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Acne Vulgaris is the most frequent skin condition in the United States. It is characterized by pimples that appear on the face, back and chest. Every year, about 80% of adolescents have some form of acne and about 5% of adults experience acne.

Acne is made up of four types of pimples or blemishes:

  • Whiteheads/Blackheads (Type 1), also known as comedones, are skin colored, non-inflammatory and appear more on the face and shoulders. The blackhead is characterized by a gray-black center. As long as they remain uninfected, they are unlikely to lead to scarring.
  • Erythematous Papules (Type 2) are small, early inflamed, reddened pimples with plugged pores.  These usually will heal with the least scarring.
  • Papulopustular Papules (Type 3) are reddened, inflamed, infected pimples with plugged pores having a small white cap.  These can lead to noticeable pitted or depressed scarring.
  • Cystic Acne (Type 4) are larger reddened and infected cystic pimples filled with an obvious amount of whitish pus,  These eruptions are known to heal with a wider and deeper pitted or depressed scar, 

The uncommon and severest form of acne is Acne Conglobata, which consists of variable coin sized superficial and deep cysts that can tunnel to create medium to large interconnecting abscesses.  These cysts can be derived from pre-existing acne eruptions of recent or past origin.  They contain an odiferous seropurulent substance which can reaccumulate after their rupture and drainage.  Their presence results in irregular and disfiguring scars which may become either atrophic or keloidal.  

Causes

Within the normal skin, the oil glands are known as sebaceous glands, which produce an oily substance called sebum.  The sebaceous glands are attached to each hair follicle wherein the sebum moves upward from the bottom to the top to then spill onto the surface of the skin, carrying any skin cells which may have shed.  Acne results when the hair follicle becomes occluded with both the sebum and cellular debris  preventing their release onto the skin’s surface. When the poral opening is closed, the pimple is called a whitehead.  If the poral opening is open, a blackhead is formed having a gray-black center due to the oxidization of its contents nearest the skin's surface.  When either a whitehead or blackhead becomes inflamed, it can progress into an erythematous (red) papule or an infected (pustular) papule.  The pustule can proceed into a cyst, or into the more severe form of acne conglobata as described above.

It is important for patients not to pick, scratch, or squeeze acne lesions for fear of their becoming more inflamed and infected leading to permanent scarring.  

Treatment

Treating acne is a relatively slow process; there is no overnight remedy. Some treatments include:

  • Benzoyl Peroxide — Used in mild cases of acne, benzoyl peroxide reduces the blockages in the hair follicles.
  • Oral and Topical Antibiotics — Used to treat any infection in the pores.
  • Hormonal Treatments — Can be used for adult women with hormonally induced acne.
  • Tretinoin — A derivative of Vitamin A, tretinoin helps unplug the blocked-up material in whiteheads/blackheads. It has become a mainstay in the treatment of acne.
  • Extraction — Removal of whiteheads and blackheads using a small metal instrument that is centered on the comedone and pushed down, extruding the blocked pore.
  • Chemical Peels — Topical application of special acids tolerable to the skin to loosen the opening of its pores and to dry the skin causing the superficial peeling of its surface.
  • Photodynamic Therapy — Acne treatment using medical equipment which generates a therapeutic wavelength of light either blue or red in color.
  • Cryotherapy — Liquid Nitrogen helps the healing of acne lesions.  It is quickly and lightly sprayed onto an area of acne.   A heavier spraying may cause blistering and should never be requested or done.  Liquid Nitrogen can also be applied to individual lesions using a cotton applicator stick.  Again overtreatment can result in blistering.


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