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Answers and Questions

What is it?

Acne is a disease of the pilosebaceous follicles that occurs when oil and dead skin cells clog the skin’s pores.

Where does acne usually occur?

Acne usually occurs on areas where there are large numbers of sebaceous (oil) glands such as face, neck, chest, upper back and shoulders.

What causes acne?

Acne is caused by the overactivity of the sebaceous glands (so they produce an excess of sebum onto the skin), especially sensitive, in people prone to acne, to normal blood levels of a hormone called testosterone, normally present in both men and women.

At the same time, the dead skin cells lining the openings of the hair follicles (the tubes that hold the hair) are abnormally cohesive and are not shed properly and block the follicles. These two effects combined cause a build-up oil in the hair follicles that become visible at the skin surface as whiteheads or blackheads.

On some people, acne does not progress beyond this stage; in other people, the build-up of oil in the hair follicles creates an ideal environment for a bacterium called Propionibacterium acnes (normally live harmlessly on the skin) to grow and to produce some enzymes which stimulates the inflammation. In more severe inflammatory acne, cysts develop and their rupture can spread the infection into nearby skin tissue, resulting in scars.

Which kind of lesions does acne cause?

Acne tipically causes one or more of the following:

How does acne begin?

Acne begins as a blockage to a sebaceous (oil) gland conduct. Certain hormones (androgens), released at puberty, cause the sebaceous glands to overproduce sebum (oil). Sebum combines with dead cells to form a plug in the hair follicles resulting in a comedone.

Who gets acne?

Both boys and girls. Acne usually develops at puberty when the hormones (testosterone and progesterone) which stimulate oil glands are first produced. Acne usually appears earlier in females than males, because females tend to start puberty earlier but males often have more severe and long lasting acne, because of much higher levels of testosterone. But women tend to have intermittent acne due to hormonal changes with their menstrual cycle and acne caused by cosmetics.

While most people outgrow their acne by their 20’s, some, especially women, have acne well into adulthood.

Can acne be hereditary?

If the mother and father had had acne, the son may too.

Does acne cause scars?

Acne, especially cystic acne, can cause scars in some people. To reduce scarring not squeeze or peek at blemishes, and also, avoid to scrub the skin.

Not true about acne

What does it cause the dark color of blackhead?

Dirt-blackhead get their dark colour through excess skin pigment – not dirt.

Can certain foods cause acne?

There is no evidence that certain foods cause acne. Food seems to have little effect on the severity of acne in most individuals. However if  you notice a relationship between certain foods such as chocolate, fatty foods, excessive amounts of milk or sweets, fried food and acne, it is best to avoid them. A balanced diet, is important not only to maintain healthy, but also to have a clear skin.

Does people with acne follow a particular diet?

NO. Scientifically there is no proof that some foods make acne worse. Eating occasional chocolate or sweet does not seem to make any difference to acne.

Why is acne caused during puberty?

Because in puberty there is the appearance of hormones (testosterone and progesterone) which stimulates oil glands.

What else causes or worsens acne?

Things you should avoid to do when having acne.

As soon as possible contact a dermatologist: before you start to treat properly your acne, before you heal from it.

Is there a grading system for acne?

Usually acne may be classified as:

Another method to classify the disease is identifying the most severe predominant lesions:

What is acne cosmetica?

Acne cosmetica is a low-grade crops of closed comedones on the cheeks of women aged 20-25 that were triggered by comedogenic substances in cosmetics.

What is adult acne?

Adult acne is defined as acne after the age of 25 years and appears to be more common in women than in men.

Two are the main forms of adult acne:

Is it important to keep spot-prone areas clean?

Yes, it is. It’s better to wash the affected area once or twice a day with a gentle cleanser. The skin needs a certain amount of oil to maintain its natural condition, so it is important to avoid aggressive washing with strong soaps, facial scrub, toners, or masks because they may dry your skin. Washing more doesn’t help as not washing at all.

What doesn’t acne worse?

What about acne and cosmetics?

This is  an usual question of women with acne.  “Noncomedogenic” designation for skin care products is a useful guide for patients when selecting cosmetics. There are some general guidelines for acne-patients:

How can acne be treated?

Acne can be treated in different ways: it depends on the type of acne, upon its severity and it varies between individuals.  Can be treated by applying topical preparations; if it does not respond to topical treatment may require systemic treatment.

Which is the goal of treatment?

How should topical antiacneic medicines to be used?

Topical preparations should be applied on all areas of the skin which are acne prone, not just on the inflamed spots present today. Sometimes topical treatments can cause redness and peeling, especially to start with. This tends to settle down reducing the number of times you use it. You can then build up your use gradually. But generally, to decrease the chance of skin irritation, it would be better to apply to dry skin after 20-30 minutes after washing the face, and apply every other day for the first two weeks. They have not to get near the eyes, the mouth and the area under the nose.

How should topical treatment work?

There are a number of topical remedies to treat acne (es. benzoyl peroxide, retinoids, azelaic acid, isotretinoin, topical antibiotics). Some work for their antibacterial effects, other can dry the skin and encourage the outer layer of skin to flake off, some with both effects.

Will home treatments work immediately?

No. It can takes weeks, if not months, for significant effects to be noticeable. Patients should have a realistic sense of timeline of acne treatment, so that they don’t become frustrated and discontinue therapy when they don’t see immediate improvement.

Are there systemic treatments for acne?

Yes, There are several oral treatments:

Will acne go away?

Yes. The goal of treatment is to keep acne under control until clears with time. Sometimes acne worsens for the first several weeks after treatment is initiated and then gradually improves. Once acne significantly improves, continued treatment is need to keep acne from appearing. The care of acne may require teamwork between the patient and the dermatologist. In fact medications may be added or deleted based on how the skin responds to treatment.