Questions answered in this video include:

1. What is acne?
2. How does acne come about?
3. How common is acne?
4. What are the trigger factors for acne breakouts?
5. Are there effective treatment options for acne?
6. Are there any limitations to who can take accutane?
7. Are there any effective over-the-counter treatments for acne?
8. Can anything be done to treat/diminish acne scars?
9. What is dermabrasion?
10. What are some ways by which one can prevent the development of acne scars?

General notes about Dr. Jaggi Rao

Dr. Jaggi Rao is a board certified dermatologist, licensed in both Canada and the United States. He is also a clinical professor of Dermatology and coordinator of the residency training program at the University of Alberta. After completing his dermatology training, Dr. Rao became the first Canadian physician to be accepted to the prestigious American Academy of Cosmetic Surgery fellowship training program. He has authored a large body of scientific articles and textbook chapters, has presented at countless medical meetings, and has served as a peer reviewer for prominent medical journals, including Dermatologic Surgery.

Background Information

Overview

Acne is a common disease of the skin which leads to the development of pimples. These pimples form as a result of hair follicles found underneath the surface of your skin getting clogged up and becoming inflamed. Common areas on the body where pimples tend to form include the face, back, neck, shoulders and chest. Although anyone can get acne, it is common in adolescents and young adults. Although acne usually does not lead to serious health consequences, if left untreated some people may suffer serious psychological distress or develop unsitely scarring as a result of this skin condition.

The exact cause of acne is not known, although several theories do exist. For one, hormonal changes such as those during the teenage years and pregnancy, are thought to play a role. Because of our general lack of insight into the exact causes or triggers of this disease, many myths regarding the cause of acne exist. For example, chocolate and greasy foods are often blamed, despite there being little evidence that foods of any type have much effect on the development of acne. Another common myth is that acne is caused by dirty skin. In fact, blackheads and pimples are not caused by dirt or grease found on the skin surface. Although stress is also not a direct cause of acne, it is thought that stress can make acne worse.

If you or a loved one suffers with acne, some practical tips to follow would be to clean your skin gently with a mild facial soap, try your best not to touch your skin so as to not spread bacteria from the environment to the skin surface, and avoid the sun as much as practically possible, as this has been shown to exacerbate the symptoms of acne.

There are many effective treatments currently available for acne, which can broadly be divided into oral medicines as well as topical creams.

Acne

Acne is a skin disease which primarily affects oil glands found on the surface of the skin called sebaceous glands. These glands produce an oily substance called sebum. Small holes in your skin called pores connect to these oil glands underneath the skin, to allow sebum to be expeled to the surface.  A tiny canal called a follicle acts as the piece which connects the sebaceous gland and the pore found on the skin surface. Inside the follicles, sebum carries dead skin cells to the surface of the skin. Also, a thin hair grows through the follicle and out to the surface. When this follicle connecting a sebaceous gland to the pore clogs up, it results in the formation of a pimple. These follicles can become plugged in many way. Usually, it is the result of  hair, sebum, and the dead skin cells clumping together and plugging the follicle, sort of like a traffic jam. Once bacteria enters the follicle, it causes swelling in the area of the plug. Once the contents of the plug begin to breakdown within this inflamed follicle, a pimple develops.

Pimples come in all shapes and sizes, and are generally classified as follows:

• Whiteheads are pimples caused by a complete blockage of a follicle, trapping all of the products of the plug-breakdown (pus) that stay under the surface of the skin.
• Blackheads are pimples in which the contents of the plug have risen to the skin’s surface, giving the pimple its characteristic black appearance. It is important to note that the black color is not the result of dirt.
• Papules are small pink bumps which are often tender.
• Pustules are pimples that have a wheel of red at the base, with pus on top.
• Nodules are painful, large, solid pimples which are found deeper in the skin.
• Cysts are deep, painful, pus-filled pimples can cause scars.

Demographics

Acne is the most common of all skin diseases, affecting people of all ages and races. However, it is most common in adolescents and young adults. Some estimates suggest that up to  80% of all people between the ages of 11-30 have acne outbreaks at some point in their lives. It is not uncommon for people to develop acne later in life either, with later-stage acne sometimes being a sign of some other underlying medical condition, particularly in women.

