Overview Of Acne Vulgaris
Acne vulgaris is a common skin condition characterized by pimples, often called “zits.” Sometimes, the person develops other skin conditions including blackheads, whiteheads, cysts, and other inflammation.
Commonly Associated With
Cystic acne, Pimples, or “Zits”
Causes Of Acne Vulgaris
Acne vulgaris occurs when pores (tiny holes on the surface of the skin) become clogged. These pores have a follicle at the bottom, which contain a hair and oil gland. These normally function by releasing oil that helps to keep the skin soft by removing old skin cells.
The pores often become clogged due to a variety of different substances. A plug, or comedone, occurs when a mixture of oil and/or skin cells blocks the pore. A whitehead is when the top of the plug (that shows on the outside of the skin) is white in appearance. A blackhead occurs when the plug is dark in appearance.
If bacteria become trapped in the plug, the person’s immune system can react to it, which causes pimples. These are typically full of some type of pus or pus-like material.
Acne that is deep within the skin can cause painful and hard cysts. This condition is called nodulocystic acne.
Acne vulgaris is most commonly seen in teenagers, but it can occur in anyone of any age, including infants. Acne is often associated with genetics, and frequently runs in families.
Possible triggers of acne include:
- Oily or greasy hair or cosmetic products.
- Hormonal changes that induce oilier skin, such as puberty-related changes, pregnancy, menstrual periods, stress, or birth control pills.
- Excessive rubbing, touching, or resting hands or objects on the face/skin.
- Certain medications, such as testosterone, estrogen, steroids, and phenytoin. Common birth control devices, such as some brands of specific IUDs, can worsen acne.
- Heavy sweating and long periods spent in high humidity environments.
- Research does not show a correlation between foods such as nuts, fried and greasy food, or chocolate cause acne.
- However, a few controversial studies have found a tenuous connection between acne and diets high in refined sugars or dairy products in some individuals.
Symptoms Of Acne Vulgaris
Acne commonly presents most heavily on the face and shoulders, but it can also occur on the arms, legs, trunk, back, and buttocks.
Skin changes can include:
- Papules, which are small red bumps
- Eventual scarring of the skin
- Crusting near or on skin bumps
- Redness around eruptions of the skin
- Pustules, which are small red bumps containing yellow or white pus
Exams & Tests
A medical professional can diagnose acne vulgaris with a simple physical examination. In most cases, it is not necessary to perform tests of any other kind. They may need to perform a bacterial culture with some patterns of acne to rule out infection if large pus bumps persist on the skin.
Treatment Of Acne Vulgaris
Steps to take to prevent acne:
- Avoid repeated skin washing or too much scrubbing.
- Clean the skin gently, using a nondrying and mild soap. Suggested brands include Neutrogena, Dove, Cetaphil, Basics, or CeraVe.
- Keep hair away from the face whenever possible.
- Remove all make-up and dirt from the skin every day. Wash skin at least once or twice a day, including after exercise.
- Shampoo hair daily if possible, especially when the hair is naturally oily.
- Make sure to use water-based or noncomedogenic cosmetics and skin creams. Testing has confirmed that noncomedogenic products do not clog pores and do not cause acne vulgaris in most individuals.
Be sure to:
- Try not wearing tight hats or headbands of any kind.
- Avoid touching the face with hands or fingers whenever possible.
- It may be best to avoid greasy creams or cosmetics.
- Never leave make-up on overnight, always be sure to remove it before going to sleep.
- Avoid aggressively scratching, squeezing, picking, or rubbing of existing pimples. Doing so could lead to slower healing, skin infections, and scarring.
- It is possible to improve acne vulgaris with small amounts of sun exposure, but for the most part all tanning does is hide the acne. Doctors do not recommend too much exposure to the sun (and ultraviolet rays), because it increases the risk for skin cancer and induces wrinkling.
If none of these strategies work to clear up the acne, use over-the-counter medications. Follow any directions given carefully and only use these products sparingly. They may contain sulfur, resorcinol, benzoyl peroxide, adapalene, or salicylic acid.
These medications typically work by drying up skin oils, killing bacteria, or causing the very top layer of the skin to peel away.
They can cause drying of the skin, redness of the skin, or excessive peeling of the skin, so be wary of over-using them.
One important note: medications that contain benzoyl peroxide can discolor or bleach clothing or towels, so apply them very carefully.
Medications From Your Health Care Provider
If acne vulgaris remains a problem despite the use of the prevention ideas listed above, a health care provider can discuss other options or prescribe more powerful medications if necessary.
Some oral antibiotics that can help treat acne include:
Doxycycline, tetracyclineminocycline, trimethoprim-sulfamethoxazole, erythromycin, and amoxicillin
Some topical antibiotics (applied directly to the skin) that can help include:
Clindamycin, dapsone creams of gels, erythromycin, derivatives of vitamin A, retinoic acid cream or gel, tretinoin, tazarotene, prescription formulas of sulfur, resorcinol, benzoyl peroxide, or salicylic acid, and topical azelaic acid
For those whose acne is caused by or worsened by hormones:
- Birth control pills can either help with the person’s acne or it can make their acne worse – it depends on the person
- A medication called spironolactone can help if birth control pills do not.
Minor procedures or other types of therapy treatments can also be helpful:
- A professional can suggest using dermabrasion to remove scars, chemical skin peeling, injection of cysts with cortisone, or drainage.
- Photodynamic therapy can also be an option for some. This involves the use of a chemical that is applied to the skin, then activated with exposure to blue light.
- Those who suffer from scarring and cystic acne could be recommended a medication called isotretinoin. This medication has known side effects, and the patient will have to be observed carefully during the course of the medication. Those who are capable of becoming pregnant who wish to take isotretinoin must use 2 forms of birth control before beginning the medication, and they are required to enroll in the iPledge program (which exists to limit the possible harm to unborn children, as this medication has been proven to produce severe birth defects) The iPledge program also applies to those without the risk of becoming pregnant. A health care provider will perform regular blood tests and exams during the course of this medication.