How Dermatologists Treat Early Acne Signs

Today, there are a number of effective acne treatments and virtually every case of acne can be controlled. However, what clears one person's acne may not work for another person. This is why appropriate treatment begins with an evaluation by a dermatologist.

During the evaluation, the dermatologist will determine the severity and types of acne lesions present. The doctor may ask questions to learn how the acne affects the patient. Sometimes the acne worries the parents; however, a young adolescent may not be concerned about appearance. The dermatologist also will want to learn if the patient is willing to follow an at-home treatment plan.

After the evaluation, the dermatologist will decide what, if any, treatment is appropriate. For a young adolescent who has mild acne, the dermatologist may prescribe a low-dose topical retinoid or benzoyl peroxide. It is important to realize that appropriate treatment may require more than one medication. Sometimes a topical antibiotic is part of the treatment plan. Severe acne may require an antibiotic in pill form as well as topical medication.

Proper skin care plays an important role in acne treatment. The dermatologist can provide tips for taking care of acne-prone skin as well as provide product recommendations for everything from cleansers to sunscreen.

Using Medication as Directed Gets Results

To get clearing, acne medication should be used as directed. Some medications must be taken daily; others may be used intermittently. Before leaving the dermatologist's office, be sure that you understand how to use the medication and when to use it.

If using the medication as directed becomes a problem or the treatment plan does not seem to work, be sure to tell your dermatologist. There are many effective treatments available today.

It is important to realize that acne cannot be cured, but it can be effectively controlled. Keeping acne under control may require long-term treatment. Acne often returns when treatment is stopped, so continue to use your medication until your dermatologist tells you to stop. This helps prevent new acne lesions from forming.

A Lifelong Difference
Acne sometimes appears earlier than parents expect. If early acne develops, teaming up with a dermatologist can help keep acne from becoming severe as well as prevent physical and emotional scars. Preventing severe acne can make a difference that lasts a lifetime.

Early Acne Treatment Helps Prevent Physical and Emotional Scars

When acne is severe, large, red bumps called “cysts” form. Cysts can be painful and may cause permanent scarring. While not life threatening, these physical effects often cause extreme emotional distress that can last a lifetime.

Anxiety, loss of self-esteem, and depression are common in people who have acne. Even mild and moderate cases cause emotional distress. When asked to talk about how acne affects them, patients often mention feelings of inferiority, embarrassment, and depression. One teenager said, “I was more self-conscious about my skin, and at times very shy because I felt my acne made me very ugly.” A college student confessed that he avoided asking girls out because he thought, “She won't be interested because of how I look.” Another patient confided, “I got severely depressed, and sometimes I wouldn't go to school because I had a particularly large pimple, and I just didn't want to be seen like that.”

Severe or long-lasting acne can cause feelings of insecurity that last a lifetime. One study found that people who had acne for a significant amount of time tend to feel “scarred for life.” Long after the acne clears, they may have low self-esteem and feelings of inferiority.

To avoid these physical and emotional scars, dermatologists recommend that early acne be properly treated and that treatment continue for as long as necessary to prevent the acne from recurring.

Early Acne Often Predicts Severe Acne

When acne begins early, between 8 and 11 years of age, it often means severe acne as a teenager. Treating the acne before it becomes severe can:

• Prevent severe acne
• Reduce the risk of acne scars
• Avoid lifelong emotional stress

Studies Confirm Link Between Early Acne and Severe Acne

Two large-scale U.S. studies looked at how acne develops during adolescence. One of these studies evaluated the severity of acne in 468 boys who ranged in age from 9 to 15 years. About half of the boys were African-American and half were Caucasian. The researchers found that acne becomes more common and more severe in adolescent boys as they mature. The researchers concluded that keeping an eye on acne in preadolescents and young adolescents can help determine when treatment, which can prevent severe acne from developing, should begin.

To expand upon these findings, the researchers evaluated acne in girls. This study followed 871 girls for 5 years. Again, about half of the participants were African-American and about half were Caucasian. At the beginning of this 5-year study, the girls were in 4th or 5th grade. Following the girls over a five-year period showed results similar to the previous study. The researchers found that the number of acne lesions and the severity increased as the girls matured. The girls who had significantly more acne lesions at age 10, when the study began, had the most severe acne at age 15. The researchers concluded that the best way to predict how severe acne will be at age 15 is to determine the severity at age 10.

