When to Visit Doctor for Acne

Acne in most people is not a serious medical condition and does not require treatment or visit to a doctor. 

It affects almost everyone and causes misery due to its uncalled for dent in both self-confidence and self-esteem. But severe acne can make people extremely conscious of their physical appearance and might as well cause depression, anxiety or embarrassment when they socialise. Visit or call your doctor for acne if:

• Your acne is worsening despite good home care.

If, after careful and consistent treatment at home, your acne isn't improving or seems to be worsening, you should contact your doctor. Your dermatologist may prescribe acne mediations, and will have helpful advice regarding proper acne skin care and home treatment.

• You have nodules and cystic breakouts.

Nodules and cysts are very severe forms of breakouts and should be evaluated by a dermatologist. These deep blemishes can easily cause scarring, so they should be treated promptly. Even if you don't have cystic breakouts, call your doctor if your skin seems very inflamed or infected.

• You think your acne may be caused by a medication.

Certain medications, such as steroids and birth control pills, may cause acne. If you are taking any medications and your skin begins breaking out, let your doctor know.

• You are extremely upset or depressed about your skin.

Do you avoid social situations because of your skin? Do you feel depressed? If you feel like your acne is adversely affecting your life or self-esteem, please talk with your doctor. He or she will have treatment options available that can not only improve your skin, but also help you deal with the feelings of frustration and despair that can come along with acne.

Waiting for acne to clear on its own can be frustrating. Without treatment, acne can cause permanent scars, low self-esteem, depression, and anxiety.

 
To avoid these possible outcomes, dermatologists recommend that people treat acne. When the skin clears, treatment should continue. Treatment prevents new breakouts. Your dermatologist can tell you when you no longer need to treat acne to prevent breakouts.

Your doctor may prescribe antibiotics (to be taken orally or for topical application), hormone containing mediations or some other cream/lotion for topical application.

Ask your doctor about the potential side effects of the treatment. Some people require long term treatment to cure acne problem. Consult a dermatologist with whom you are comfortable as acne is as much an emotional condition as a physical one. In addition to treatment follow simple measures like regularly cleaning your face and avoiding foods which seem to worsen your acne (fried foods, chocolates and other hot food items.)

What Causes Acne?

Acne, medically known as Acne Vulgaris, is a skin disease that involves the oil glands at the base of hair follicles. 

It commonly occurs during puberty when the sebaceous (oil) glands come to life - the glands are stimulated by male hormones produced by the adrenal glands of both males and females.

The word acne comes from the word acme meaning "the highest point", which comes from the Greek akme meaning "point" or "spot" - it was originally misspelt, with an 'n' rather than an 'm' in 1835. 

Skin cells, sebum and hair can clump together into a plug, this plug gets infected with bacteria, resulting in a swelling. A pimple starts to develop when the plug begins to break down.

American Academy of Dermatology (AAD) describes that acne appears when a pore in our skin clogs. This clog begins with dead skin cells.

Normally, dead skin cells rise to surface of the pore, and the body sheds the cells. When the body starts to make lots of sebum (see-bum), oil that keeps our skin from drying out, the dead skin cells can stick together inside the pore. Instead of rising to the surface, the cells become trapped inside the pore.

Sometimes bacteria that live on our skin, p. acnes, also get inside the clogged pore. Inside the pore, the bacteria have a perfect environment for multiplying very quickly. With loads of bacteria inside, the pore becomes inflamed (red and swollen). If the inflammation goes deep into the skin, an acne cyst or nodule appears.

Mayo clinic lists three factors for occurrence of acne. They are as follows:

• Overproduction of oil (sebum)- Hair follicles are connected to sebaceous glands. These glands secrete an oily substance known as sebum to lubricate your hair and skin. When your body produces an excess amount of sebum and dead skin cells, the two can build up in the hair follicles and form together as a soft plug, creating an environment where bacteria can thrive.

•  Irregular shedding of dead skin cells resulting in irritation of the hair follicles of your skin

• Build-up of bacteria- •   When the oil is trapped inside the skin pores, some bacteria are produced which alter the composition of oil and it results in skin irritation.

Factors that may worsen acne:

These factors can trigger or aggravate an existing case of acne:

• Hormones. Androgens are hormones that increase in boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy and the use of oral contraceptives can also affect sebum production.
• Certain medications. Drugs containing corticosteroids, androgens or lithium are known to cause acne.
• Diet. Studies indicate that certain dietary factors, including dairy products and carbohydrate-rich foods — such as bread, bagels and chips, which increase blood sugar — may trigger acne.

