About Acne

Of all skin problems, acne is one of the commonest[1]. It affects people of all ages and backgrounds, showing up as whiteheads, blackheads, spots and pimples, and, in some people, deep painful bumps. Acne most commonly occurs on the face but can also appear on the back, chest, shoulders and neck. If left untreated (or if you pick or squeeze the spots), acne can leave scars that last into adulthood.

In most people, acne clears up after a few years. But some people continue to have this problem into their 20s and 30s – even beyond[2]. Acne affects not only a person’s skin, but can also have an impact on their emotional well-being; therefore treating acne is an important step in the right direction.

What causes acne?

Below are just a few factors that contribute to acne[3]:

Hormones

Acne usually begins around puberty, when males and females both experience an increase in the production of sex hormones (called androgens). These hormones have an effect on the activity and size of the sebaceous glands – glands in the skin that produce an oily substance called sebum to protect the hair follicles and the skin. When hormones surge during puberty, the sebaceous glands enlarge in the areas where acne occurs.

Clogged Pores

The lining of the wall of the hair follicle sheds skin cells, which then stick together with the sebum produced by the sebaceous glands. This causes a plug to form below the surface of the skin. This plug cannot be washed away. This process can take days to weeks for a visible spot to form. Whiteheads and blackheads are the result of this clogging of the pores. The sebum and cell debris together contribute to the growth of bacteria that naturally live in your pores.

Bacteria and inflammation

Your body's own immune system will naturally attempt to clear the clogged pores by sending in certain specialized cells that invade the follicle to help clean it up. However, in the process, the wall of the follicle may weaken and rupture, emptying the contents of the follicle into the surrounding tissue. When this occurs, swelling or redness can develop around the affected follicle, resulting in the larger bumps or pimples characteristic of acne. These are known as papules and pustules and can sometimes cause scarring.

Getting to the Root of the Problem

If you've tried over-the-counter lotions and creams and have not experienced noticeable improvement, you may want to make an appointment with your doctor or nurse. He or she will choose the appropriate treatment depending on the severity of your acne.

[1] Plewig & Kligman, Acne and Rosacea, 3rd edition, Springer-Verlag Berlin Heidelberg 2000; p1.
[2] Plewig & Kligman, Acne and Rosacea, 3rd edition, Springer-Verlag Berlin Heidelberg 2000; p27.
[3] Plewig & Kligman, Acne and Rosacea, 3rd edition, Springer-Verlag Berlin Heidelberg 2000; p28-29

Acne Myths

While society blames poor diet, stress and a number of bad habits as leading causes for the outbreak of acne, the truth is that these things have little or nothing to do with it. And while proper nutrition, exercise, plenty of sleep and regular gentle washing are great for the complexion and general health, they won’t fully prevent acne. So what can you do to prevent breakouts? For starters, learn to separate the myths from the facts.

Myth: People get acne from poor hygiene.
Fact: Acne begins below the surface of the skin when the hair follicle becomes plugged. Bacteria that cause inflammation in the hair follicles of your skin may contribute to the formation of acne spots and blackheads. However, the blackheads aren't plugged with dirt, and the spots simply won't get better with repeated washing. In fact, over-washing may actually irritate your skin.

Myth: Chocolate and fatty foods cause acne.   
Fact: Although eating too many fatty foods is never a good idea, studies show that no specific food has been proven to cause acne. However, every individual is different. Some people notice breakouts after eating certain foods – and these foods can differ depending on the person. If that’s the case for you, it can help to cut down on that food and see if it makes a difference.

Myth: Using makeup causes acne.
Fact: Some makeup can promote the clogging of pores. Look for makeup labeled "non-comedogenic," which is specially formulated not to clog your pores or aggravate skin.

Myth: Frequent washing of the face can reduce the oil and prevent new breakouts.
Fact: No matter how much you scrub, you can't prevent clogged pores. And washing too frequently or with harsh cleansers can over-dry and irritate your skin, causing it to produce more oil and make your acne worse. Try a mild cleanser such as Cetaphil® and gently wash your face no more than twice a day.

Myth: If I use a certain product, my spots will disappear within hours!  
Fact: There is no overnight cure for acne. The life-cycle of a spot can take 8 to 12 weeks to run its course. Therefore no medication will work overnight and it may take several weeks before you begin to see major improvements. If you are given a treatment by your doctor or nurse, be sure to follow his or her advice and stick with it for the recommended amount of time.

Myth: You just have to let acne run its course.
Fact: The truth is acne can be cleared up. If the acne products you have tried haven’t worked, consider seeing a doctor or nurse, who may refer you to a dermatologist if needed. With the products available today, there is no reason why someone has to endure acne or get acne scars.

Emotional Impact

Acne. It's never fun, and there's never a good time to get it. Whether you're a teen experiencing the first signs of a breakout or an adult who has suffered for years, acne can have a huge emotional impact on your confidence, your social life and your outlook.

