Todd Reynolds MD
Teen Years: Acme of Acne
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Aug 6, 2008 - 9:02:36 AM

Acne can be a major source of anxiety during the teen years.  It usually will begin as the body produces more hormones as a normal part of puberty.  As many as 80% of teenagers and young adults will experience some form of acne. 

Each hair follicle on the skin contains oil-producing glands that assist in hair growth and skin protection.  These glands are down within the pores where each hair emerges.  The hair follicle and oil glands, collectively called the pilo-sebaceous unit, are located on all parts of the body except the palms and soles.  They are most dense on the face, upper neck, chest, and back.  Therefore, acne is mainly seen in these areas.

Androgens, what we consider to be “male hormones,” are the stimulators of these hair/gland units.  These hormones cause two changes that are precursors to acne development.  First, the oil glands get over-productive.  Secondly, the hair follicle cells proliferate and are sloughed off into the follicle.  These sloughed cells can obstruct the passageway out to the skin.  As a result, there is an accumulation of oil and cell debris within the blocked follicle.
This blockage is a setup for the next factor.  Bacteria can grow in this environment, and this, in turn, causes inflammation within the follicle.  We see this inflammation as a red bump or “zit.”  A plugged follicle that is open to the skin surface appears as a “blackhead” because the air turns the oil black.  A plugged follicle with a very thin layer of skin over it can appear white or a “whitehead.” 

If the follicle wall ruptures beneath the skin, it leads to worsening inflammation and the development of nodules or cyst.  Cystic acne tends to be more disfiguring and potentially scarring to the skin.

There are many myths and old wives’ tales about what will cause acne.  Foods such as chocolate or greasy foods such as French fries will not cause acne.  Both sexes get acne, but males tend to have worse cases due to the male hormones.  Heredity plays a role, as does your immune status.     

Some things can make acne worse.  Oil-based makeup, suntan oil, hair gels, and sprays; anything that can potentially block the follicles can lead to worsening of acne lesions.  Also, hard scrubbing of the skin, squeezing, or picking at acne lesions can cause follicle rupture within the skin and lead to more severe lesions. 

Medical treatment of acne is primarily aimed at unclogging the follicles, getting rid of the bacteria that can cause inflammation, and keeping the follicles open.  Soap and water and commercial facial washes remove oil and cell debris to unblock and keep pores open.  Prescription medicines, such as retinoids (Retin-A and others) work similarly.

Many over-the-counter medicines will contain a mild antibiotic ingredient such as benzoyl peroxide, sulfa, or salicylic acid.  These tend to work well for mild acne.  For moderate acne, prescription antibiotics can be used either in a topical or pill form.  Very severe cases, such as is seen with nodular cystic acne, may need more potent medications such as accutane.
 
It’s important to keep in mind that acne treatment can be a slow process.  Many medications can take several weeks or months to see improvements.  As always, if you have questions or concerns about acne, consult your regular doctor for individual treatment recommendations.

The content in this column is for informational purposes only.  Consult your physician for appropriate individual treatment.  Dr. Reynolds practices Family Medicine in Chesterfield.


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