Do Not Use Acne Medications Duribng Pregnancy

Some potent acne medications must not be used by women who are pregnant or who may become pregnant because of the potential harm to a fetus. These medications include:

• Hormonal therapy – estrogen, flutamide, spironolactone
• Isotretinoin
• Oral tetracylines – doxycycline, minocycline, tetracycline
• Topical retinoids – adapalene, tazarotene, tretinoin

Women in their child-bearing years need to avoid pregnancy while using these medications.

Here's the lowdown on why these medications should not be used during pregnancy:

Hormone therapy. The “female” hormone, estrogen, and the anti-androgens, flutamide and spironolactone, are sometimes used to treat acne in women. None should be taken while a woman is pregnant. Flutamide and spironolactone can cause birth defects. It is not known if these medications can be passed along when a woman is breast feeding so the medications must also not be used if a woman chooses to breast feed.

Isotretinoin. Isotretinoin must not be used by a woman who is pregnant, trying to become pregnant or breast feeding.

This potent acne medication has revolutionized acne therapy due to its effectiveness in treating severe and therapy-resistant acne. However, isotretinoin also has the potential to cause some serious side effects. The most serious is the potential to cause severe birth defects in a developing fetus. For this reason, it is imperative that women taking isotretinoin follow the pregnancy-prevention program. This requires using 2 forms of birth control continuously beginning 1 month before therapy starts and not ending until 1 month after isotretinoin therapy is complete. A women taking isotretinoin must also be carefully monitored by her dermatologist during therapy. If pregnancy occurs, isotretinoin must be stopped immediately. Women planning a pregnancy should discontinue taking isotretinoin and maintain birth-control methods for at least 1 month before trying to become pregnant.

Oral tetracyclines. Tetracycline as well as doxycycline and minocycline—which are synthetically derived from tetracycline—must not be used by women who are pregnant or breast feeding because of potential side effects. These broad-spectrum oral antibiotics can inhibit bone growth and discolor permanent teeth in both a fetus and a child being breast fed.

Topical retinoids. The topical (applied to the skin) retinoids adapalene, tazarotene and tretinoin carry warnings stating that it is not known if these medications can adversely affect a developing fetus or child that is being breast fed.

5 Key Factors that Causes Acne in Different Skin Colors

Whether it's a few pimples or severe acne, there are five key factors that people with skin of color, especially those of African descent, should know before they begin acne treatment. Considering these factors can help individuals with skin of color make informed decisions about their treatment options and obtain better results.

5 Key Factors that Causes Acne in Different Skin Colors:

1. Dark skin prone to developing “dark spots.”

These darkened spots on the skin, which dermatologists call “post-inflammatory hyperpigmentation,” can occur at the site of a healed or healing inflamed acne lesion. Caused by excessive melanin production, this darkening of the skin is a normal reaction when dark skin becomes inflamed, such as after a rash, scratch or pimple. While these spots tend to gradually disappear over time, they are the number one complaint among dark-skinned patients with acne vulgaris. Like acne, “dark spots” can diminish one's self-esteem and affect a person's ability to function confidently in society.

How to treat “dark spots.” When these spots appear, they can be treated with a topical skin-lightening product. Some skin-lightening agents are available over-the-counter, and stronger forms can be obtained from a dermatologist. Dermatologists can also recommend cosmetic tips that will make the spots less apparent. Additionally, some topical acne treatments used by dermatologists may help fade the discoloration.

Sunscreen may help. Although there are no clinical studies to confirm this, some dermatologists find that repeated sun exposure leads to longer treatment time and that daily use of sunscreen (SPF of 15 or higher) helps resolve the spots more quickly. Only sunscreen labeled “noncomedogenic” should be used. “Noncomedogenic” means the product will not clog pores.

2. Acne treatments designed to dry the skin should be use with caution.

Acne medications that can have a drying effect on the skin, such as benzoyl peroxide, should only be used under the supervision of a dermatologist as these medications may irritate the skin and prolong post-inflammatory hyperpigmentation in some cases. Benzoyl peroxide can also decolorize skin.