Causes

Although the cause of acne is unknown, there are certain factors which likely contribute to its pathogenesis. For one, the hormonal changes seen in the teenage years can result in excess sebum production, causing the follicles to plug up more often. By the same mechanism, hormonal changes during pregnancy can also lead to the development of acne. because birth control pills also contain high doses of progesterone +/- estrogen, two of the main hormones which icnrease during pregnancy and during adolescence in females, starting or stopping these pills can again trigger increases in acne symptoms. Some researchers have suggested that acne may be a hereditary condition, meaning that it may run in families. If this is in fact true, it would suggest that our genes may play a role in the development of acne. Other types of medicine besides birth control pills, such as certain psychiatric medications and testosterone derivatives, can exacerbate acne. Finally, certain makeups, moisturizers, sun tanning creams and other similar prodcuts may contribute to the development of acne, particularly if these products have a large amount of grease in them, as this may in turn clog the follicles in the skin.

Treatments

Acne is typically treated either by general practitioners or else physicians who specialize in the treatment of skin disorders (dermatologists). The goals of treatment are four-fold, and include attempting to heal all existing pimples, prevent new pimples from forming, avert the formation of acne scarring and lastly to reduce the psychological effects which this condition can have of individuals, especially teenagers.

In terms of preventing scars, the most important thing is to begin treatment as early as possible. This may be done using several methods. In less severe cases, your doctor may suggest the use of over-the-counter medications applied topically to the surface of the skin. Examples of such products include facial cleansers, spot treatments for pimples and alcohol-based toners. For serious cases of acne, a physician may opt to use prescription strength medications, of which there is a wide variety. Again, topical agents such as antibacterial or retinoid based creams may be used. Conversely, orally ingested agents such as antibiotics or isotretinoic acid may be used, to name but a few of the available acne-figthing medications.

Routine Acne Skin Care

There are several skin care practical tips which everyone can follow in order to help minimize the chances of developing acne. Most importantly, people should wash their face daily with a gentle facial cleanser so as to remove the excess contaminants picked up during the course of the day, including bacteria, grease and environmental pollutants. This will help to prevent such material from contributing to clogged pores. Cleansing can be done in the morning, evening and/or after a heavy workout. Keep in mind that scrubbing the face too firmly will not only not prevent acne, but may in fact make the problem worse! Secondly, try not to touch your skin, as this may lead to the transfer of unwanted bacteria from your hands to your face. Furthermore, people who attempt to pinch, pick or squeeze their pimples may either make the problem worse, or else may end up inadvertently causing acne scars or hyperpigmentation of the skin. Another practical tip for men is to be careful when shaving. Try to use both manual and electric shavers, in order to establish which method works best and leaves you with the least amount of razor burn and acne. It is important to always use a sharp blade, and only shave when necessary. It is also a great idea to soten your beard with soap and warm water prior to shaving. Besides increasing the amount of wrinkles you have and predisposing you to skin cancer, excessive sun exposure should also be avoided due to the risk of increasing the symptoms of acne. Furthermore, many of the medications used in the treatment of acne sensitize patients to the sun, causing them to burn more readily. It is also very important to choose makeup as well as any products you may want to apply to your face carefully. In particular, always look for the word “NONCOMEDOGENIC” on the label. This means that the product will not clog your pores, and it is highly recommended that people who suffer with acne avoid puting any product on their face which does not have this label. Finally, it is a important to shampoo your hair regularly, especially if you have oily hair, in which case you may want to shampoo your hair daily.

Acne Triggers

As already mentioned, there are several factors which have been identified which can lead to the worsening of acne. Of these, fluctuating hormone levels is likely the most significant factor. Examples of situations in which this may be an issue are during adolescence, pregnancy, when starting or stopping birth control and between 2 to 7 days before the start of a woman’s period. Pressure from tight-fitting sports equipment such as bike helmets, backpacks or even tight collars has been implicated as a trigger for acne. Similarly, pollution as well as climates with a high humidity are two environmental factors linked to acne exacerbation. As discussed, it is never a good idea to squeeze or pinch existing pimples, as this can not only worsen acne but may in fact lead to scarring and hyperpigmentation. Finally, always be gentle when washing your face, as hard scrubbing may increase acne symptoms. 

Acne Research

Scientists are looking at new ways to treat acne. Current research includes working on new drugs to treat acne, including new topical antibiotics. In addition, more is being learned about the bacteria found on the skin surface which leads to the development of acne. Another strategy scientists are using is to look at ways in which to prevent the plugs which cause comedones to form. Finally, others are looking at ways to stop the hormone testosterone from causing acne.

All of the cutting-edge research being done to ultimately enhance our ability to treat acne has resulted in many exciting new developments recently. For one, a vaccine which could protect its recipients from the onset of acne during adolescence has already been successfully tested on mice. Secondly, the genome for the primary bacteria responsible for acne has been sequenced, potentially expediting the process of developing new antimicrobial weapons in the fight against acne!