Myths About Pimples

Do you think you already know a lot about acne? Think again as you might be surprised that some of the things you've heard about acne aren't true.

Myth 1- Acne only affects teenagers

Fact- No! Even adults can develop acne for the first time. Teens definitely suffer from the problem more because of puberty.

Myth 2- Acne occurs on dirty face

Fact- Acne is a complex skin disorder that can't be boiled down to simply "dirt." It's likely that the connection between the skin condition and dirt was made because blackheads are, well, black -- but blackheads aren't caused by dirt, either.

Myth 3- Scrubbing hard relieves acne

Fact- Scrubbing acne too hard can actually inflame blackheads. A cleanser with ingredients like benzyl peroxide, salicylic acid and sulphur compounds can help clear the skin.

Myth 4- Acne doesn’t need treatment

Fact- Acne should not be allowed to “run its course”. Various advanced treatments are available to treat acne the initial stage itself then why bother to tolerate the unsightly bumps.

Myth 5- Popping will make cure pimples

Fact- Popping pimples spreads inflammatory gunk into surrounding tissues which can cause scarring. Also if you pop it the wrong way, the bacteria can penetrate deeper into the skin.

Myth 6- Sunscreen can worsen acne

Fact- Picking the right sunscreen is the solution. Chemicals like Helioplex dissipate UV light using a chemical reaction which may cause acne. People prone to acne can use a physical sunscreen like zinc oxide instead.

Myth 7- Makeup aggravates acne

Facts- Some truth lies to this basis. Heavy makeup like thick liquid foundation can clog skin pores. Wear light lose powder foundations like mineral powder if you suffer from acne. Of course, thick foundation cover the pimple better but one needs to compromise.

Myth 8- Acne can be cured

Fact- Not yet! However, it can be treated effectively.

Myth 9- Acne is a cosmetic problem

Fact- It can affect one psychologically too. Acne can produce low self esteem and change the way affected people feel about themselves. Permanent scars can add up to it.

Myth 10- Tanning can clear up skin

Fact- while tan can temporarily mask acne, the sun can dry and irritate the skin leading to more breakouts. Chose a sunscreen that says noncomedogenic or nonacnegenic on the label, meaning it won’t clog pores.

Myth 11- Washing face frequently prevents breakouts

Fact- Washing face can remove dirt and oil from the face, unclogging the pores but getting overboard can make your skin dry and irritated.

Myth 12- Sex can cause acne

Fact- It is an age-old myth. Although the sex hormone testosterone is a major cause of acne, whether or not you engage in any sexual act has no effect on acne and definitely doesn’t cause 

Tips for acne troubles in summer

During summers, sweat and oil secretion increases and get deposited on the skin. An oily and sweaty skin also attracts more dirt and pollutants.

Which is why summers aggravate acne problem because of heat and sweat. Following are some tips to prevent skin from acne during the heated climate:

Cleansing is the keyword

Daily cleansing and skin care, with appropriate products, is the only way of protecting the skin from eruptions and oily-skin problems. The pores must be kept free of hardened oil and the oiliness of the skin surface must also be reduced.

If your skin is oily, an astringent toner should be used after cleansing. Wipe the face with it, using cotton. Some home ingredients can also be used. Rose water can be mixed with cucumber juice and applied on the face to reduce oiliness. Night-time cleansing is a must, to remove the pollutants that have been deposited on the skin during the day.

Wash your face with plain water

During summer, people tend to wash their face too often with soap and water. This actually destroys the normal acid-alkaline balance of the skin, since most soaps are alkaline in nature. If there is rash, pimples or acne, the face should be washed with a medicated soap, or medicated cleanser only twice a day, morning and night. You may wash the face several times a day with plenty of plain water.

No blackheads, no acne

Preventing blackheads help in the prevention of acne. If there are blackheads, a facial scrub should be used on the blackhead-prone areas. But do not apply scrubs on acne, pimples or rash. Mix rice powder with rose water. Apply it on the areas with blackheads daily. Rub gently on the skin with circular movements. Leave on for five minutes and wash off with water. This can be done after cleansing in the morning.

Avoid use of oily creams

If the skin is oily and prone to eruptions, avoid the use of oily creams and moisturisers. If there is dryness of the skin, it is usually a superficial dryness of the outermost layer. For this, mix one teaspoon each of honey and curd and apply daily, washing off with plain water after 20 minutes.

A paste of fresh methi leaves can also be applied on the skin. Keep it on for 15 to 20 minutes and wash off with water.

