Acne: How to treat it

Acne affects the skin of most teenagers and a significant number of adults.

The condition involves the buildup of sebum in the pores of the skin. Sebum is an oily substance made by the sebaceous glands under the skin.

When this becomes trapped, it can form pimples on the surface of the skin. These are small, red, pus-filled spots or zits. Breakouts range from mild and occasional to severe and ongoing.

Prompt treatment can help individuals overcome the emotional and psychological effects.

Pimples are not in themselves bad for overall health, although they can occasionally become infected or develop into cysts.

The major impact of acne is on quality of life. A person with acne can experience anxiety, embarrassment, and a loss of confidence.

Fast facts on pimples

Here are some key points about pimples. More information is in the main article.

  • Most teenagers and a significant number of adults experience pimples.
  • Prompt treatment of pimples can help to overcome the emotional and psychological effects.
  • Stress, anxiety, greasy hair, and a high-fat, high-sugar diet may increase the risk in some people.
  • Doctors recommend gently washing the face no more than twice daily.
  • Popping pimples increases the risk of infection.
  • Over-the-counter (OTC) pimple treatments often contain benzoyl peroxide, salicylic acid, and sulfur.
  • Prescription medication for pimples includes topical treatment, antibiotics, isotretinoin, and laser and light therapy.

What makes pimples worse?

It is unknown exactly why acne flares up for some people at certain points in their lives, but hormonal activity appears to play a role by causing an increase in sebum production.

Pimples are more common during puberty and adolescence, and women often find they break out just before menstruation.

Other factors include stress and anxiety, which can increase the levels of adrenaline and cortisol.

A hot, humid climate with an increased risk of sweating can also make it worse.

Some studies suggest that carbohydrate-rich foods or chocolate may trigger acne, but the link has not been confirmed.

Cooking greasy food may worsen symptoms due to the grease blocking pores. Eating greasy food, however, has not shown the same signs of directly affecting acne.

Home management

A number of home treatments and strategies may help to reduce the incidence of pimples.

Avoid touching the face

As far as possible, refrain from any touching of your face with your hands.

Hold your telephone away from the skin on your face as it may have on its surface skin residue or sebum. Glasses also collect sebum and skin residue, so clean them regularly.

Before touching the face, wash your hands with soap.

Shaving

People who shave should use safety razors with a sharp blade or an electric shaver.

Before shaving, soften the skin by having a warm shower or washing with warm, soapy water.

Keep your hands and nails as clean as you can by washing them regularly with soap. Keep your nails short.

Do not pop pimples

Bursting a pimple may push the infection further into the skin, causing more serious blockage and more severe swelling and redness.

The popping of pimples also increases the risk of scarring.

Urgent removal

Before an important event, such as a public-speaking engagement or wedding, it may be deemed socially preferable to get rid of a pimple.

Seek specialist treatment if removal of a pimple is urgent.

Loose clothing

If the pimples are on the back, shoulders, or other places normally covered by clothing, wear loose, cotton clothing where possible.

Headbands, caps, and scarves should be avoided or washed regularly.

Makeup

It is important to remove all makeup before going to sleep and to choose the right types.

Some products have a lower risk of triggering an outbreak. Look for the words noncomedogenic or nonacnegenic on the label.

Washing your face

Washing the face no more than twice each day can help.

Face-washing tips include:

  • using a mild soap and lukewarm water
  • wash gently and do not scrub the skin
  • gently apply an OTC lotion containing benzoyl peroxide with the fingertips

Hair

Sebum and skin residue collect in hair, so keep the hair clean and away from the face. Some hair products, such as those with cocoa or coconut butter, may worsen acne.

Sun exposure

Use of tanning beds or overexposure to sunlight may result in the production of more sebum, as well as increasing the risk of skin cancer.

Some medications for acne may also make the skin more prone to sunburn, so caution is advised.

Over-the-counter treatment

A range of OTC preparations is available from pharmacies and drugstores, usually in the form of gels, pads, creams, lotions, and soaps. Most of these are topical treatments, for applying directly onto the skin.

One popular suggestion is to put toothpaste on pimples to dry them out, but the ingredients in toothpaste may further irritate the skin. It is better to use an appropriate cream.

Most OTC products for pimples or acne contain the following active ingredients:

Resorcinol: This helps the breakdown of blackheads and whiteheads. The same active ingredient is used to treat dandruff, eczema, and psoriasis.

Benzoyl peroxide: This active ingredient attacks and kills bacteria and slows down the glands’ production of oil. Benzoyl works as a peeling agent, accelerating skin turnover and clearing pores. This, in turn, reduces the bacterial count in the affected area.

