Acute Care: Injuries and Illnesses
ACNE
Introduction
Acne is a common skin disorder, and is thought to affect up to 85% of
persons between ages 12 and 25. It may continue to cause problems for
people beyond their 20's but usually is less severe. Treating acne,
whether in its mild or more severe forms, requires understanding and
commitment to the skin care and therapy recommended by your Physician
and/or Nurse.
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What is Acne?
Acne is an ongoing disorder that involves the skin's oil-producing
glands (sebaceous glands) and the hair follicles. Breakouts of acne will
occur where these glands are concentrated, such as the face, neck, upper
arms and chest.
Normally, the sebaceous glands produce a natural oil that flows from the
oil ducts through the hair follicle openings to lubricate and soften the
skin. Bacteria is also present, but rarely causes a problem. At the
onset of puberty, hormones stimulate and enlarge the sebaceous glands,
thereby increasing their activity. Changes in the linings of the hair
follicles (also referred to as pores) cause an increase in the number of
dead skin cells being shed by the body. A buildup of debris may occur in
the hair follicle, causing an obstruction of the oil flow and bacteria.
This buildup or congestion results in the formation of COMEDONES -
"whiteheads" and/or "blackheads". Trapped bacteria and other aggravating
factors may lead to inflamed lesions - red papules and pustules. In more
severe cases, long lasting cysts and nodules may occur.
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Aggravating Factors
- No one factor explains acne, but some conditions
may increase the severity of Acne.
- Diet is not considered a factor in the
production of acne lesions. Well balanced diets are
encouraged for overall health, but no study has
proven that foods such as chocolate, cola, milk and
milk products will exacerbate acne. If you feel
those products impact your acne, then you should
avoid excessive amounts.
- Stress (emotional and physical) is a frequent
factor in worsening of acne. Stress is difficult to
avoid since students are under pressure to perform
well and meet deadlines. Difficulties in
relationships, fatigue, poor eating habits, lack of
exercise and/or illness may all cause physical and
emotional stress.
- Hormones stimulate the sebaceous glands and oil
production. Hormonal factors explain why acne begins
at puberty, and why women often experience increased
oiliness and/or acne flares prior to their menstrual
periods. Hormone supplements (i.e. birth control
pills, steroids) may also impact acne. It's
advisable to discuss acne with your physician before
starting birth control pills.
Friction and Sweating, especially in combination can
lead to increased acne lesions. Touching of hands to
the face is a common source of friction and
bacteria. Sweating produces increased bacteria and
is problematic in occluded areas such as:
- Sweatbands or ball caps on foreheads
- Tight fitting helmets
- Shoulder straps and backpacks
- Jobs or activities in hot, humid or dirty
environments may tend to increase acne. Examples
include:
- Restaurant kitchens or factories
- Construction or landscape sites
- Aerobics and/or weightlifting workouts
- Showers using the stronger, antibacterial
soaps are desirable after
these activities.
- Hair products (sprays, gels, pomades) that come
in contact withthe skin may worsen acne. A general
rule is to wash hair frequently, limit your use of
hair products and keep hair off the face as
possible.
- The use of skin products is often a major
problem in aggravating acne lesions. Reading labels
is essential. Labels on moisturizers, makeups, and
sunscreens should state:
- oil free
- Non-comedogenic (no comedones) for "acne prone skin"
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Treatment
The routine acne treatments do not cure acne, but
only control acne while it subsides on its own. Often a
period of 6 weeks of treatment is necessary before
benefits are seen. Acne treatments are divided into
topical
treatments (applied to the skin) and oral
treatments (pills by mouth). These treatments are
effective because of their antibacterial,
anti-inflammatory, or keratolytic ("unplug pores")
actions.
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Anti-Bacterial Treatment
Topical:
(Apply 15 minutes after washing to reduce
irritation)
- Benzoyl peroxides (soaps and washes, gels,
lotions)
- Antibiotics - Clindamycin, Erythromycin,
Sulfacetamide
- Benzoyl peroxide plus erythromycin =
Benzamycin
- Antibacterial soaps (e.g., Dial, Coast,
Irish Spring, Lever 2000)
Oral Antibiotics:
- Erythromycin
- Tetracycline
- Doxycycline
- Minocycline
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Anti-Inflammatory Agents
Oral and Topical Antibiotics as listed above.
Intralesional injection locally of a corticosteroid
suspension into persistent cysts or nodules. Oral
steroids are rarely used, only in severe cases.
Keratolytic Agents:
- Tretinoin (Retin-A) cream, gel, liquid
- Azelaic Acid Cream (Azelex)
- Isotretinoin (Accutane*)
- Isotretinoin (Accutane) is an oral drug
approved by the FDA for the treatment of severe
cystic acne, which has not responded to the more
standard acne treatment. Accutane requires close
medical supervision with frequent appointments
and blood tests. It is a very effective,
expensive treatment, and is usually administered
for 5 months.
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Exfoliants
- Alpha Hydroxy Acids (AHA) (cleansers,
solutions, lotions)
- Sulfur (soaps, lotions)
- Salicylic Acid (soaps, washes, lotions)
Final Note
As mentioned above, it is important to use oil-free
"noncomedogenic" skin products. Unless directed
otherwise by your nurse/physician, use mild soaps to
your face, antibacterial or acne soaps to your
chest/back.
Mild Soaps (Examples)
- Neutrogena
- Purpose
- Basis
- Cetaphil
- Dove
- Oil of Olay
Moisturizers (Examples)
* Use SPF formulas when possible in morning
- Neutrogena facial lotion
- Purpose
- Eucerin Facial lotion
- Moisturel
- Oil of Olay
Cosmetics (Examples)
- Most of the major companies have products which
are noncomedogenic, e.g., Almay, Avon, Mary Kay,
Estee Lauder, Clinique, Revlon, etc.
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