Neem leaves can also be used to treat rashes, pimples and acne. A handful of neem leaves can be simmered on very low fire in four cups of water for one hour. Leave it overnight. Next morning, strain and use the water to wash the face. Make a paste of the leaves and apply on pimples, rash and acne.

It is also important to make sure that the hair and scalp are kept scrupulously clean. If the scalp is oily, or if there is dandruff, it can lead to pimples and acne. Keep the hair away from the face while you sleep.

Cleanliness is an important aspect

If your skin is prone to pimples, wash your pillow covers and towels often in warm soapy water, after adding two teaspoons of an antiseptic solution.

Also remember to wash your cosmetic brushes very often and dry them thoroughly before putting them away.

Drink plenty of water

Acne can out of a congested system also. So, include fresh fruits, raw salads, sprouts and curd in your daily diet and drink 6 to 8 glasses of water. Add lime juice to a glass of water and have it first thing in the morning.

Last, but not the least, if acne makes an appearance, get professional care at right time, because acne can spread and cause extensive scarring.

Different Types of Acne Scars

Any burn, injury, or trauma like surgery can cause scars on skin. Of all kinds, acne scars are most distressing and widely discussed topic in the world.

Acne scars are common to teenagers as well as adults. They are not just unsightly but can cost you your confidence too.

To treat them, it is necessary to know the type of scar one has. Yes! Scars too have types.

Essentially there are four type of major acne scars. They are listed below:


Ice Pick Scars

Deep, narrow scars that appear like the skin has been pierced with a sharp object such as an ice pick are called ice pick scars.

They seem to make a small but deep hole in the skin which may look like a large, open pore.

An infection from a cyst or other deep inflamed blemishes can cause ice pick scars. The skin tissue is destroyed leaving a long column-like scar.

This type of scar can be treated through punch incision or punch grafting.

Boxcar scars

They are round or oval incisions with steep vertical sides. These scars are wider than the ice pick scars and give the skin a pitted appearance.

When acne destroys the collagen, tissue is lost. The skin above this area is left without support and a depression is formed.

Boxcar scars can be mild to severe, depending upon the amount of tissue lost.

Treatment for Boxcar scars include elevation, dermal fillers and laser resurfacing.

Rolling Scars

This type of scar is usually wave-like motion across a normal appearing skin.

When the fibrous bands of tissue develop between the skin and the tissue living below it, rolling scars are formed.

These bands pull the epidermis, binding it to the deeper structures of the skin.

This pulling of epidermis from within creates the wave-like appearance on the skin.

These types of scars can be treated with subcision.

Hypertrophic or Keloid Scars

This scar looks like a raised, firm mass of tissue. They often grow larger than the original acne.

Hypertrophic scars are mostly found on the torso, especially in men.

These scars are caused by an over-production of soften scar tissue unlike boxcar and ice pick scars that are caused by a loss of tissues.

These types of scars can be treated with steroid creams or injections that help shrink and flatten the scar. Interferon injections are also used for this purpose.

What is Acne Rosacea?

Rosacea is a skin condition that affects parts of the face. Symptoms can include facial flushing, facial redness, spots, thickening of the skin, and eye problems such as dry eyes and sore eyelids.

American Academy of Dermatology describes Rosacea in detail.

There are so many signs and symptoms that rosacea has four subtypes:

• Erythematotelangiectatic rosacea: Redness, flushing, visible blood vessels.
• Papulopustular rosacea: Redness, swelling, and acne-like breakouts.
• Phymatous rosacea: Skin thickens and has a bumpy texture.
• Ocular rosacea: Eyes red and irritated, eyelids can be swollen, and person may have what looks like a sty. 

Types of Rosacea-

Some people have more than one rosacea subtype at the same time. Each subtype requires different treatment.

Subtype 1: Facial redness, flushing, visible blood vessels

Signs and symptoms

• Flushing and redness in the centre of the face.
• Visible broken blood vessels (spider veins).
• Swollen skin.
• Skin may be very sensitive.
• Skin may sting and burn.
• Dry skin, roughness or scaling.
• Have a tendency to flush or blush more easily than other people.

Subtype 2: Acne-like breakouts

Signs and symptoms

• Acne-like breakouts, usually where the skin is very red.
• Acne-like breakouts tend to come and go.
• Oily skin.
• Skin may be very sensitive.
• Skin may burn and sting.
• Visible broken blood vessels (spider veins).
• Raised patches of skin called plaques (plaks).