Salicylic acid: This breaks down blackheads and whiteheads and slows the shedding of cells that line the follicles of the oil glands.

It is effective in treating inflammation and swelling. Salicylic acid is also used as a fungicide and in many dandruff shampoos.

Salicylic acid causes the epidermis to shed skin more easily, prevents pores from becoming blocked, and creates space for new cells to grow.

Sulfur: This has been used for centuries to treat acne, psoriasis, and eczema. Sulfur helps by breaking down blackheads and whiteheads. It is unclear exactly how it works, but elemental sulfur slowly oxidizes to become sulfurous acid, which has antibacterial properties.

Retin-A: This unplugs blocked pores. Retin-A contains Tretinoin, an acidic form of vitamin A. Applied to the skin, it acts as a chemical peel.

Azelaic acid: This fortifies the cells that line the follicles, stops oil eruptions, and reduces bacterial growth.

It is a saturated dicarboxylic acid found naturally in wheat, rye, and barley.

Azelaic acid also reduces inflammation by removing free radicals.

It is useful for patients with darker skin who have dark patches on their face, known as melasma, or whose acne spots leave persistent brown marks.

OTC medications will have different concentrations of these active ingredients. It is advisable to start with the lowest strength.

At first, you may experience skin irritation, redness, or burning, but these usually stop with continued use.

People with sensitive skin are commonly advised to use creams or lotions.

Gels tend to be better for people with oily skins. Gels are usually alcohol-based and dry the skin.

Prescription medications

If OTC medications are not effective, a healthcare professional may be able to assist with a prescription for stronger medication.

Topical prescription treatments

Examples of topical medications that are available on prescription include tazarotene, adapalene, and tretinoin. They are all derived from vitamin A.

Some topical antibiotics may help to rid the skin of excess bacteria.

It may take a while to find a suitable dosage and combination.

Some people find that a prescription containing benzoyl peroxide combined with an antibiotic can help.

Benzoyl peroxide should be used sparingly, as too much can harm the skin and bleach clothes.

Dapsone gel may help patients with inflammatory acne.

Side effects linked to topical prescription medications include burning, peeling, redness, and stinging. The patient should keep in touch with their doctor to minimize adverse effects.

Antibiotics

Oral antibiotics, usually tetracycline, can be used together with a topical treatment for severe acne. Pregnant or breastfeeding mothers should take an erythromycin instead of tetracycline.

Most patients on oral antibiotics should notice improvements after about 6 weeks. A course may last from 4 to 6 months.

Tetracycline cannot be used with birth controlpills, and too much direct sunlight exposure should also be avoided.

Antibiotic resistance is a growing problem among patients with pimples.

Doctors will advise tapering off antibiotics as soon as symptoms start to improve, or as soon as it becomes obvious that the drugs are losing their efficacy.

When topical benzoyl peroxide is prescribed together with an oral antibiotic, the risk of antibiotic resistance is lower.

Isotretinoin

For very severe symptoms, such as deep cysts, antibiotics may not be enough.

Isotretinoin, also known as Accutane or Roaccutane, may be prescribed.

This is a systemic oral treatment, which means it is taken as pills and affects the whole body.

A course lasts 15 to 20 weeks. During this time, the doctor must monitor the patient closely, because there is a risk of serious side effects.

Isotretinoin must not be prescribed to pregnant women or anyone who might become pregnant, due to the risk of fetal abnormalities.

Adverse effects include severely dry and cracking skin, nosebleeds, joint pain, and liver damage.

Depression and suicidal tendencies have been linked to isotretinoin, but a causal relationship has not been confirmed.

Two-thirds of users find that their symptoms disappear long term after treatment.

Birth control

Women with pimples may benefit if they take a combination of norgestimate and ethinyl estradiol.

Birth control pills can slightly increase the risk of hypertension, blood clots, and heart disease.

Laser and light therapy

Laser and light therapy targets Propionibacterium acnes (p. acnes), the bacteria that cause acne inflammation.

This therapy reaches deep into the skin without affecting the surface. By damaging the sebaceous glands, it causes them to produce less sebum, or oil.

Use of this treatment is controversial and its safety and effectiveness have not been proven.

Chemical peels and microdermabrasion

Microdermabrasion is commonly used for skin rejuvenation and to improve the appearance of acne scars.

These cosmetic procedures may be more effective when used alongside other acne treatments.

Dermatologists use special chemical peels that are not available from pharmacies.

Drainage and extraction

Drainage and extraction is used to remove a large cyst, especially if the cyst has not responded to medication.

It reduces the pain and lowers risk of a scar. If the cyst has to be dealt with rapidly, the doctor may inject it with medication.

Anyone who is concerned about the severity of their acne should visit a doctor or dermatologist.

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