WHAT is acne?

Acne is essentially a chronic inflammation of our hair follicles.   The most common form of acne is called Acne Vulgaris.  There are other forms of acne like Gram-Negative Folliculitis, Acne Fulminans, Acne Rosacea, and others, but these are very rare – in general when people are talking about common, everyday acne, they are talking about Acne Vulgaris.

Acne starts in the pores of our skin.  Every one of our pores consists of a hair follicle and a sebaceous gland.  The sebaceous gland produces oil called sebum that lubricates our skin (so people with oily skin just have a lot more natural lubrication).    Acne begins to form when the dead skin cells that we are constantly shedding every day get trapped in this sebum and create a plug in the pore, resulting in what is called a comedo.  If there is bacteria present, these microorganisms can cause a local infection and that’s when you get those pimples and pustules – those red bumps that come up!

The comedo is the primary lesion in acne.  Comedones are blackheads and whiteheads.  A blackhead is an open comedo which means that the pore which is packed with these skin cells is open to the surface of the skin.  These skin cells are exposed to oxygen and they darken.  A whitehead is a closed comedo meaning that there’s a cover over it and is white colored because it is not exposed to the air.

The next level of severity is to have a papule or a pustule.  There’s a bacterium on our skin called Propionibacterium Acnes (sometimes referred to as “P. Acnes” for short).  When these bacteria get trapped under our skin with a blackhead or a whitehead it produces a papule or a pustule and that’s how we get our pimples.

The most severe cases of acne usually present themselves in the form of nodules or cysts.  This is what we refer to as cystic acne.  These are those deep, painful lesions under the skin – sometimes they come to a head and sometimes they don’t – but they hurt when you press them and make your skin swollen in the area.  Cystic acne is the acne that dermatologists most worry about most because they have the highest chances of leading to permanent scarring.

WHAT causes acne?

There are many things in our daily lives that can make us more susceptible to acne, but the most common causes of acne are:

  • Hormones: acne common in teenagers and people going through adolescence and women going through pregnancy because of all the hormones that are being produced
  • Genetics: people with family history of acne are more prone to getting acne
  • Environment: if you live in very humid environments or places with a lot of pollution
  • Other factors: some medication, using some cosmetic products that are heavy in oil, constant friction on the skin, from clothing or sports equipment.

There are many ways to treat the different types of acne at home or at the doctor’s office:

Treating Blackheads and Whiteheads

If you have whiteheads and blackheads, these tend to be very responsive to Tretinoin (more commonly referred to as Retin-A).  There are many different types of Tretinoin products which is a prescription medication.  Retinol is a weaker form of Tretinoin and can be found over-the-counter.  We recommend people apply Tretinoin or Retinol on a nightly basis because these medications tend to be deactivated by the sun so don’t work as well during the day.

Treating Pimples & Pustules

If you have red pimples and pustules there is probably bacteria involved.  This is when doctors might recommend using topical or oral antibiotics – these will help to kill the bacteria on the surface of your skin.  Look for ingredients like Benzoyl Peroxide, Akne-Mycin or Clindamycin in products to help treat your pimples and pustules.

Severe or Cystic Acne

When people have a severe form of acne or cystic lesions, doctors may consider using a treatment called Isotretinoin (more commonly known as Accutane).  There is a lot of controversy around this medication but Accutane is a fantastic medication that performs better than any other medication can perform for severe acne, but it needs to be monitored closely by your physician.

At The Doctor’s Office

There are many procedures that can be done in the doctor’s office to help combat your acne.  Estheticians may be able to perform facials or comedone extractions which can help clear up your skin.  Doctors will tend to perform heavier, more concentrated chemical peels.   There are acne laser treatments but these are rarely used because they are typically not covered by insurance and aren’t necessarily a much better treatment option than other procedures.

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