Acne

Whether you call them blemishes, pimples, or zits, most of us experience mild acne at some point in our lives. More often a problem in the teen years, acne vulgaris, as it’s known medically, starts when skin pores become blocked by excess oil and dead skin cells. Some people have severe acne resulting in hundreds of pimples across the face, chest, and back, although many treatments can help.

What Causes Acne?

There are different types of acne. The most common acne is the type that develops during the teen years. Puberty causes hormone levels to rise, especially testosterone. High hormones cause signal skin glands to start making more oil (sebum). Oil releases from the pores to protect the skin and keep it moist. Acne begins when oil mixes with dead cells and clogs the skin's pores. Bacteria can grow in this mixture. And if this mixture leaks into nearby tissues, it causes swelling, redness, and pus. A common name for these raised bumps is pimples.

Certain medicines can cause acne to develop. This type of acne usually clears up when you stop taking the medicine.

It isn't just teens who are affected by acne. Sometimes newborns have acne because their mothers pass hormones to them just before delivery. Acne can also appear when the stress of birth causes the baby's body to release hormones on its own. Young children and older adults also may get acne.

A few conditions of the endocrine system, such as polycystic ovary syndrome and Cushing's syndrome, can lead to outbreaks of acne.

Home Treatment

Treatment at home can help reduce acne flare-ups.

• Wash your face (or other affected skin) gently one or two times a day.
• Do not squeeze pimples, because that often leads to infections, worse acne, and scars.
• Use water-based skin care products that gently clean your skin. Avoid products such as milky cleansers, cold creams, lipsticks, and lip glosses that contain oils.
• Use over-the-counter medicated creams, soaps, lotions, and gels to treat your acne. Always read the label carefully to make sure you are using the product correctly.

Examples of some over-the-counter products used to treat acne include:

• Benzoyl peroxide (such as Brevoxyl or Benzac), which unplugs pores.
• Alpha-hydroxy acid, which dries up blemishes and causes the top skin layer to peel. You'll find alpha-hydroxy acid in some moisturizers, cleansers, eye creams, and sunscreens.
• Salicylic acid (Propa pH or Stridex), which dries up blemishes and causes the top skin layer to peel.
• Tea tree oil, which kills bacteria. You'll find tea tree oil in some gels, creams, and oils.

Other products that may help your overall skin condition include skin pore-cleaning strips. When you peel these sticky strips off your skin, dirt and/or makeup is removed by the strip.

You'll have better results if you follow the directions for using topical medicines. If you use a product too often, acne can get worse.

Medications

Medicines can help manage the severity and frequency of acne outbreaks. A number of medicines are available. Your treatment will depend on the type of acne you have (pimples, whiteheads, blackheads, or cystic lesions). These medicines improve acne by:

• Unplugging skin pores and stopping them from getting plugged with oil (tretinoin, which is sold as Retin-A).
•  Killing bacteria (antibiotics).
•  Reducing the amount of skin oil (isotretinoin).
•  Reducing the effects of hormones in producing acne (certain oral contraceptive pills for women).

The best medical treatment for acne often is a combination of medicines. These could include medicine that you put on your skin (topical) and medicine that you take by mouth (oral).

Medication Choices

Treatment of acne depends on whether inflammation or bacteria are present. Some acne consists only of red bumps on the skin with no open sores (comedonal acne). Topical creams and lotions work best for this type of acne. But if bacteria or inflammation is present with open sores, oral antibiotics or isotretinoin may work better.

The most common types of medicines that doctors use to treat acne include:1

• Benzoyl peroxide, such as Brevoxyl or Benzac.
• Salicylic acid, such as Propa pH or Stridex.
• Topical and oral antibiotics, such as clindamycin, sulfacetamide, erythromycin, and tetracycline.
• Topical retinoid medicines, such as tretinoin (Retin-A), adapalene (Differin), and tazarotene (Tazorac).
• Azelaic acid, such as Azelex, a topical cream.
• Isotretinoin, an oral retinoid.
• Low-dose birth control pills that contain estrogen (such as Estrostep, Ortho Tri-Cyclen, or Yaz), which work well on moderate acne in women and for premenstrual flare-ups. Estrogen softens the effects of testosterone by lowering oil production.
• Androgen blockers, such as spironolactone. Androgen blockers can be useful in treating acne. These medicines decrease the amount of sebum (oil) made in your pores.

Medicine side effects In general, doctors prefer to use topical products for acne rather than oral antibiotics, which are more likely to have side effects. Oral antibiotic side effects can include:2, 3

• Yeast infections (women).
• Diarrhea.

What To Think About

If you are pregnant, talk to your doctor about whether you should take antibiotics for acne. Some antibiotics are not safe to take during pregnancy.

Over time, bacteria can become resistant to antibiotics, which means that the antibiotics are no longer effective at killing or controlling the bacteria causing the acne. This is called drug resistance. When this occurs, a different antibiotic may be used.

After acne is under control, you often need ongoing treatment to keep it from returning. This is the maintenance phase of treatment. Your doctor may suggest treatments other than antibiotics for long-term use, to avoid the risk of drug resistance.

Topical medicines usually have fewer and less serious side effects than oral medicines. But topical medicines may not work as well as oral medicines for severe acne.

Isotretinoin (such as Sotret) and tazarotene (Tazorac) can have serious side effects. Women who take isotretinoin or tazarotene need to use an effective birth control method, to avoid having a baby with serious birth defects. The U.S. Food and Drug Administration (FDA) has announced that the companies that make isotretinoin have a program to register doctors who prescribe isotretinoin and the people who take it. The program is to ensure that women taking this medicine understand the risk of birth defects, take precautions to avoid pregnancy, and know what to do if they become pregnant. If your doctor suggests that you take isotretinoin, you must be registered with iPLEDGE in order to get the drug.

The FDA’s Center for Drug Evaluation and Research division has also warned that isotretinoin (such as Sotret) may be linked with depression, psychosis, and, in rare cases, suicidal thoughts or attempts. The link between this medicine and depression is not clear and is being watched very closely. Talk to your doctor about the side effects of isotretinoin to decide whether it is right for you. If you are taking isotretinoin and feel depressed, see your doctor for treatment.