Acne

Acne is a disorder resulting from the action of hormones on the skin's oil glands (sebaceous glands), which leads to plugged pores and outbreaks of lesions commonly called pimples or zits. Acne lesions usually occur on the face, neck, back, chest, and shoulders. Nearly 17 million people in the United States have acne, making it the most common skin disease. Although acne is not a serious health threat, severe acne can lead to disfiguring, permanent scarring, which can be upsetting to people who are affected by the disorder.

Who Gets Acne?

People of all races and ages get acne. It is most common in adolescents and young adults. Nearly 85 percent of people between the ages of 12 and 24 develop the disorder. For most people, acne tends to go away by the time they reach their thirties; however, some people in their forties and fifties continue to have this skin problem.

Myths About the Causes of Acne

There are many myths about what causes acne. Chocolate and greasy foods are often blamed, but foods seem to have little effect on the development and course of acne in most people. Another common myth is that dirty skin causes acne; however, blackheads and other acne lesions are not caused by dirt. Finally, stress does not cause acne.
At least four factors are important in the development of acne: plugging of the hair follicle with abnormally cohesive desquamated cells, sebaceous gland hyperactivity, proliferation of bacteria (especially Propionibacterium acnes) within sebum and inflammation (Figure 1).

How Is Acne Treated?

Acne is often treated by dermatologists (doctors who specialize in skin problems). These doctors treat all kinds of acne, particularly severe cases. Doctors who are general or family practitioners, pediatricians, or internists may treat patients with milder cases of acne.

The goals of treatment are to heal existing lesions, stop new lesions from forming, prevent scarring, and minimize the psychological stress and embarrassment caused by this disease. Drug treatment is aimed at reducing several problems that play a part in causing acne: abnormal clumping of cells in the follicles, increased oil production, bacteria, and inflammation. Depending on the extent of the person's acne, the doctor will recommend one of several over-the-counter (OTC) medicines or prescription medicines that are topical (applied to the skin) or systemic (taken by mouth). The doctor may suggest using more than one topical medicine or combining oral and topical medicines.

Categories of Acne

Acne can be classified into three categories for the purposes of treatment: comedonal, inflammatory and nodulocystic. Comedonal acne consists predominantly of open or closed comedones with little or no accompanying inflammation. This type of acne typically responds to topical keratolytic agents that decrease the cohesiveness of the follicular cells. Erythematous papules and pustules characterize inflammatory acne, but comedones may also be present. Topical agents alone may be insufficient to treat inflammatory acne, which may benefit from systemic antibiotics. Nodulocystic acne may consist of comedones and inflammatory lesions, as well as deeper nodules and cysts. Although a six-month course of systemic antibiotics may be effective, nodulocystic acne frequently requires treatment with isotretinoin (Accutane). Before the initiation of isotretinoin therapy, however, patients should be evaluated for other causes of antibiotic treatment failure. Unusual causes of recalcitrant acne include drug-induced acne, tropical acne, acne conglobata and acne fulminans.

Herbal and Mineral Acne Treatment Aids
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