Topical acne medications for skin of color. Clinical studies show that some topical medications, such as retinoids, safely and effectively treat acne in skin of color without the drying effects when used properly. Topical retinoids, which are only available by prescription, include adapalene, tazarotene and tretinoin.

3. Pomade may be the culprit.

A recent survey of acne patients with skin of color revealed that almost half, 46.2%, use pomade (oil or ointment for hair) to style or improve the manageability of their hair and that 70.3% of the patients using pomade developed forehead acne. The acne that develops from using pomade is called “acne cosmetica” or “pomade acne.” It occurs when pomade blocks pores and acne develops on the scalp, forehead and/or temples—places where pomade comes into contact with the skin. Pomade acne usually consists of blackheads and whiteheads, with perhaps a few papules and pustules.

Treatment. For pomade acne, treatment consists of these options:

• If using pomade to decrease scalp dryness, try applying pomade one inch behind the hairline.
• If using pomade to style or make hair more manageable, try applying pomade to the ends of the hair only to avoid contact with the scalp and hairline.
• Stop using pomade.

Once use of pomade stops, pomade acne should clear. If it persists, be sure to see a dermatologist.

Folliculitis. Pomade can also contribute to a bacterial infection of the scalp called “folliculitis,” in which pus bumps and redness develop around the hair. Folliculitis can cause hair loss and the spread of infection. If folliculitis is suspected, discontinue using pomade and see a dermatologist.

4. Moisturizers can worsen acne.

Moisturizers relieve the dry or “ashy skin” that is common among dark-skinned people. When using moisturizer, make sure the label includes the word “noncomedogenic.” This means the product will not clog pores. If acne gets worse after moisturizing with a product labeled “noncomedogenic,” discontinue moisturizing and seek the advice of a dermatologist.

5. Keloid may form after acne outbreak.

When scarring occurs in a person with skin of color, there is a greater tendency for a keloid (large raised scar that spreads beyond the size of the original wound) to form. While uncommon in acne patients with skin of color, keloids have been seen on the chest, back and jaw line. Early and aggressive acne treatment is needed to prevent scarring because keloids, unfortunately, tend to return even when treated.

Treatment. Scar treatment should be discussed with a dermatologist or dermatologic surgeon before it is undertaken. Depending on the location, treatment may involve pressure, silicone gels, surgery, laser treatment or radiation therapy.

Before beginning any acne treatment, be sure to consider these key factors and direct your questions to a dermatologist. But, don't delay treatment as dermatologists recommend early and aggressive acne treatment in skin of color to prevent scarring and darkened spots from developing.

How to Tell When You Need to See a Dermatologist

You may feel awkward about seeing a dermatologist, especially if you've been told that acne is something you will eventually outgrow. To help you decide whether or not it's time to consult a dermatologist, listed below are some statements. Do any apply to you?

• My acne makes me shy.
• I am embarrassed by my acne.
• My outlook on life is less optimistic since I developed acne.
• None of the over-the-counter products and/or remedies I've tried has worked.
• I am beginning to see scars after acne lesions clear.
• I have painful, pus-filled lesions (nodules) in addition to blackheads and whiteheads (comedones), and reddened spots on my skin.
• I have dark skin, and a patch that is darker than my skin appears when an acne lesion clears.

If you said “yes” to any of the above statements, seeing a dermatologist may be beneficial. Today, virtually every case of acne can be successfully resolved. Not only can dermatologists help resolve existing acne, they can also help prevent new lesions from forming and reduce your chance of developing disfiguring scars.

How Acne Affects People's Lives

"There is no single disease which causes more psychic trauma, more maladjustment between parents and children, more general insecurity and feelings of inferiority and greater sums of psychic suffering than does acne vulgaris." -- Sulzberger and Zaldems, 1948

While known for quite some time, the psychosocial effects of acne have not been fully appreciated until recently. The reasons for this are many. After all, everyone gets acne to one degree or another. In most cases, it goes away on its own. While it's running its course, it is not a serious threat to anyone's overall physical health. In addition, until the last couple of decades, there was very little anyone could do to treat it.

