Acne

What is acne?

Acne, also known as acne vulgaris, is one of the most common skin problems. It is usually seen on the face, neck, chest, shoulders, or upper back of many teenagers and young adults. Acne occurs when the pores on the surface of the skin become plugged. A pore is the opening of a hair follicle (root) and an oil gland. Normally, oil glands help keep the skin smooth and remove old skin cells. When oil glands make too much grease, pores may become blocked. This allows dirt to collect, which encourages the growth of bacteria in the glands. When these bacteria release toxic substances, it can produce irritation and swelling of the skin. This leads to the formation of painful bumps or lumps, which are commonly called pimples.

What causes acne?

The exact cause of acne is not known. The following are possible causes of acne:

• Genetics: Acne is more likely to occur if other family members also had acne problems.
  
  
• Hormones: Hormones are special chemicals in the body. Hormonal changes may occur during puberty, monthly periods, pregnancy, or use of birth control pills. An increase in androgens (male sex hormones) may also cause the oil glands to enlarge and make more sebum.
  
  
• Infections: Germs, such as bacteria, may cause acne.
  
  
• Medicines: Certain medicines, such as steroids, hormones, and anticonvulsants (phenytoin) may cause acne.
  
  
• Skin cosmetics: Harsh skin makeup and cleansers may change the cells of the follicles and block the pores.
  
  
• Stress: Emotional and physical stress, such as tiredness and feeling upset, angry, or sad, may cause an acne flare-up.

What are the different types of acne?

The different types of acne are as follows:

• Comedones: Comedones, or plugs, are blocked pores having blackheads or whiteheads on their surface. Blackheads turn dark, or black, because pores are open to the air, while whiteheads are cream-colored and are in closed pores. Comedones are often found on the forehead, nose, cheeks, and sometimes in the ears.
  
  
• Papulopustular: These are small, pink, painful pimples, called papules, which are near the surface of the skin.
  
  
• Nodular: Nodules are large, hard, and painful pimples that are deep below the skin and are pus-filled.

How is acne diagnosed?

Caregivers will take your past and present health history. They may also want to know if other family members have had acne. Acne is usually diagnosed after carefully examining your skin. Caregivers may also do cultures where samples from your skin or acne pus are taken. These samples are sent to a lab and checked for the presence of bacteria.

How is acne treated?

Treatment usually depends on the extent of the skin disease. Acne may be mild, moderate, or severe based on the type of acne and the number of comedones, papules, and nodules. With treatment, such as medicine and good hygiene, complications may be prevented and your acne may be controlled. You may need any of the following:

• Laser treatment: A narrow beam of light is used to kill the overactive cells that are causing the inflammation swelling.
  
  
• Medicines:
  
  
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Hormonal therapies: Medicines, such as oral contraceptives and androgen blockers, may control the production of sebum in the oil glands.
    
    
  • Isotretinoins: These are vitamin-based medicines, which are most useful in treating severe acne. These medicines may have serious side effects. It is important to ask your caregiver for more information before using isotretinoins. Females must not get pregnant or breast feed while taking this medicine.
    
    
  • Steroids: This medicine may be given to decrease inflammation.
    
    
  • Topicals: Topicals are medicines, such as gels, ointments, creams, pastes, or liquid solutions that are put on your skin. They may be antiseptics (germ-killers), comedone treatments, or medicines that decrease swelling and skin shedding.
    
    
  • Vitamin A and other mineral supplements: Caregivers may give you vitamin A or minerals to improve your skin.
  
  
• Phototherapy: You may need bright ultraviolet (UV) light treatments if your acne is very bad.
  
  
• Surgery: Surgery may be needed to treat severe forms of acne. Caregivers may use certain chemicals or tools to remove or scrape off skin that is affected by acne.

What are the risks of having or treating acne?

• Treatment of acne should be done as soon as possible to prevent serious problems. If not treated early, acne may infect and damage your skin. You may have swelling, bleeding, or infections. These infections may spread to your blood and other surrounding tissues. Acne may cause you to feel embarrassed, ashamed, frustrated, and self-conscious. Some people have depression or other emotional problems because they feel so bad about themselves and their appearance.
  
