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Guide Health: The science of acne and how to control it

Washing your skin and keeping it clean is ideal, but don't overdo it

Acne, scientifically known as acne vulgaris, affects about 80 per cent of people between 11 and 30 years of age, so it is indeed a common skin condition. Even if you are older, you may still experience acne because 12 per cent of people continue to have flare-ups late into their lives.

While it is not deadly, acne can be emotionally devastating. About half of sufferers have symptoms of depression and/or anxiety. If you had (or have) acne, you may identify with the social embarrassment and with the resulting emotional issues.

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Acne is the result of obstructed sebaceous follicles. The sebaceous glands are adjacent to hair follicles and produce oils or sebum which keep hairs and skin lubricated, moisturized and protected.

When the sebaceous glands become obstructed with dead skin cells and excess sebum, a plug or comedone forms. Open comedones are commonly referred to as “black heads” because they are exposed to air and become black in colour; closed comedones are called “white heads.”

The presence of comedones is the hallmark of acne. If the comedones become infected, a pimple which contains pus results.

Some people are more at risk for acne. About 80 per cent of the time, acne has a family tendency. Thus there may be a genetic factor involved or, alternatively, common family habits like diet may be the cause. Hormones are involved, and both male and female hormones are able to affect sebaceous glands.

Oily creams and ointments, for example oily cosmetics, can worsen acne if the added “grease” increases follicle obstruction.

It is unclear if foods play a role. Some people seem to have their acne worsen when they eat fatty foods while other people are not affected regardless of what dietary fats they consume. The theory is that some dietary fats enhance sebum production, but it is unclear exactly which foods are the offenders.

If you can link your acne “outbreaks” to the consumption of specific foods, then it makes sense to avoid the foods.

Physical pressure from headbands, chin straps, sports helmets, and even violins can worsen acne, especially if you are perspiring. Protecting your skin against the friction and using an absorptive fabric will reduce the risk for an acne exacerbation.

Washing the skin at least twice a day with a mild soap or soapless cleanser is ideal to keep the skin clean. Washing more often or with an antiseptic cleanser only irritates the skin so you not only have acne, but damaged skin as well.

You can remove the comedones by cleansing with hot water and gently expressing the comedones. However, this can be difficult and it can lead to irritated skin.

The most common treatments are benzoyl peroxide creams, lotions and gels used daily or twice daily. Although lower concentrations do not require a prescription, the higher ones do. It should also be noted, too, that because benzoyl peroxide is a type of peroxide, it can discolour pillow cases and clothing that comes into contact with it.

Exfoliants are found in some products, for example salicylic acid. The Proactiv line of products contains both benzoyl peroxide and salicylic acid; its effectiveness lies in its use as a complete system, that is, cleansing along with treatment.

Prescription treatments include both topical and oral antibiotics. Tetracycline, minocycline, and doxycycline capsules are prescribed for severe acne, although it is suggested that treatment be limited in order to prevent antibiotic resistance. Erythromycin and clindamycin creams and lotions are available, but it is recommended the product combine the antibiotic with benzoyl peroxide to reduce the risk for bacterial resistance.

Topical tretinoin and oral isotretinoin are exfoliants and highly active “peelers.” They are able to successfully remove comedones, reduce inflammation, and clear acne, but both topical and oral formulations are contraindicated in pregnancy. Contraception is recommended for both men and women if they are taking oral isotretinoin. Another complication of this group of drugs is their ability to increase sun sensitivity and the risk for sunburn.

Acne is usually self-limited. However, if you are affected, the skin condition can have major social and emotional impact. It may be true but it is not all that helpful to say that you are not alone. So remember, do keep your skin clean, and don’t be hesitant to obtain a prescription cream or lotion. Treating the acne may have a big impact for you!

About the author


Marie Berry is a lawyer/pharmacist interested in health and education.



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