Acne – from mild to severe – affects nearly 85% of people between the ages of 12 and 25[1]. The emotional impact of acne is both long-lasting and far-reaching. In a clinical study on quality of life, they found that acne patients (a relatively severely affected group) reported levels of social, psychological and emotional problems that were as great as those reported by patients with chronic disabling diseases such as asthma, epilepsy, and diabetes[2]. Not only can acne cause physical scars if left untreated, but it can also leave lifelong emotional scars[3], including:

• Reduced self-confidence
• Embarrassment
• Depression and anxiety
• Frustration and anger
• Poor body image

Managing the Emotional Effects of Acne

While you may not be able to make your acne completely disappear, there is plenty you can do to manage your condition. These tips can help:

• Get the information you need about acne and learn to distinguish fact from fiction in our Acne Myths section.
• Book an appointment with your doctor or nurse. A healthcare professional is there to help you and will evaluate your skin and may prescribe treatments for you.
• Cleanse your face regularly with a mild, non-soap cleanser, but not too often. Cleaning more than twice a day can irritate your skin, causing more breakouts. Cleansing will not prevent acne from occurring, but a gentle skin care routine can help maintain your skin’s integrity.
• NEVER squeeze, pick or pinch acne pimples or use sharp objects on them. This will only contribute to infection, inflammation and possible scarring.
• If you use cosmetics or moisturisers, be sure they are "non-comedogenic" or "non-acnegenic" (not acne causing).

[1] Plewig & Kligman, Acne and Rosacea, 3rd edition, Springer-Verlag Berlin Heidelberg 2000; p27.
[2] Mallon et al, The quality of life in acne: a comparison with general medical conditions using generic questionnaires, BJD 1999; 140: 672-676.
[3] Plewig & Kligman, Acne and Rosacea, 3rd edition, Springer-Verlag Berlin Heidelberg 2000; p727.

What to expect from your treatment

Although there is no quick cure for acne, it can be managed with the proper medication or a combination of medications. There are several prescription treatments, both topical (applied to the skin) and oral (taken by mouth), that are highly effective in treating the different types of acne. If you have tried pharmacy treatments with limited success, it may be time to see your doctor or nurse.

Effective acne therapy takes patience and perseverance. From the time a spot begins to form under the skin until it disappears can take 8 to 12 weeks. Therefore no medication — topical or oral — will work overnight. It may take several weeks for you to begin to see any major improvements. Your doctor can help you understand how the process works and when you can expect to see results.

If you are using creams, gels or lotions, it is important to cover the entire affected area (don’t just spot-treat), as the medication may help prevent new pimples from forming. It is also important to follow the instructions for applying these treatments, since using too much of the product will not help your skin get better faster and may lead to greater irritation.

Depending on the medication, you may experience some minor irritation or dryness. In most cases, this will go away as your skin becomes accustomed to the treatment. A non-comedogenic moisturiser (one that won’t clog your pores) may be helpful to manage any dryness that may occur.

As acne is related to hormonal changes in the body, it may continue to appear over many years. You may also notice that it gets better — and worse — over certain periods of time. Following your doctor’s advice and a good treatment plan can help you manage your acne and keep your skin clear.

Skin Care

Your skin is more than just the first thing people see about you – it's also the body's largest organ. Your skin serves as a defence against germs and the environment and is a reflection of your overall health. Treating your skin right should be part of your daily routine. Keeping it healthy and looking great gives you more confidence and allows your true beauty to shine through.

Diet & Hydration

While diet does not play a role in the formation of acne, eating a well-balanced diet with a variety of fruits and vegetables helps your body fight off infection and is beneficial for your overall health. And don't forget your water. Drinking eight or more glasses of water daily will help keep skin looking its best.

Cosmetics

Be sure to choose makeup and moisturisers that are labeled "non-comedogenic." They are specially formulated to not irritate your skin or clog your pores. To hide current spots, use a concealer that matches your skin tone – not a lighter shade like you would use for under your eyes. Lighter shades can bring more attention to the area. If you have red blemishes, experiment with green concealers. The green neutralizes the red; then you can follow with your foundation to blend.

Skin Regimen

Your skin care regimen should include daily washing with a mild cleanser, moisturizing and application of sunscreen. Washing too frequently or with a harsh cleanser can overly dry your skin, causing it to produce more oil. Again, choose moisturisers and sunscreen that are "non-comedogenic," so they won't cause additional pimples. Sunscreen is important to use every day, year-round, to combat the damaging effects of the sun.

And if you have persistent acne, see a doctor or other healthcare professional. He or she can prescribe effective treatments to combat the spots you have now and prevent future spots from forming.

Stress

While stress doesn't directly cause acne, it can cause fluctuations in your hormones. Hormones cause your pores to produce more oil, which can lead to clogged pores and spots. In today's busy world, we all experience stress, both good and bad. Try to minimize the bad stress, and remember to take time for yourself. Healthy ways to reduce stress include exercising, meditation and getting enough sleep.