The key to getting rid of acne it to know what it is, what it looks like, and how to treat it. For more information about acne and products that will help treat it, visit askderm.com

1. How to
Get Rid
of Acne

2. What is Acne?
• Acne is a very common, chronic, skin disease that
affects 60-70% of Americans at some time during their
lives.
• It is more frequent in adolescence and young
adulthood, thought it may present at any age. Acne
begins as a noninflammatory comedonal condition and
then evolves to the mildly inflammatory papular
pustular acne before proceeding to the more
inflammatory nodulocystic lesions. Each stage seems to
be separated by 2–3 years. It becomes more common
and severe, reaching its peak between 14–17 years in
females and 16–19 years in males. For most people,
acne diminishes over time and tends to disappear, but
at 40 years of age 1% of men and 5% of women exhibit
acne lesions

3. What is Acne? Cont’d
• Acne by definition is a multifactorial, chronic disease of
the pilosebaceous units. The hair follicles become
plugged with oil and dead skin cells. Acne most
commonly appears on face, neck, chest, back and
shoulders, where there are more sebaceous glands.
Acne can be distressing and annoyingly persistent.
Acne lesions heal slowly, and when one begins to
resolve, others seem to crop up.
• Depending on its severity, acne can cause emotional
distress and lead to scarring of the skin. The good news
is that effective treatments are available — and the
earlier treatment is started, the lower your risk of
lasting physical and emotional damage.3
• The treatment should be directed to prevent physical
and emotional scarring.

4. What Causes Acne?
• Acne develops as a result of blockages in follicles.
Follicular hyperkeratinization and formation of a plug
of keratin (a protein from the skin) and sebum (a mix of
naturally occurring oil, and dead skin cells) is the
earliest change (a microcomedo). Enlargement of
sebaceous glands and an increase in sebum production
occur with increased male sex hormones production
(androgens). The microcomedo may enlarge to form an
open comedo (blackhead) or closed comedo
(whitehead or milia). Comedones are the direct result
of sebaceous glands' becoming clogged with sebum. In
these conditions, the bacteria called Propionibacterium
acnes, which lives in the sebaceous glands, can cause
inflammation, leading to inflammatory lesions.

5. What Causes Acne? Cont’d
• Genetics: Acne is more frequent in
adolescents which both parents had
acne. A family history of acne is
associated with early acne
appearance.
• Hormonal activity: Increase of
androgens (testosterone,
dihidrotestosterone and
dehydroepiandrosterone sulfate)
during puberty, menstrual cycle,
pregnancy, post menopause, etc.
Insulin growth factor has also been
associated with certain type of acne
and polycystic ovary syndrome.
Follicular
hyperkeratinization
Excess sebum production
Proliferation of
P.acnes
Inflammation

6. What Causes Acne? Cont’d
• Psychological factors: Most of the recent studies
indicate that increase in the level of emotional stress
increases the severity of acne flares, probably due to
the increase in the production of neuropeptides
around the sebaceous glands that also increase sebum
production and inflammation.
• Diet: No direct link has been found between acne and
diet. In particular, no effect has been established
between chocolate, shellfish, or fatty foods. However,
the influence of dietary factors on the initiation and
course of acne has recently received increased
recognition. A connection has been postulated
between acne and nutrients with high glycemic index,
as well as with milk and dairy products.

7. What Causes Acne? Cont’d
• Tobacco: Clinical evidence and experimental
data showed a straight correlation between
smoking habit and post-pubertal acne in
which the clinically non-inflammatory type is
the most frequent

8. Signs & Symptoms
• Acne is a polymorphic disease, in other words
it is characterized by the presence of different
types of lesions simultaneously. In almost all
patients comedones (white and black heads),
papules and pustules (pinheads and pimples)
can be found at the same time. Two main
patterns of disease have been described. The
first pattern is that of essentially
noninflammatory disease, which tends to be
an early phase often seen in the peri-pubertal
age group.