Acne, nonetheless, has a significant impact on a person's outlook on life. Recent studies have detected the following as common among people with acne:

• Social withdrawal
• Decreased self-esteem
• Reduced self-confidence
• Poor body image
• Embarrassment
• Feelings of depression
• Anger
• Preoccupation
• Frustration
• Higher rate of unemployment

The effects listed above are often interrelated, with one effect leading to another and another, only to make the first effect worse. These negative psychosocial effects can have a crippling impact, discouraging patients from pursuing life's opportunities--socially, on the job, or at school.

What are the Treatments for Acne Scars

A number of treatments are available for acne scars through dermatologic surgery. The type of treatment selected should be the one that is best for you in terms of your type of skin, the cost, what you want the treatment to accomplish, and the possibility that some types of treatment may result in more scarring if you are very susceptible to scar formation.

A decision to seek dermatologic surgical treatment for acne scars also depends on:

• The way you feel about scars. Do acne scars psychologically or emotionally affect your life? Are you willing to "live with your scars" and wait for them to fade over time? These are personal decisions only you can make.
• The severity of your scars. Is scarring substantially disfiguring, even by objective assessment?
• A dermatologist's expert opinion as to whether scar treatment is justified in your particular case, and what scar treatment will be most effective for you.

Before committing to treatment of acne scars, you should have a frank discussion with your dermatologist regarding those questions, and any others you feel are important. You need to tell the dermatologist how you feel about your scars. The dermatologist needs to conduct a full examination and determine whether treatment can, or should, be undertaken.

The objective of scar treatment is to give the skin a more acceptable physical appearance. Total restoration of the skin, to the way it looked before you had acne, is often not possible, but scar treatment does usually improve the appearance of your skin.

The scar treatments that are currently available include:

Collagen injection. Collagen, a normal substance of the body, is injected under the skin to "stretch" and "fill out" certain types of superficial and deep soft scars. Collagen treatment usually does not work as well for ice-pick scars and keloids. Collagen derived from cows or other non-human sources cannot be used in people with autoimmune diseases. Human collagen or fascia is helpful for those allergic to cow-derived collagen. Cosmetic benefit from collagen injection usually lasts 3 to 6 months. Additional collagen injections to maintain the cosmetic benefit are done at additional cost.

Autologous fat transfer. Fat is taken from another site on your own body and prepared for injection into your skin. The fat is injected beneath the surface of the skin to elevate depressed scars. This method of autologous (from your own body) fat transfer is usually used to correct deep contour defects caused by scarring from nodulocystic acne. Because the fat is reabsorbed into the skin over a period of 6 to 18 months, the procedure usually must be repeated. Longer lasting results may be achieved with multiple fat-transfer procedures.

Dermabrasion. This is thought to be the most effective treatment for acne scars. Under local anesthetic, a high-speed brush or fraise used to remove surface skin and alter the contour of scars. Superficial scars may be removed altogether, and deeper scars may be reduced in depth. Dermabrasion does not work for all kinds of scars; for example, it may make ice-pick scars more noticeable if the scars are wider under the skin than at the surface. In darker-skinned people, dermabrasion may cause changes in pigmentation that require additional treatment.

Microdermabrasion. This new technique is a surface form of dermabrasion. Rather than a high-speed brush, microdermabrasion uses aluminum oxide crystals passing through a vacuum tube to remove surface skin. Only the very surface cells of the skin are removed, so no additional wound is created. Multiple procedures are often required but scars may not be significantly improved.

Laser Treatment. Lasers of various wavelength and intensity may be used to recontour scar tissue and reduce the redness of skin around healed acne lesions. The type of laser used is determined by the results that the laser treatment aims to accomplish. Tissue may actually be removed with more powerful instruments such as the carbon dioxide laser. In some cases, a single treatment is all that will be necessary to achieve permanent results. Because the skin absorbs powerful bursts of energy from the laser, there may be post-treatment redness for several months.

Skin Surgery. Some ice-pick scars may be removed by "punch" excision of each individual scar. In this procedure each scar is excised down to the layer of subcutaneous fat; the resulting hole in the skin may be repaired with sutures or with a small skin graft. Subcision is a technique in which a surgical probe is used to lift the scar tissue away from unscarred skin, thus elevating a depressed scar.