Subtype 3: Thickening skin

Signs and symptoms

This subtype is rare. When it does occur, the person often has signs and symptoms of another subtype of rosacea first. The signs of this subtype are:

• Bumpy texture to the skin.
• Skin begins to thicken, especially common on the nose. When the skin thickens on the nose, it is called rhinophyma (rye-NO-fie-ma).
• Skin may thicken on the chin, forehead, cheeks, and ears.
• Visible broken blood vessels appear.
• Pores look large.
• Oily skin.
•  

Who gets rosacea?

Rosacea is common. Most people who get rosacea are:

• Aged 30-50 years.
• Fair-skinned, and often have blonde hair and blue eyes.
• Family history of rosacea.
• Prone to acne cysts and/or nodules.
• Women are a bit more likely than men to get rosacea. Women, however, are not as likely as men to get severe rosacea.

What causes rosacea?

Experts are not sure what the exact causes of rosacea are. The following related factors are said to contribute:

• Abnormalities in facial blood vessels

Skin specialists suggest that a major factor is probably abnormalities in the blood vessels of the face, which cause the flushing, persistent redness and visible blood vessels. What causes the inflammation of the blood vessels is still a mystery.

• Light skin colour

A much higher percentage of people with fair skin develop rosacea compared to other people.

• Demodex folliculorum (microscopic mite)

Demodex folliculorum lives on human skin and usually causes no problems. However, patients with rosacea have much higher numbers of these mites than others do. Experts do not know whether the mites cause the rosacea, or whether the rosacea causes the overpopulation of the mites - i.e. whether the high population of demodex folliculorum is the cause or the effect of rosacea.

• H. pylori bacteria

H. pylori, a bacteria found in the gut, stimulates the production of bradykinin, a protein known to cause blood vessels to dilate. Experts suggest that this bacterium may play a role in the development of rosacea.

• Family history (inheritance, genes)

30% to 40% of patients with rosacea have a close relative with the condition. Unfortunately, scientists do not yet know how which genes are involved and how they are passed on.

Treatment of Acne Vulgaris

Acne Vulgaris or Acne cannot be cured but can be efficiently treated. If home remedies do not correct the problem, one must seek medical help.

Essentially three types of drugs have proven to be effective in treating acne. They are prescribed by the dermatologist depending on the severity of the problem. They are as follows:

Benzyl Peroxide

• It is a common topical treatment for acne. It kills bacteria, reduces inflammation and helps to unclog pores. It effectively clears comedones (blackheads and whiteheads).
• It is an over-the counter drug and does not need a prescription to be bought. It comes with different names and strengths such as- 2.5%, 5% and 10%.
• You must wash your skin before applying it. It may commonly cause mild irritation. You can try using the lower strength if irritation happens.
• To prevent irritation, you can start with 2.5% preparation first and then increase it later if you want.
• Apply once daily for several hours and wash off. You can gradually increase the time left on the skin.
• Once used to it, you can apply it twice-a-day also.
• It may bleach your facial hair, bed linen or clothes that come in contact.

Retinoids

• Retinoids are great at unclogging blocked skin pores. They include adapalene, tretinoin and isotretinoin which come in various brand names.
• They also reduce inflammation to some extent. This is why they are used early in acne to treat comedones and mild inflammation.
• A prescription is needed for all retinoids.
• They could make skin red and peel it off. This trend could settle over time.
• The spots could become a little worse before improving.
• Skin could become sensitive to sunlight. Therefore, it is advised to be applied at night and washed off in the morning.
• Burning, irritation and dryness are common side-effects. So, less frequent application and lower strength are advised initially.
• While on a treatment for retinoids, one should not be pregnant or lactating as it could cause serious birth defects in the unborn child.

Azelaic Acid

• This alternative mainly functions on the blocked pores and unclogs them. Just like retinoids, it clears comedones.
• It does relieve inflammation to some extent but not as much as benzyl peroxide. However, azelaic acid causes less irritation than benzyl peroxide.

Antibiotics

• Various antibiotics come handy in treating acne. They reduce the number of bacteria and intensity of inflammation. But they fail at unclogging pores.
• This is why, they may treat inflamed acne but comedones may remain.
• Prescription is needed to buy topical antibiotics.
• They may cause mild irritation but generally cause lesser side-effects than other topical preparations.

Once the spots have cleared, acne commonly flares up again if you stop treatment. Therefore, after the spots have gone or are much reduced, it is common to carry on with a maintenance treatment to prevent acne from flaring up again.

It is common to need maintenance treatment for 4-5 years to keep acne away. This is typically until the late teens or early 20s. In a small number of cases, acne persists into the 30s, or even later. For these people it is possible to continue to treat the skin to keep it under control.