Aggravating acne.(Column)

Acne: It's the dreaded 4-letter word among teenagers. As common as it is, there is much confusion and many misconceptions about what causes acne and what can be done to treat it. In this column, I will cover the basics of acne, including causes, types, and treatment options. Although I will refer primarily to facial acne, the same principles apply to acne on the chest or back. Also, acne that is a component of conditions such as polycystic ovarian syndrome is not discussed here.

What is Acne?

Acne is a condition of the hair follicle, or pilosebaceous unit. When an abnormal amount of keratinous (skin) debris collects in the pilosebaceous unit and doesn't get shed properly, this debris creates a plug, called a comedone (co-mee-done). Comedones can be open (no overlying skin, known as blackheads) or closed (with a thin layer of overlying skin, known as whiteheads).

The sebaceous gland associated with that hair follicle adds oil to this debris, creating a hospitable environment for the ubiquitous bacteria, Propionibacterium acnes (P. acnes). As this bacteria thrives, it causes the pilosebaceous unit to bulge and then eventually rupture, causing varying degrees of inflammation in the surrounding skin. This inflammation results in papules (red bumps), pustules (zits, pimples), and cysts and nodules (the deeper painful acne lesions). Thus, there are two types of acne: comedonal and inflammatory. Many patients have both types concurrently. The type of ache can be further graded as mild, moderate, and severe.

Treatment Options

The types of treatment will vary depending on the types of lesions and severity. In general, there are several categories of treatment: topical and oral antibiotics, hormonal therapies, topical and oral retinoids, azelaic acid, sulfur-based medications, and salicylic acid.

Topical antibiotics are used to treat P. acnes, while the oral forms are used primarily as anti-inflammatories. Topical antibiotics include benzoyl peroxide, erythromycin and clindamycin. These medications come in various forms: benzoyl peroxide as a lotion cleanser or gel, erythromycin and clindamycin as lotions, or combination creams: Benzamycin (benzoyl peroxide/ erythromycin) and Benzaclin (benzoyl peroxide/clindamycin).