Skin grafting may be necessary under certain conditions—for example, sometimes dermabrasion unroofs massive and extensive tunnels (also called sinus tracts) caused by inflammatory reaction to sebum and bacteria in sebaceous follicles. Skin grafting may be needed to close the defect of the unroofed sinus tracts.

Treatment of keloids. Surgical removal is seldom if ever used to treat keloids. A person whose skin has a tendency to form keloids from acne damage may also form keloids in response to skin surgery. Sometimes keloids are treated by injecting steroid drugs into the skin around the keloid. Topical retinoic acid may be applied directly on the keloid. In some cases the best treatment for keloids in a highly susceptible person is no treatment at all.

In summary, acne scars are caused by the body's inflammatory response to acne lesions. The best way to prevent scars is to treat acne early, and as long as necessary. If scars form, a number of effective treatments are available. Dermatologic surgery treatments should be discussed with a dermatologist.

What are th Types of Acne Scars

There are two general types of acne scars, defined by tissue response to inflammation: scars caused by increased tissue formation, and scars caused by loss of tissue.

Scars Caused by Increased Tissue Formation
The scars caused by increased tissue formation are called keloids or hypertrophic scars. The word hypertrophy means "enlargement" or "overgrowth." Both hypertrophic and keloid scars are associated with excessive amounts of the cell substance collagen. Overproduction of collagen is a response of skin cells to injury. The excess collagen becomes piled up in fibrous masses, resulting in a characteristic firm, smooth, usually irregularly-shaped scar.

The typical keloid or hypertrophic scar is 1 to 2 millimeters in diameter, but some may be 1 centimeter or larger. Keloid scars tend to "run in families"—that is, abnormal growth of scar tissue is more likely to occur in susceptible people, who often are people with relatives who have similar types of scars.

Hypertrophic and keloid scars persist for years, but may diminish in size over time.

Scars Caused by Loss of Tissue

Acne scars associated with loss of tissue—similar to scars that result from chicken pox—are more common than keloids and hypertrophic scars. Scars associated with loss of tissue are:

Ice-pick scars usually occur on the cheek. They are usually small, with a somewhat jagged edge and steep sides—like wounds from an ice pick. Ice-pick scars may be shallow or deep, and may be hard or soft to the touch. Soft scars can be improved by stretching the skin; hard ice-pick scars cannot be stretched out.

Depressed fibrotic scars are usually quite large, with sharp edges and steep sides. The base of these scars is firm to the touch. Ice-pick scars may evolve into depressed fibrotic scars over time.

Soft scars, superficial or deep are soft to the touch. They have gently sloping rolled edges that merge with normal skin. They are usually small, and either circular or linear in shape.

Atrophic macules are usually fairly small when they occur on the face, but may be a centimeter or larger on the body. They are soft, often with a slightly wrinkled base, and may be bluish in appearance due to blood vessels lying just under the scar. Over time, these scars change from bluish to ivory white in color in white-skinned people, and become much less obvious.

Follicular macular atrophy is more likely to occur on the chest or back of a person with acne. These are small, white, soft lesions, often barely raised above the surface of the skin—somewhat like whiteheads that didn't fully develop. This condition is sometimes also called "perifollicular elastolysis." The lesions may persist for months to years.

How to Prevent Having Acne Scars

As discussed in the previous section on Causes of Acne Scars, the occurrence of scarring is different in different people. It is difficult to predict who will scar, how extensive or deep scars will be, and how long scars will persist. It is also difficult to predict how successfully scars can be prevented by effective acne treatment.

Nevertheless, the only sure method of preventing or limiting the extent of scars is to treat acne early in its course, and as long as necessary. The more that inflammation can be prevented or moderated, the more likely it is that scars can be prevented.

What are the Causes of Acne Scars

In the simplest terms, scars form at the site of an injury to tissue. They are the visible reminders of injury and tissue repair. In the case of acne, the injury is caused by the body's inflammatory response to sebum, bacteria and dead cells in the plugged sebaceous follicle. Two types of true scars exist, as discussed later: depressed areas such as ice-pick scars, and raised thickened tissue such as keloids.

When tissue suffers an injury, the body rushes its repair kit to the injury site. Among the elements of the repair kit are white blood cells and an array of inflammatory molecules that have the task of repairing tissue and fighting infection. However, when their job is done they may leave a somewhat messy repair site in the form of fibrous scar tissue, or eroded tissue.