  
• Even with treatment, it may take a long time for acne to heal and clear. Acne may also cause you to have unwanted side effects. Your skin may become irritated and look worse right after starting a new acne treatment. You may also have headaches, allergic reactions, irritability, depression, dizziness, upset stomach, or vomiting. The medicine, isotretinoin, may cause you to have miscarriages or birth defects if taken while being pregnant. You may also need stronger or multiple antibiotics or surgery to treat your infection and other problems. These antibiotics may cause kidney or liver damage. A scar may form at the site of the acne after treatment. Ask your caregiver if you are worried or have questions about your skin disease, medicine, or care.

How should I take care of my skin?

• Avoid using hot water or washcloths when washing your face: Rubbing or scrubbing your face with hot water or washcloths may irritate and damage your skin. Gently pat your face dry with a clean towel or cloth after washing your face.
  
  
• Be careful with the medicines you are taking: Certain medicines, including natural and herbal medicines, may trigger an acne flare-up. Always check for skin changes when taking your medicines. Ask your caregiver first before you use herbal medicines or products to control acne.
  
  
• Do not squeeze, pop, or pick your pimples: Using your bare hands or black head removers may damage your skin and cause infection or scarring. Sometimes, a caregiver may remove a pimple for you. This is done in a clean and germ-free way that will not hurt your skin.
  
  
• Protect your skin by avoiding too much sun exposure: Wear sunscreen that has a sun protectant factor (SPF) approved by your caregiver. Follow the directions on the label when using sunscreen.
  
  
• Try to avoid stress: You may talk to your family or friends about things that upset you. Tell them how acne may be affecting your life.
  
  
• Use water-based, oil-free makeup, soaps, or skin cleansers. Oil-based makeup may cause acne to get worse. Check product labels on water-based makeup, since even these may have some oil added to them. Use mild soaps or cleansers that are oil-free and do not irritate acne when washing your face.

When should I call my caregiver?

Call your caregiver if:

• You are a female using medicine to treat acne, and you want to get pregnant, or you get pregnant.
  
  
• You are a female using medicine to treat acne, and you have sex without using 2 forms of birth control, or you miss a period.
  
  
• You are using medicine to treat acne, and you have problems with your vision, or dryness of the eyes that is painful or constant.
  
  
• You are using medicine to treat acne, and your eyes get red and swollen, or you get a rash, blisters, red patches, or your skin begins to peel, or you get bruises on your legs. Call if you get sores on your face or in your mouth, throat, nose, or eyes.
  
  
• You are using medicine to treat acne, and you get very thirsty or urinate a lot.
  
  
• You have a fever.
  
  
• Your acne is not getting better after treatment or your acne is getting worse.
  
  
• You do not feel good about yourself because of your acne.
  
  
• You have questions or concerns about your skin condition, treatment, or care.

When should I seek immediate care?

Seek immediate help or call 911 if:

• You are using medicine to treat acne, and you have chest pain or new or worsening heartburn.
  
  
• You are using medicine to treat acne, and you get a severe headache, blurred vision, faintness or dizziness. Seek care immediately if you begin to throw up or you have a seizure.
  
  
• You are using medicine to treat acne, and you develop hives, a swollen face or mouth, or you have trouble breathing all of a sudden.
  
  
• You are using medicine to treat acne, and you have severe stomach, bowel or pelvic pain, or painful or difficulty swallowing. Seek care immediately if you have rectal bleeding, diarrhea that contains blood, or dark-colored urine. Get immediate help if your skin or the whites of your eyes turn yellow.
  
  
• You are using medicine to treat acne, and you have new muscle weakness, joint or back pain, or you break a bone.
  
  
• You are using medicine to treat acne, and you are seeing or hearing things that are not really there, including ringing in your ears, or if your hearing gets worse.
  
  
• You are using medicine to treat acne, and you begin to have angry or violent thoughts.
  
  
• You feel depressed, or you are thinking about hurting or killing yourself.
  
  
• Your acne has pus coming out of it or has a bad smell.
  
  
• You have signs of a stroke: The following signs are an emergency. Call 911 immediately if you have any of the following:
  
  
  • Weakness or numbness in your arm, leg, or face (may be on only one side of your body)
    
    
  • Confusion and problems speaking or understanding speech
    
    
  • A very bad headache that may feel like the worst headache of your life
    
    
  • Not being able to see out of one or both of your eyes
    
    
  • Feeling too dizzy to stand

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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