Diseases and Skin Conditions

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What is Acne?

Acne is a skin condition which has plugged pores (blackheads & whiteheads), inflamed pimples (pustules) & deeper lumps (nodules & cysts).  Acne occurs on the face, as well as the neck, chest, back, shoulders and upper arms. Acne can be disfiguring and upsetting to the patient.

Who gets Acne?

Close to 100% of people between the ages of 12 & 17 have at least an occasional whitehead, blackhead or pimple, regardless of race or ethnicity. In most cases, acne starts between the ages of 10 & 13 and usually lasts for 5 to 10 years. It normally goes away on its own sometime in the early 20’s. However, acne can persist into the late 20’s or 30’s or even beyond. Some people get acne for the first time as adults.

Acne affects young men and young women about equally, but there are differences. Young men are more likely to have more severe, longer lasting acne. Despite this, young men are less likely to visit a dermatologist for their acne. In contrast, young women are more likely to have intermittent acne due to hormonal changes associated with their menstrual cycle and acne caused by cosmetics. These kinds of acne may afflict young women well into adulthood.

What causes acne?

In order to understand how acne treatments work, it is important to understand that acne is a complex disease caused by four interacting factors:

  1. Too much waxy-oily substance produced (sebum)
  2. Abnormal thickening of the skin's outer layer (epidermis) resulting in plugged pores
  3. An increase in skin bacteria
  4. Inflammation

Acne has nothing to do with dirt or not washing your face. Acne is not caused by foods. However, if certain foods seem to make your acne worse, try to avoid them.


For treatment to work it must interfere with what is causing the acne. Today’s acne treatments do one or more of the following:

  • Decrease sebum production
  • Reduce P. acnes (bacteria)
  • Normalize skin shedding
  • Eliminate inflammation

What can be done at home about it?

Mild acne, which consists of blackheads & whiteheads, often clears up after several years, even without treatment & can be controlled at home by a simple skin care routine. Gentle washing with warm water & a mild soap twice a day to remove dead skin cells & excess oil may be adequate. Washing too often or too vigorously may actually make your acne worse. Wear as little cosmetics as possible.

Oil-free, water-based moisturizers and make-up should be used. Choose products that are “non-comedogenic” (should not cause whiteheads or blackheads) or “non-acnegenic” (should not cause acne). Remove your cosmetics every night with mild soap or gentle cleanser and water.

Acne itself or some of the treatments may result in an irritated skin. You can moisturise with a non- irritating moisturiser

Some people may be able to manage their acne with over-the-counter (non-prescription) treatments containing benzoyl peroxide or salicylic acid. At-home treatment requires 4-8 weeks to see improvement. Once acne clears, treatment must be continued to prevent new lesions from forming.


For some, however, even mild cases of acne may require the help of a dermatologist, who can assess the situation and determine an appropriate therapy. In these cases, combination therapy (two or more treatments) may be used. Combination therapy may include use of a prescription topical antibiotic or topical retinoid-like drug.

These prescription topicals can be very effective in clearing mild acne.


Antibiotics taken by mouth such as lymecycline, doxycycline , minocycline or erythromycin are often prescribed.

Birth control pills (e.g. Diane 35) may significantly improve acne, and may be used specifically for the treatment of acne. It is also important to know that oral antibiotics may decrease the effectiveness of birth control pills. As a precautionary measure use a second form of birth control.

In cases of unresponsive or severe acne, isotretinoin may be used. Patients using isotretinoin must understand the side effects of this drug. Pregnancy must be prevented while taking the medication, since the drug causes birth defects. However, under the supervision of a dermatologist, most side effects can be well managed. Therefore, monitoring with frequent follow-up visits is necessary.

Remember, for best results…

Tremendous gains have been made in acne treatment. Today, virtually every case of acne can be resolved. Speak to your dermatologist, sooner rather than later. The earlier you start acne treatment the better your chances of getting it under control. It is important to be realistic about your expectations and to remember that treatment takes time, at least several months.

Your dermatologist will evaluate you and suggest the appropriate treatment regimes considering your age, sex, and the type of acne you have.

In order to achieve the best possible results you need to use your acne treatments exactly as prescribed. Acne only clears when the treatment targets everything that is causing the acne. Since most acne medications target only 1 or 2 causes, 2 or 3 products are often necessary. To see clearer skin, these products must be used as prescribed.

Controlling acne is an ongoing process. All acne treatments work by preventing new acne breakouts. Existing blemishes must heal on their own, and therefore, improvement takes time. If your acne has not improved within two to three months, your treatment may need to be changed.

As with many things in life, there is no quick fix solution. It takes time for treatment to work and target the underlying problem. Keep motivated as the results are well worth it!


  • Use cosmetics that are noncomedogenic (this means it won’t cause blackheads and whiteheads)
  • Test new cosmetics on a patch of skin for a few days to see if your skin tolerates it
  • Use an effective, sun block when going into the sun
  • Be patient and stick to your treatment
  • Ask your dermatologist for advice
  • Avoid alcohol products which may irritate your skin
  • Never apply more medication than recommended by your doctor in the hope that it will work faster
  • Never pick or squeeze any pimple or lesion on your face

More advice…

  1. Never pop, squeeze, or pick acne. Popping and squeezing pimples, whiteheads, blackheads, and cysts tend to make acne worse. All this does is make the acne last longer.
    This can make it difficult to see clearer skin no matter what treatment you are using. Trying to get rid of a pimple by popping or picking also can lead to scarring, which can be permanent.
  2. Avoid abrasive soap, facial scrub, toner, astringent, and masks. These can irritate the skin, and irritated skin is more likely to break out. Irritated skin also makes it more difficult to tolerate acne medication.
    A mild cleanser used twice a day to wash the skin is actually more effective for controlling acne and preventing breakouts.
  3. Do not scrub your skin clean. While scrubbing away oil and grime may seem like a good idea, scrubbing actually irritates acne-prone skin. Irritating the skin generally leads to breakouts

    When washing the skin, use lukewarm (not hot) water and gently apply a mild cleanser with your fingertips. Washcloths and puffs tend to be too abrasive. Limiting washing to twice a day can help reduce irritation and dryness.

  4. Wait 5 to 15 minutes to apply acne medication. Applying acne medication right after you shower or wash your face can irritate the skin and lead to breakouts. Wet skin is most absorbent. To avoid irritation, dermatologists recommend waiting 5 to 15 minutes before applying acne medication.
  5. Use only oil-free skincare and hair care products. Makeup, hair gel, and other products used by people with acne-prone skin should not contain oil. Oil tends to clog pores and lead to breakouts. Look for products that are labelled “oil free,” “nonacnegenic,” or “noncomedogenic.” This means the product does not clog pores.
  6. Apply acne medication before makeup. Wearing an oil-free makeup is fine, but make sure it does not prevent the acne medication from working. Makeup should always be applied after topical acne medication.
  7. Continue using the medication when skin clears. To keep skin blemish free, most people with acne need to continue using at least 1 acne medication. If you have been using an over-the-counter product, you may be able to taper your use to a few times a week.
  8. Gently cleanse skin after sweating. Sweating, especially under a hat or helmet, can aggravate acne-prone skin. Gently cleansing the skin as quickly as possible afterwards can help prevent breakouts. When cleansing the skin, avoid the temptation to rub or scrub sweat from the skin. This can irritate the skin and cause breakouts.
  9. Give acne-fighting products enough time to work. As a rule of thumb, it takes 6 to 8 weeks before you begin to see an improvement. Improvement does not mean blemish-free skin, but a noticeable difference. It generally takes about 6 months to see clear skin.

Related Links

Adult Acne

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