Adolescent & Adult Acne
Acne is the most common skin disease during adolescence and early adulthood. Adolescent acne in females between the ages of 14 and 17 and in males between the ages of 16 and 19. Males are affected more severely than females. Eighty-five percent of high school students will have some acne. Ten percent of those with adolescent acne will continue to suffer from it into their 20's and 30's. And sometimes "adult acne" will begin in the 20's, 30's and 40's and later years and continue due to stress and fatigue which can cause increased production of hormones by the adrenal gland with increased levels of androgens. These hormones worsen acne. Six percent of females and eight percent of males in their fifties and later still suffer from the symptoms of adult acne (acne rosacea). Acne rosacea affects more than 17 million adult Americans and approximately 60 million adults in other countries.
Adolescent acne usually begins one to two years before puberty and is caused by stimulation of the facial sebaceous glands by androgens, the male hormones. (Women also produce small quantities of male hormones; this is the basis of acne in women.) It is thought that acne sufferers, rather than having higher levels of the hormones, actually have sebaceous glands that are more sensitive to the hormone.
Today there is a desire to find new and innovative ways to treat acne, rosacea, dermatitis and other skin conditions naturally without the use of drugs, lasers and sometimes harmful chemicals. This is not an unrealistic acne treatment goal. It is possible to live with, control and manage acne treatment safely and effectively.
Most acne suffers have gained much knowledge in their battle with this skin condition, but unfortunately, most of the gained knowledge has not been helpful in solving the problem. Sadly most information available is about acne treatments that do not work, which results in years of frustration for the acne sufferer as usually they continue seeking information and migrate from dermatologist to dermatologist for years in their search for the best acne treatment answer. Knowledge of the symptoms does not solve the 'cause or etiology' of acne.
Three Acne-Causing Factors
Acne is caused by three factors:
- Abnormal keratinization of the lining of the sebaceous glands caused by androgen stimulation, resulting in plugging of the gland.
- Increased production of sebum by the sebaceous gland due to androgen stimulation.
- A bacterium, Propionibacterium acne, proliferates within the gland and modifies the sebum. Propionibacterium acne is a bacterium normally found on the skin.
The plugging of the gland and the action of the bacterium cause an intense inflammatory reaction, resulting in a blackhead (open comedone) or a whitehead (closed comedone). The color of the blackhead is due to melanin granules and is not dirt. Continued plugging and inflammation lead to the pustules (pimples), papules and cysts of acne.
Acne Types And Definitions
Acne vulgaris is the most common form of acne.
Comedonal acne: non-inflammatory lesions such as blackheads and whiteheads
Whiteheads: Whiteheads result when a pore is completely blocked, trapping sebum (oil), bacteria, and dead skin cells, causing a white appearance on the surface.
Papules: Papules are small, red, tender bumps with no head.
Pustules: Pustules are similar to whiteheads, but are inflamed, and appear as a red circle with a white or yellow center.
Nodules: Nodules are large, hard bumps under the skin's surface. Scarring is common.
Cysts: Cysts can appear similar to nodules, but are pus-filled, and have been described as having a diameter of 5mm or more across.
Acne conglobata: highly inflammatory, with cysts that communicate under the skin with abscesses and burrowing sinus tracts.
Acne rosacea: is not true acne. Rosacea, previously called acne rosacea, is a chronic skin disease that affects both the skin and the eyes. Rosacea is characterized by redness, bumps, pimples, and, in advanced stages, thickened skin on the nose. Rosacea usually occurs on the face, although the neck and upper chest are also sometimes involved. A mild degree of eye (ocular rosacea) involvement occurs in more than 50 percent of people with rosacea.
Adult Acne: the result of fluctuating hormones that occur naturally as we mature. Certainly pregnancy can sometimes worsen or improve the symptoms of adult acne because it profoundly affects hormones.
Perioral Dermatitis: tiny papules (red bumps), pustules (pus-filled yellowish bumps) and scaling with intense itching. Perioral dermatitis is usually localized to the surrounding area of the mouth and on the chin, or extend to involve the eyelids and the forehead.
