ACNE-Ltd III
Adult Acne and Lifestyle Treatment Information

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About Acne

The desire exists today 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.

Acne vulgaris (common acne) is a condition of the sebaceous glands of the skin. These sebaceous glands surround each hair follicle and produce sebum, an oily substance, to lubricate the hair. Acne symptoms usually appears on the face, back and chest.

Acne is the most common skin disease during adolescence and early adulthood. It peaks 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.

The disease 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.

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 Terms 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 excoriée: 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. You can learn more about ocular rosacea on our Rosacea-Ltd website. And to learn more about ocular conditions and use of eye makeup please visit our Ocular Rosacea page.
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

Acne Scars

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.

Acne Rosacea

Acne rosacea is the combination of acne and rosacea and is sometimes called "adult acne" erroneously by some dermatologist and patients. Rosacea and acne are two entirely different skin disorders that happen to co-exist together at the same time. Rosacea is sometimes confused with acne with symptoms of facial redness, papules and pustules, but no pimples, blackheads or whiteheads. You may learn more about rosacea at Rosacea Ltd III.

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TYPES OF ACNE SCARS

After an acne lesion has healed, it can leave a red or hyper-pigmented blemish on the skin. This is actually not a scar, but rather a post-inflammatory change, which is part of the skin's natural healing process. The redness or hyper-pigmentation is seen as the skin goes through its healing and remodeling process, which takes approximately 6-12 months. If no more acne lesions develop in that area, the skin can heal normally. Generally the reddish or brownish acne blemishes that are left behind after an acne pimple occurs eventually fade with no need for treatment. Picking or squeezing acne can increase the risk for scarring. Any color change or skin blemish still present after 1 year is considered to be a permanent residual scar.

Most people recover from acne without any outward or visual signs, although some will have noticeable acne scars. The term acne scars 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. Most people will have acne scars that are mild. Acne scars are the result of a wound in our skin healing, resulting in too much collagen in that particular spot. Unlike other scars, however, acne scars are bound down and depressed within our skin. Since the wound occurs within the dermis from the original inflammation brought on by acne, the scar is often within the skin, rather than on its surface. This makes acne scarring very difficult to improve.

There are a number of different types of scarring caused by acne, which can be classified as follows:

Ice-pick scars are deep pits that are the most common and a classic sign of acne scaring. Ice-pick scars are narrow, sharp scars that make the skin appear it has been punctured with an ice pick, hence the name. They are usually narrower than 2 mm and extend into the deep dermis or subcutaneous layer. Ice-pick scars are usually too deep to correct with skin resurfacing treatments such as dermabrasion or laser resurfacing.
Boxcar scars are more angular scars that usually occur on the temple and cheeks, and can be either superficial or deep. These are similar in appearance to a chicken pox scars. Boxcar scars are round to oval depressions that have sharp vertical edges. Unlike ice-pick scars they do not taper to a point at the base. Shallow boxcar scars are 0.1-0.5 mm in depth and can usually be treated with conventional skin resurfacing techniques. Deep boxcar scars are >0.5 mm in depth and require full-thickness treatment techniques.
Hyper-trophic scars are raised scars, which stay within the boundary of the original wound and can reduce in size with the passage of time.
Keloid scars, on the other hand, are overgrowths of tissue, which expand beyond the original wound site. The scar is rubbery and firm and may itch. Often they form to be much larger than the original acne blemish.
Rolling scars is term used to describe scars that give the skin a wave-like appearance on the skin's surface due to their wide and shallow depth. Rolling scars occur as a result of tethering of otherwise normal-appearing skin to the subcutaneous tissue below. This process gives the skin a rolling or undulating appearance. Conventional skin resurfacing techniques do not work on rolling scars. They must be corrected by breaking up the subcutaneous fibrous bands.

If you have a red or brownish mark on your face that you got from an acne blemish, it should eventually fade. However, it may take 12 months or longer. The best way to avoid these kinds of marks by not squeezing or popping acne, no matter how tempting it may seem. The best approach is to get treatment for acne soon after it appears to prevent further severe acne and more scarring. If you have nodules, see your doctor or dermatologist for treatment. There are some topical skin care products and medications that can improve mild scarring, but most deep acne scars are treated with a combination of surgical procedures and skin resurfacing.

There are some ways to speed up this healing process:

Wearing a good sunscreen is important. Unprotected exposure to the sun causes more skin damage and delays healing.
Avoid the urge to picking at scabs. Scabs form to protect the healing process that is going on underneath them. Pulling a scab off before it is ready interferes with the healing and remodeling process, prolonging the time that post-inflammatory blemishes will be visible.
With increased awareness about the damage to the skin from free radicals, theoretically it would seem that an antioxidant would help treat post-inflammatory blemishes or even permanent scars. There are no scientific studies to support the theory that any oral or topical antioxidant prevents or heals skin damage. In fact, Vitamin E, when applied topically to healing wounds, has been shown to cause more harm than good. As antioxidant research continues, scientists may find a formulation that effectively reverses skin damage, but until then any claims of skin rejuvenation through the use of antioxidants are false.
Avoid the use of facemasks, peels or anti-wrinkle creams. These will not help in the healing process and may irritate your skin further, making the scars red and even more noticeable. Most serious scarring is caused by the more severe forms of acne, with nodules more likely to leave permanent scars than other types of acne.
Jojoba oil when applied to the skin can aid in the healing process. Jojoba oil has antimicrobial properties, which means it actually discourages the growth of some bacterial and fungal microbes that attack the skin. In addition, the chemical composition of jojoba closely resembles that of the skin's natural sebum, so it is easily absorbed and rarely causes allergic reactions, even in the most sensitive individuals. Jojoba oil is actually composed of liquid wax esters rather than oil. The body's natural sebum also contains wax esters, which act as a sort of natural moisturizer and environmental barrier for the skin. Jojoba oil can prevent the skin from becoming too oily. Because the structure of jojoba oil so closely resembles natural sebum, it can actually trick the skin into producing less natural sebum, which, unlike jojoba, can clog pores. Jojoba oil may help treat acne, both by reducing sebum production and by protecting the skin from harmful bacteria.

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We continually update this site to keep you informed of the latest scientific findings about acne.

This page last updated: March 12, 2010

ACNE-Ltd IIIAdult Acne and Lifestyle Treatment Information