9. Signs & Symptoms Cont’d
• There is increased oil production on the face,
chest, back and shoulders. This may be
accompanied by an increase in pores’ size,
blackheads or open comedones. Occasionally
noninflammatory whiteheads or closed
comedones will also be seen, premonitory of
other more significant inflammatory disease.
This presentation of the disease is also known
as comedonal acne (see fig. 2 - 3)

10. Signs & Symptoms Cont’d
• The second clinical pattern is that of inflammatory
disease, that tends to lead to more scarring. This may
span the full gamut from papules (pinheads), pustules
(pimples), nodules and cysts and any combination of
these. Postinflammatory macular disease may follow
resolution and these may be red or hyperpigmented,
representing a component of postinflammatory
change. Severe forms of inflammatory acne such as
nodular cystic disease, with all its potentially
destructive sequelae, often occur later in predisposed
individuals. (Fig 4 and 5)
• If acne is not adequately treated, physical atrophic
(depressed) or hypertrophic/keloid (elevated) scars
may occur. (Fig.6)

11. Fig. 2 Comedonal acne
Fig. 3 Comedonal acne (open comedones)
Fig.4 Papular-pustular acne
Fig. 5 Nodulocystic acne Fig 6. Atrophic acne scars(back)

12. Acne Myths
• Acne is a disease that will improve by itself and has to
run its course: Dermatologists know that letting acne
runs its course is not always the best advice because
without treatment dark spots and permanent scars can
appear on the skin as acne clears. Acne treatment
helps also increasing the self–esteem of the person.
• Acne is a contagious infectious disease: Patients
believe that acne is an infection and that they are
infectious to others. Although Propionobacterium
acnes is important in the extension of the disease from
simple comedones to full blown inflammatory lesions,
it is a secondary phenomenon once the disease has
been initiated. Thus, acne is not an infectious or
contagious disease

13. Acne Myths Cont’d
• Sexual activity is related with acne: There are
misconceptions regarding variably too little or too
much sexual activity and acne. First that too much sex
or masturbation may worsen acne. Second that
somehow when females begin having a regular sex life
their acne will be improved. Although acne is tied up
with androgen metabolism at the level of the
sebaceous glands, there appears no basis to either of
these rather strange extrapolations. Acne is occurring
at a similar stage as sexual adventure and this may be a
plausible reason for the uninformed to associate the
two. One may also possibly look at the beneficial effect
of oral contraceptives on acne as a possible
explanation for improvement associated with the
beginning of sexual activity in females.

14. Acne Myths Cont’d
• Acne is curable: There is a widespread belief
that acne is curable and that a course of
antibiotics is all that is required. Patients will
often make statements such as: ‘the
treatment didn’t work because when I
stopped the tablets the acne came back again’
or, ‘the acne only improved but didn’t
completely disappear’. It must be made clear
that continued treatment is required and that
there is no cure (although isotretinoin may
cause long term remission of the disease).

15. Acne Myths Cont’d
• Frequent skin hygiene and intense face cleansing
improve acne: Not only are the facial cleansing
regimens of patients with acne often burdensome,
they can be expensive. The evidence for the role of a
lack of facial hygiene in acne pathogenesis and for face
cleansing in its management is mostly of poor quality.
Furthermore, face-washing has been proposed as
being traumatizing, and so exacerbating acne and as
increasing the skin irritation adverse effects of topical
tretinoin and isotretinoin (though not other topical
therapies) in acne treatment. Additionally, commonly
used soaps and shampoos have been found to be
comedogenic when applied to the rabbit ear.

16. Acne Treatment
• Today, there are many effective acne treatments. This
does not mean that every acne treatment works for
everyone who has acne. But it does mean that virtually
every case of acne can be controlled.
• People who have mild acne have a few blemishes. They
may have whiteheads, blackheads, papules, and/or
pustules. Many people can treat mild acne with
products that can be bought without a prescription. A
product containing benzoyl peroxide or salicylic acid
often help to clear the skin. This does not mean that
the acne will clear overnight. At-home treatment
requires 4-8 weeks to see improvement. Once acne
clears, a maintenance treatment must continue to
prevent breakouts.