Corticosteroid Acne: caused by the use of steroids. It results in pustular acne on the face, chest, back, arms and thighs.
Baby Acne: Infantile acne generally affects the cheeks, and sometimes the forehead and chin. It is more common in boys and is usually mild. In most children the symptoms settle down within a few months.
Acne cosmetica: acne caused by cosmetics, characterized by small pink bumps, the symptoms of acne cosmetica are usually quite mild, with little chance of scarring.
Acne excoriee: scratched or picked pimples.
Acne conglobata: a form of nodulocystic acne in which there are interconnecting abscesses and sinuses
Nodulocystic acne: a severe form of acne affecting the face, chest and back, characterized by multiple nodules and frequently, scars.
Factors That Worsen Acne
- Squeezing pimples can lead to rupture, more symptoms of inflammation, and permanent acne scars.
- Using cosmetics or other oily skin or hair products which block pores. All oily selenium should be avoided. Cosmetics, because of their chemical compounds, are directly related to acne. In fact, acne cosmetica, or acne caused by cosmetics, is a common mild form of acne. This type of acne is triggered by topical factors and not the complex processes that take place inside the body. Even those people who are not susceptible to acne sometimes suffer from acne cosmetica. Because it is generated by outside chemical substances, acne cosmetica is easy to get rid of. Acne cosmetica is small, rashy, pink bumps on the cheek, chin and forehead. It develops over a period of a few weeks or months and may be persistent for a long time. The outbreak can be stopped by end the use of the particular cosmetic which triggers the onset. In any condition, people suffering from acne should avoid using cosmetics. Studies have shown that make-up may not cause true acne, but it can worsen the existing acne condition. Many women find that their eye makeup can trigger or aggravate ocular symptoms that may mimic or cause ocular rosacea. Replace every three to four months the entire bottle of makeup as there is a good chance of bacterial growth from the applicator after use on your eyelids to the eye make up bottle. Often when you experience a flare or worsening of ocular irritation, simply replacing your eye makeup can easily solve the problem as bacteria can reproduce rapidly in mascara, eye liner or eye shadow containers. Each time you use an eye makeup product it is exposed to airborne bacteria and pollutants as well as bacteria that is always present on the skin's surface.
- Stress and fatigue can cause increased production of hormones by the adrenal gland with increased levels of androgens. These hormones can worsen acne symptoms. (Athletes who take anabolic steroids, which contain androgenic hormones, may experience symptoms of acne.)
- The pre-menstrual period in women can be a time of increased acne symptoms due to hormonal shifts. Approximately 70 percent of menstruating women experience minor acne symptoms before their period which is indicative of temporary hormone change.
- Similarly, some birth control pills contain androgens which can worsen acne symptoms.
- Winter tends to be a time of worse acne for many people, as the pores shrink in much colder weather, causing more clogging of pores. However, very warm weather provides a better environment for bacteria to grow on the skin exterior.
- Hats and headbands which cover the forehead can lead to a localized outbreak, as can excessive sweating.
- Dehydration can worsen acne symptoms. Consuming more water helps us to reduce facial redness and sebaceous gland oils. Adult acne is sometimes the result of stress and/or dehydration.
Goals of Acne Therapy
- Decrease the abnormal keratinization of the sebaceous gland
- Decrease production of sebum
- Reduce the bacterial effect
- Decrease symptoms of inflammation
The term "scarring" refers to a fibrous process in which new collagen is laid down to heal an injury. It affects 30% of those with moderate or severe acne vulgaris symptoms. Most people will have acne scars that are mild. However, some will have scars that look significant even to others. There are a number of different looking scars caused by acne. They can be classified as follows:
- Ice pick scars: Deep pits that are the most common symptoms and a classic sign of acne scaring.
- Boxcar scars: Angular scars that usually occur on the temple and cheeks, and can be either superficial or deep. These are similar to chicken pox scars.
- Hypertrophic scars: Thickened, or keloid scars.
- Rolling scars: Scars that give the skin a wave-like appearance.