserved for the most severe forms of acne. It's very effective, but people who take it need close monitoring by a dermatologist because of the possibility of severe side effects. Isotretinoin is associated with severe birth defects, so it can't be taken by pregnant women or women who may become pregnant during the course of treatment or within several weeks of concluding treatment. In fact, the drug carries such serious potential side effects that women of reproductive age must participate in a Food and Drug Administration-approved monitoring program to receive a prescription for the drug. In addition, isotretinoin may increase the levels of triglycerides and cholesterol in the blood and may increase liver enzyme levels. Although cause and effect hasn't been proved, studies have reported the development of inflammatory bowel disease with isotretinoin use.

  • Oral contraceptives. Oral contraceptives, including a combination of norgestimate and ethinyl estradiol (Ortho-Cyclen, Ortho Tri-Cyclen), have been shown to improve acne in women. However, oral contraceptives may cause other side effects that you'll want to discuss with your doctor.

  • Laser and light therapy. Laser- and light-based therapies reach the deeper layers of skin without harming the skin's surface. Laser treatment is thought to damage the oil (sebaceous) glands, causing them to produce less oil. Light therapy targets the bacterium that causes acne inflammation. These therapies can also improve skin texture and lessen the appearance of scars, so they may be good treatment choices for people with both active acne and acne scars.

  • Cosmetic procedures. Chemical peels and microdermabrasion may be helpful in controlling acne. These cosmetic procedures {which have traditionally been used to lessen the appearance of fine lines, sun damage and minor facial scars} are most effective when used in combination with other acne treatments.

Acne scar treatment
Doctors may be able to use certain procedures to diminish scars left by acne. These include fillers, dermabrasion, intense light therapy and laser resurfacing.

  • Soft tissue fillers. Collagen or fat can be injected under the skin and into scars to fill out or stretch the skin, making the scars less noticeable. Results from this acne scar treatment are temporary, so you'd need to repeat the injections periodically.

  • Dermabrasion. Usually reserved for more severe scarring, dermabrasion involves removing the top layer of skin with a rapidly rotating wire brush. Surface scars may be completely removed and deeper acne scars may appear less noticeable. Dermabrasion may cause pigmentation changes for people with darker skin.

  • Microdermabrasion. This newer acne scar treatment involves a hand-held device that blows crystals onto skin. These crystals gently abrade or "polish" the skin's surface. Then, a vacuum tube removes the crystals and skin cells. Because just the surface cells are removed, the skin isn't damaged. However, results are subtle and scars may still be noticeable, even after several sessions.

  • Laser, light source and radiofrequency treatments. In laser resurfacing, a laser beam destroys the outer layer of skin (epidermis) and heats the underlying skin (dermis). As the wound heals, new skin forms. Less intense lasers (nonablative lasers), pulsed light sources and radiofrequency devices don't injure the epidermis. These treatments heat the dermis and cause new skin formation. After several treatments, acne scars may appear less noticeable. This means shorter recovery times, but treatment typically needs to be repeated more often and results are subtle.

  • Skin surgery. A minor procedure (punch excision) cuts out individual acne scars. Stitches or a skin graft repairs the hole left at the scar site.

Complementary and alternative medicine

A range of dietary supplements and herbal medicines claim to offer new ways to prevent or treat diseases in general. Some supplements show promise and are slowly gaining acceptance in mainstream medicine. But the benefits and risks of many products and practices remain unproved in human clinical trials.

Mangosteen. Mangosteen has been demonstrated to exhibit potent anti-inflammatory and anti-bacterial properties. Natural remedies that lower inflammation can be very beneficial in the prevention or treatment of disease. Mangosteen can be used as an effective adjunct with standard therapies to reduce many of the side effects and helps to speed up recovery.

When indicated; mangosteen juice, when consumed daily, may be preferred over some medications that have adverse effects with prolonged usage. In case studies; Xango mangosteen juice from the whole fruit puree has successfully been used to treat acne and can even be used topically for a more rapid healing effect.

In some cases, people may experience a healing crisis or detoxifying effect {an increase or outbreak of symtoms that may last from 4 to 10 days} in the earliest stages of use. Once the body is cleared of the toxins that exasperate the condition, the healing process can get underway. This is normal and should be expected when using a quality natural product. Results will vary with individuals but the long term benefits are well worth the short term discomfort as mangosteen juice has been effective in some of the most severe cases of acne.

Mangosteen juice from the whole fruit puree consumed daily, has successfully been used to treat inflammatory conditions and has demonstrated numerous additional benefits over other natural products. More mangosteen research is needed, but current scientific studies have demonstrated promising results. Mangosteen Science

 

Source - Phytoscience Research Group, American Academy of Dermatology, Mayo Clinic, National Library of Medicine.

Updated 16 July 2009