17. Acne Treatment Cont’d
Topical treatment: This is a treatment that is applied to
the skin. There are many topical acne treatments, and
there is no magic product or regimen that is right for
every person and situation. Topical treatment is usually
broken down into two categories:
• Cleansers: A good part of any topical regimen can
include both mild cleansers that keep the skin clean
and minimize sensitivity and irritation and exfoliating
cleansers that remove the outer layer of the skin and
loosen pore-clogging dirt.
• Topical leave on products: Topical products can help
kill the bacteria that cause acne and others work on
reducing the oil. The topical medicine may contain a
retinoid, benzoyl peroxide, antibiotic, or even salicylic
acid.

18. Acne Treatment Cont’d
Systemic treatment: This is a treatment that works
throughout the body and may be necessary for
inflammatory (red, swollen) types of acne, including
the papular-pustular and nodulocystic forms. Your
dermatologist may prescribe one or more of these:
• Antibiotics (helps to kill bacteria and reduce
inflammation).
• Birth control pills and other medicine that works
on hormones (can be helpful for women).
• Isotretinoin (the only treatment that works on all
that causes acne).

19. Acne Treatment Cont’d
Procedures that treat acne: Your dermatologist may treat
your acne with a procedure that can be performed during an
office visit. These treatments include:
• Lasers and other light therapies: These devices reduce the
p. acnes bacteria. Your dermatologist can determine
whether this type of treatment can be helpful.
• Chemical peels: You cannot buy the chemical peels that
dermatologists use. Dermatologists use chemical peels to
treat 2 types of acne — blackheads and papules.
• Acne removal: Your dermatologist may perform a
procedure called “drainage and extraction” to remove a
large acne cyst. This procedure helps when the cyst does
not respond to medicine. It also helps ease the pain and
the chance that the cyst will leave a scar. If you absolutely
have to get rid of a cyst quickly, your dermatologist may
inject the cyst with medicine.

20. Outcome
• Waiting for acne to clear on its own can be
frustrating. Without treatment, acne can
cause permanent scars, low self-esteem,
depression, and anxiety.
• To avoid these possible outcomes,
dermatologists recommend that people treat
acne. When the skin clears, treatment should
continue. Treatment prevents new breakouts.
Your dermatologist can tell you when you no
longer need to treat acne to prevent
breakouts.

21. Quality of Life
• The presence of acne can negatively affect quality of
life, self-esteem, and mood in adolescents. Acne is
associated with an increased incidence of anxiety,
depression, and suicidal ideation. The occurrence of
these and other co-morbid psychological disorders
should be considered in the treatment of acne patients
when appropriate. A strong physician-patient
relationship and thorough history taking may help to
identify patients at risk for the adverse psychological
effects of acne. Successful treatment of acne with
isotretinoin qualitatively decreases depressive
symptoms and improves quality of life. The effect of
other topical and systemic therapies for acne on
psychological symptoms has not been assessed.

22. Quality of Life Cont’d
• In addition to the effect of acne on the patient, family and
social relationships may also be strained. Parents may
worry about the short- and long-term repercussions of
their child’s appearance, such as being bullied at school or
having permanent scarring from acne lesions. As teens gain
independence during adolescence, their attitudes toward
treatment and adherence to the prescribed regimen may
be adversely affected. Parents and patients may not always
be adequately educated about the causes and treatment of
acne, which may further delay or affect successful
treatment. Poor adherence to therapy is a barrier to
successful acne treatment. There is a positive correlation
between treatment adherence and improved quality of life
for other cutaneous diseases such as psoriasis and is an
important area of future research in the clinical setting of
acne treatment.

23. Where to Get Help?
• http://www.askderm.com/
• http://www.askderm.com/skin-care
• http://www.askderm.com/skin-
care?skin_concern=269
• http://www.askderm.com/glytone-10-
benzoyl-peroxide-acne-treatment-gel
• http://www.askderm.com/phytomer-oligopur-
purifying-cleansing-gel
• http://www.askderm.com/glytone-flesh-
tinted-acne-treatment-lotion