Acne is a disease of the oil glands (sebaceous glands) and occurs where these glands are the largest and most active (face, back, shoulders, and chest). It often begins at puberty but it may begin after the teenage years. All teenagers have some acne. One in three needs to take medicine for it. There is no magic age when acne clears up. Sometimes it can go on into the thirties or forties or longer. With good treatment tailored to your precise type of acne, we can achieve excellent control of the problem, but we could not cure acne.
An overproduction of certain hormones causes skin cells to reproduce. Then, those cells block off the oil glands. The blockage occurs within the middle layer of skin, so scrubbing your face does not get deep enough to remove the blockage. When oil glands are first blocked, they produce tiny white bumps called whiteheads or closed comedones. Bacteria may then grow in the blocked oil glands and produce red bumps or even pus bumps. When the oil grands open spontaneously, black color change is often noted, thereby called blackheads or open comedones.
Acne may flare for no clear reason. Some of the things that make acne worse include heat, humidity, hormones, cosmetics, oils, heredity, emotions, bacteria, and picking or rubbing at the acne.
- Washing – Acne is not caused by dirt, and scrubbing the skin is not a part of the treatment. Too much rubbing can irritate acne. Wash gently using a soft wash cloth or your finger tips. Be gentle! Do not use “buff puffs,” skin machines, or abrasive soaps.
- Antibiotics – Acne is not an infection! But normal skin bacteria that grow in the oil glands can make acne worse. Antibiotics are often used to treat acne when it is red or inflammed because the treatment lowers the growth of bacteria in the oil glands.
- Diet – The role of diet in causing acne is unknown. Foods that get a bad name for causing problems include chocolate, candies, dairy products, and peanut butter. If you feel strongly that something in your diet is making your acne worse, try stopping it for a while. Certain medicines are known to make acne worse, such as INH (a tuberculosis medicine), hormone pills, Dilantin® (a seizure medicine), lithium (mood stabilizer), very potent vitamins, and cough medicines that contain iodine or bromine.
- Picking and Squeezing – This will make your acne worse and cause prolonged healing, pigment changes, and sometimes scarring. If you aren’t aware you are picking when watching TV, reading, studying, driving a car, etc., wear gloves. Good gloves to wear are Dermal Gloves® found in most drugstores. If you pick in front of the mirror, use your will power to not pick.
Your doctor treats your acne from both the inside and the outside.
- Astringents – If you have very oily areas, you can use an astringent such as Sebanil® or Oxi pads to remove the excess oil.
- Large Pores – some people tend to have a grainy complexion or large prominent pores, mainly on the nose and mid-face.
- To open up the blocked oil glands, your doctor may prescribe tretinoin (Retin-A®) cream or gel, Adapalene (Differin®) cream or gel, tazerotene (Tazorac®) cream or gel, or benzoyl peroxide gels. All acne treatment applied to the skin can cause some dryness, irritation, and redness. This can really be a problem in winter. You can lessen irritation by applying your medicine properly. Only use a small amount and apply a thin coat. Avoid using it on sensitive areas, such as around the eyes, corners of the mouth, upper lip, and the creases about the nose. If you have an irritation problem,
- Be sure your skin is dry when you apply your medicine. A blow dryer set on a medium setting will help dry the skin before you apply your medicine.
- Also, a moisturizing cream applied to wet skin is helpful if it stays irritated.
- At first, these medicines are often applied every second or third night. Then, you can use them more often until they are used nightly. When you begin using these, your skin may be dry and red during the first 10 to 14 days of use. After that, you’ll do better and you won’t see these reactions.
- Slight worsening during the first 2-4 weeks has been noted in about 20% patients.
- If you have many large painful red bumps and pus bumps, an oral antibiotic will be used. Tetracycline, erythromycin, doxycycline, and minocycline are the drugs most often used. These pills are taken once or twice a day. Most often, you will need 8-10 weeks of treatment to improve your acne much. Each of these antibiotics has other side effects and cautions. Although you will receive detailed instructions, some of the things you should know include:
- Tetracycline should not be taken with food. It binds to calcium in dairy products and then you would not get the full dose. Stomach ache, excess sunburn, and vaginal yeast infections can occur with the use of tetracycline.
- Bactrim may cause hypersensitive reaction (rash) on the skin. Excess sunburn and vaginal yeast infections can occur with the use of tetracycline.
- Erythromycin may also cause stomach upset.
- Minocycline can cause headaches, make you dizzy, or cause blue-gray spots on your skin and mucous membranes. This pigment is most common in healing acne lesions and on the shins. Very rarely skin exposed to sun can become a diffuse blue or gray color. If you become dizzy or get a headache, you should skip taking the medicine for two days then restart again. If the symptoms come back, stop the medicine and call your health-care provider.
- If you have any adverse effects from the antibiotics, please stop the treatment and contact our clinics right away.
- Oi1 glands respond very slowly, and nothing will speed the response. Try not to get too upset with your slow response. Keep in mind that there is no medicine that will prevent you from ever having another pimple. After a good response, your doctor may wish to stop the oral antibiotics and use topical antibiotics in a solution or cream instead. If you do not respond to these treatments after 10 to l 2 weeks, your doctor may wish to try something else. Many over-the-counter preparations that claim they treat acne have not been proven to work. Some may make the acne worse.
- Cortisone Injections for inflamed lesions (nodules and cysts) plus warm compress are helpful. However, they may cause atrophy (depressions) or hypo-pigmentation (white spots). These side effects are rare and most often clear by themselves in time.
- Isotretinoin – One in twenty boys and one in two hundred girls will have painful deep scarring acne or cystic acne. Deep acne often responds to oral antibiotics and topical medicines, but some people may require isotretinoin pills. This is a strong medicine that calls for you to register in national I-Pledge program and be followed each month by your doctor for 5-7 months. Automatic refills are not permitted. Laboratory studies (blood drawn) are necessary each month to monitor for systemic side effects from the treatment. Oral contraceptives are often started one month before isotretinoin is prescribed for female patients of child-bearing age.
UW Dermatology Department
1 S. Park St 7th Floor
Madison, WI 53715
Clinic: 608 287-2450
American Family Children’s Hospital
Pediatric Dermatology Specialty Clinic
1675 Highland Ave.
Madison, WI 53792
Clinic: 608 263-6420
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 06/25/2010
Copyright © 06/25/2010 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#6491
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