White blood cells and inflammatory molecules may remain at the site of an active acne lesion for days or even weeks. In people who are susceptible to scarring, the result may be an acne scar. The occurrence and incidence of scarring is still not well understood, however. There is considerable variation in scarring between one person and another, indicating that some people are more prone to scarring than others. Scarring frequently results from severe inflammatory nodulocystic acne that occurs deep in the skin. But, scarring also may arise from more superficial inflamed lesions.

The life history of scars also is not well understood. Some people bear their acne scars for a lifetime with little change in the scars, but in other people the skin undergoes some degree of remodeling and acne scars diminish in size.

People also have differing feelings about acne scars. Scars of more or less the same size that may be psychologically distressing to one person may be accepted by another person as "not too bad." The person who is distressed by scars is more likely to seek treatment to moderate or remove the scars.

What is Acne Scarring

Before talking about scars, a word about spots that may look like scars but are not scars in the sense that a permanent change has occurred. Even though they are not true scars and disappear in time, they are visible and can cause embarrassment.

Macules or "pseudo-scars" are flat, red or reddish spots that are the final stage of most inflamed acne lesions. After an inflamed acne lesion flattens, a macule may remain to "mark the spot" for up to 6 months. When the macule eventually disappears, no trace of it will remain—unlike a scar.

Post-inflammatory pigmentation is discoloration of the skin at the site of a healed or healing inflamed acne lesion. It occurs more frequently in darker-skinned people, but occasionally is seen in people with white skin. Early treatment by a dermatologist may minimize the development of post-inflammatory pigmentation. Some post-inflammatory pigmentation may persist for up to 18 months, especially with excessive sun exposure. Chemical peeling may hasten the disappearance of post-inflammatory pigmentation.

Acne Treatment for Anybody's Acne Problem

Today, every case of acne can be resolved. The key to getting rid of acne lesions and preventing new ones from forming lies in knowing that:

Resolution takes time. Treatments that promise “fast,” miraculous” or “overnight” results often capture the attention of acne sufferers hoping for quick resolution. However, the fact remains that acne does not clear overnight. On average, 6 to 8 weeks are needed to see initial results. Once acne significantly improves or clears, continued treatment is needed to keep acne from re-appearing. If acne does not improve in 6 to 8 weeks, treatment may need to be adjusted as not every acne treatment clears every case of acne.

What works for one person may not work for another. What is an appropriate treatment for one person may not clear another's acne because many factors affect resolution, including the cause(s) of the acne, a person's skin type and the kind of acne lesions present.

A dermatologist's help may be required. With so many factors affecting clearance and a multitude of treatment options available (some only by prescription), a dermatologist's help can make a difference. Before prescribing treatment, dermatologists consider several factors, including the severity of the acne, types of lesions present, co-existing conditions, as well as the patient's age, skin type, lifestyle and motivation.

The knowledge gained from considering these factors allows dermatologists to create effective individualized therapy that will resolve the patient's acne over time and prevent new lesions from forming.

Sometimes a dermatologist may combine two or more treatment options. A patient may be instructed to use one medication in the morning and the other at night. Or, two medications may be combined in one prescription medication. Due to possible side effects, over-the-counter medications should not be combined unless directed by a dermatologist or other medical practitioner.

Acne responds especially well to early treatment. Dermatologists recommend that acne be treated early to maximize effectiveness as well as help prevent scarring.

Who Gets Acne?

Close to 100% of people between the ages of twelve and seventeen have at least an occasional whitehead, blackhead or pimple, regardless of race or ethnicity. Many of these young people are able to manage their acne with over-the-counter (nonprescription) treatments. For some, however, acne is more serious. In fact, by their mid-teens, more than 40% of adolescents have acne severe enough to require some treatment by a physician.

In most cases, acne starts between the ages of ten and thirteen and usually lasts for five to ten years. It normally goes away on its own sometime in the early twenties. However, acne can persist into the late twenties or thirties 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 than young women to have more severe, longer lasting forms of acne. Despite this fact, young men are less likely than young women 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.

Acne lesions are most common on the face, but they can also occur on the neck, chest, back, shoulders, scalp, and upper arms and legs.

