Acne
Signs and Symptoms
Blackheads or whiteheads on face, neck, shoulders, or back;
Pimples (zits);
Cysts.

Acne occurs when the hair follicles of your skin become plugged. Each
follicle contains sebaceous glands that secrete a fatty oil (sebum) to
lubricate your hair and skin.
When your body produces sebum and dead cells faster than they can exit from
the pore, the two solidify as a white, cheesy plug. This plug may close the
pore, causing the follicle wall to bulge, thus creating a whitehead. If the
pore stays open, the top surface of the plug may darken, causing a blackhead.
Blackheads are neither caused nor colored by dirt.
Pimples are infections that develop when whiteheads rupture the follicle
wall. After the rupture, solidified sebum, dead cells, and bacteria invade
your skin. Ruptures deep within your skin form boil-like infections called
cystic acne.
In some situations, the sebaceous gland continues to secrete material that
does not rupture through the skin. Instead, a flattened, pliable lump forms
under the skin. This is called a sebaceous cyst or wen. Sometimes the lumps
can be an inch or more in diameter. Generally, there is no discoloration or
pain unless the cyst becomes infected.
Three out of four teenagers have some acne. It is most prevalent in
adolescence, because hormonal changes stimulate the sebaceous glands during
these years, increasing sebum production and the chances of acne. Menstrual
periods, the use of birth control pills or cortisone medications, and stress
may aggravate acne in later life. Sudden onset of severe acne in a mature
woman may be caused by a tumor that affects hormone production. This requires
prompt medical attention.
Application of oil or grease to your skin can aggravate acne. This includes
use of oil-based makeup, suntan oil, or hairdressing solutions, as well as
oils from machinery or cooking.

Does Diet Affect Acne?

Diagnosis.
Acne usually is easy to diagnose. Pimple-like pustules alone, with no
blackheads or whiteheads, may be another skin disease (see Rosacea) or a
reaction to medications such as corticosteroids.

How Serious Is Acne?
For many people, acne is a chronic problem from puberty through early
adulthood. It eventually clears up in most cases, but permanent scars may
remain. Medical treatment usually provides visible improvement within a few
months, but the condition can affect self-esteem, confidence, personality,
and social life.

Treatment.
Your acne may require a lengthy, consistent treatment involving four basic
steps. First, identify everything that aggravates your acne and avoid these
things. Second, follow your physician's advice about removing blackheads and
mature pimples, or have this done by a professional. Third, use a cleansing
agent or soap that dries out your skin enough to cause minor shedding of skin
so that the follicular plugs flake. Finally, promote skin peeling within your
follicles, either by using one of the medications described below or by using
a sunlamp (with proper caution).

Medication.  Two types of medication can help acne. The first is topical,
that is, you apply it directly to your skin. This lotion dries up the oil and
promotes the skin's peeling. Over-the-counter lotions are mild and contain
benzoyl peroxide, sulfur, resorcinol, or salicylic acid as the active
ingredient. Stronger lotions containing these ingredients or a vitamin A acid
(tretinoin or retinoic acid) require a prescription and supervision by your
dermatologist.
The second type of medication is taken orally. For severe acne, your
dermatologist may prescribe either an antibiotic (tetracycline) or—if your
acne is severe—a new form of vitamin A acid (isotretinoin). Both can cause
side effects, and neither should be used during pregnancy. The vitamin A
preparation, in particular, may cause birth defects. Because such harmful
effects are likely to occur during the very early stages of pregnancy, even
before you are certain you are pregnant, do not use this drug if you are not
using birth control measures.

Surgery.  Cystic acne and sebaceous cysts may require minor surgery (under
local anesthesia) for drainage and removal.
Doctors may use cosmetic surgery to diminish scars left by acne. The main
procedures are dermabrasion or peeling by freezing or chemicals. However, if
your skin tends to form scar tissue (see Keloids), these procedures can make
your complexion much worse.
Peeling procedures eliminate superficial scars. Dermabrasion, usually
reserved for more severe scarring, consists of abrading the skin with a
rapidly rotating wire brush. Your doctor will use a local anesthetic or
topical freezing of your skin during the procedure. General anesthesia
ordinarily is not required. Generally, dermabrasion is done as an outpatient
procedure.


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