Acne is a disease of the oil-producing glands and hair follicles of the skin. The most common areas in which acne occurs are the face, neck, chest, back, shoulders and upper arms. It can cause significant emotional distress and embarrassment and persists, even while under treatment. Scarring can occur, especially with the most severe forms of acne, and the tendency for people with the disease to traumatize the lesions with picking and squeezing. Individual lesions heal slowly and new lesions appear before the older are resolved.
There are effective treatments available, and new, more effective products are frequently introduced. Many people see a physician only when the disease becomes severe. Its best to start treatment as soon as the condition becomes a problem, physically and/or emotionally. The sooner the treatment is started, the better to achieve the best cosmetic result possible, lessen scarring and reduce or eliminate the toll on emotional well-being.
The American Academy of Dermatology has a system for classification of acne. It describes three levels of disease: mild, moderate and severe. Mild acne is defined by few to several papules and pustules (pimples), but no nodules. Moderate acne has several to many papules and pustules with few to several nodules. Severe acne is defined as the presence of numerous or extensive papules and pustules as well as many nodules.
Four factors work together to cause acne. They are:
- Overproduction of oil (sebum)
- Abnormal shedding of dead skin cells which irritate and plug hair follicles
- Bacteria (Propionibacterium acnes) and debris buildup
- Inflammation caused by the bodys immune response
Inflammation increases when the hair follicles open up, pouring out fats and bacteria into the surrounding skin. A plugged hair follicle may bulge above the surface of the skin to produce a whitehead. If the plug is open to the air the contents may darken, producing blackheads. A raised red spot with a white center is called a pimple. Blockage of the follicle and inflammation deep below the surface of the skin can cause lumps in the skin, called cysts.
Factors that can make acne worse include:
Hormones, called androgens, increase in puberty in both males and females, causing the sebaceous glands to increase in size and make more sebum. Oral contraceptives and pregnancy can cause hormonal changes that trigger the production of more sebum.
Several medications are known to cause or worsen acne, corticosteroids, androgens and lithium (used to treat bipolar disorder).
Some foods can trigger acne including dairy products and high-carbohydrate foods, such as bread, bagels, and chips, which increase blood sugar.
It is a myth that greasy foods, chocolate, and dirty skin cause acne. In fact, scrubbing the skin too vigorously and using harsh chemicals and soaps can irritate skin and make acne worse. Cleansing the skin with gentle products to remove excess oil and dead skin cells is effective and usually non-irritating.
There are a number of risk factors which can trigger and aggravate acne, hormonal changes being the greatest, especially in:
- Teenagers of both genders
- Two to seven days before menstruation
- Certain medications, especially corticosteroids, androgens and lithium
Other risk factors include:
- Recurrent direct contact with greasy or oily substances such as cosmetics
- A family history of acne
- Friction or recurrent pressure on the skin, such as cell phones and collars
- Stress doesnt cause acne but can aggravate it
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