Normal Distribution of Acne
Acne also has significant economic impact. Americans spend well over a hundred million dollars a year for nonprescription acne treatments, not even taking into account special soaps and cleansers. But there are also the costs of prescription therapies, visits to physicians and time lost from school or work.

What are the Types of Acne

Acne is the term for plugged pores (blackheads and whiteheads), pimples, and even deeper lumps (cysts or nodules) that occur on the face, neck, chest, back, shoulders and even the upper arms. Acne affects most teenagers to some extent. However, the disease is not restricted to any age group; adults in their 20s - even into their 40s - can get acne. While not a life threatening condition, acne can be upsetting and disfiguring. When severe, acne can lead to serious and permanent scarring. Even less severe cases can lead to scarring.

When you read about acne or other skin diseases, you encounter words or phrases that may be confusing. For example, the words used to describe the lesions of acne—comedo, papule, pustule, nodule and cyst—are understandable only if you know each word's definition. It also is helpful to have a photo that is characteristic for each type of lesion.

Here is a brief summary of definitions of words used to describe acne, with accompanying photos. Let's begin, though, with the definition of lesion, an all-purpose word:

Lesion — a physical change in body tissue caused by disease or injury. A lesion may be external (e.g., acne, skin cancer, psoriatic plaque, knife cut), or internal (e.g., lung cancer, atherosclerosis in a blood vessel, cirrhosis of the liver).

Thus, when you read about acne lesions you understand what is meant—a physical change in the skin caused by a disease process in the sebaceous follicle.

Acne lesions range in severity from comedones (blackheads and whiteheads) to nodules and cysts. Here is a brief definition of acne lesions:

Comedo (plural comedones)—A comedo is a sebaceous follicle plugged with sebum, dead cells from inside the sebaceous follicle, tiny hairs, and sometimes bacteria. When a comedo is open, it is commonly called a blackhead because the surface of the plug in the follicle has a blackish appearance. A closed comedo is commonly called a whitehead; its appearance is that of a skin-colored or slightly inflamed "bump" in the skin. The whitehead differs in color from the blackhead because the opening of the plugged sebaceous follicle to the skin's surface is closed or very narrow, in contrast to the distended follicular opening of the blackhead. Neither blackheads nor whiteheads should be squeezed or picked open, unless extracted by a dermatologist under sterile conditions. Tissue injured by squeezing or picking can become infected by staphylococci, streptococci and other skin bacteria.

Papule — A papule is defined as a small (5 millimeters or less), solid lesion slightly elevated above the surface of the skin. A group of very small papules and microcomedones may be almost invisible but have a "sandpaper" feel to the touch. A papule is caused by localized cellular reaction to the process of acne.

Pustule — A dome-shaped, fragile lesion containing pus that typically consists of a mixture of white blood cells, dead skin cells, and bacteria. A pustule that forms over a sebaceous follicle usually has a hair in the center. Acne pustules that heal without progressing to cystic form usually leave no scars.

Macule — A macule is the temporary red spot left by a healed acne lesion. It is flat, usually red or red-pink, with a well defined border. A macule may persist for days to weeks before disappearing. When a number of macules are present at one time they can contribute to the "inflamed face" appearance of acne.

Nodule — Like a papule, a nodule is a solid, dome-shaped or irregularly-shaped lesion. Unlike a papule, a nodule is characterized by inflammation, extends into deeper layers of the skin and may cause tissue destruction that results in scarring. A nodule may be very painful. Nodular acne is a severe form of acne that may not respond to therapies other than isotretinoin.

Cyst — A cyst is a sac-like lesion containing liquid or semi-liquid material consisting of white blood cells, dead cells, and bacteria. It is larger than a pustule, may be severely inflamed, extends into deeper layers of the skin, may be very painful, and can result in scarring. Cysts and nodules often occur together in a severe form of acne called nodulocystic. Systemic therapy with isotretinoin is sometimes the only effective treatment for nodulocystic acne. Some acne investigators believe that true cysts rarely occur in acne, and that the lesions called cysts are usually severely inflamed nodules, and the term nodulocystic should be abandoned. Regardless of terminology, this is a severe form of acne that is often resistant to treatment and likely to leave scars after healing.