Acne and You

Acne scars can be more distressful than the pimples and cysts that cause them. Before answering the question posed, it's necessary to discuss the different types of scars.

Most acne scars are not true scars and aren't permanent. Post-pimple marks are pink, red or brown spots that will fade with time and can be covered by makeup. Pink or red marks should fade in 3 to 4 months.

Dark brown marks can last 6 months to a year or longer. These are caused by the melanin pigment in the dermis found in cells called melanophages. These scavenger-like cells remain behind to clean up the pus and mess caused by papules and pustules. The challenge in treating these medically is penetration to the depth of the upper dermis, where melanophages reside. The darker your skin, the darker the spots will be. They can be treated painlessly with skin lighteners containing hydroquinone, which does not affect the normal skin color.

Superficial scarring, such as small, shallow depressions, can be improved with topical retinoids, available over-the-counter and in prescription medications. If caught early, these depressed, shallow scars may respond to microdermabrasion, which helps stimulate collagen production. There are over-the-counter microdermabrasion products, or you can have it done professionally. At minimum, 6 to 8 treatments performed on a weekly basis is necessary to see any results.

Treatment of more serious acne scars

Shallow, sunken depressions in the skin with fairly smooth edges, and sunken depressions with ragged, uneven edges are known as Dell scars. Several treatments with microdermabrasion can soften the ragged-edge scars a bit. Laser resurfacing with a CO2 laser or radiofrequency treatments have shown promising results for long-term improvement of these scars. Areas of sunken depression may be filled with materials such as bovine (cow) or human collagen. For deep depressions, there are permanent fillers which serve as something like Bondo does on dents in a car. If you decide on this option, discuss it with the doctor and make sure you understand the pros and cons - if the filler fails, it can leave an even bigger depression and larger scar than you had originally.

The scars usually found on the cheeks are called ice-pick scars, because of their appearance - they look like someone has taken an ice pick to the skin. They're small, deep holes with jagged edges and steep sides. These can evolve over time into depressed fibrotic scars, which also have sharp edges and steep sides, but are larger and firmer at their base than ice-pick scars. These scars are difficult to treat, unfortunately. They require surgery, either cutting out the hole and sewing the sides together, or transplanting skin from behind the ear to fill in the hole, then lasering the entire area so it blends in with the surrounding skin.

Severe cystic acne scarring can result in sinus tracts, leaving spaghetti-like tunnels under the skin that connect one sebaceous gland to another. These pull down and tether the skin. Extensive surgery to remove these tracts may lead to further scarring and increase the likelihood that new cysts will form in these damaged areas. If you have this type of scarring, seek out an accomplished specialist with references for performing surgery on these types of scars.

You can see from the above that scarring can be difficult to remove, which is why the primary goal of most dermatologists is to prevent scarring. If your acne is progressing to the severe stage and home remedies and over-the-counter treatments aren't working for you, see a dermatologist immediately.

Most people who believe they have sensitive skin - don't.

The clinical (medical) definition of sensitive skin is skin that has a noticeable reaction with product application. The product can be ANY product, including prescription and over-the-counter. If the skin turns red, itches, tingles or burns (any one, anycombination or all four), it is classified as clinically sensitive skin.

What causes sensitive skin?

There are two causes of sensitive skin: environment and genetics.

Environmental factors causing sensitive skin are usually product-based. Every product you use on your skin contains numerous ingredients. The more products you use, the more ingredients you're exposed to, and the more likely you are to create a sensitive skin response. Stripping your skin of its barrier function through multiple product use often results in irritated skin.

Genetic factors are more complex. One-fifth of babies develop eczema (atopic dermatitis) within the first 6 months. Other symptoms may include allergies, asthma and hayfever. By the age of 12, most children outgrow atopic dermatitis. However, their skin may remain somewhat immunologically compromise and their risk of developing skin sensitivities is greater. Adults with a history of childhood eczema are prone to eyelid dermatitis, hand eczema and tiny red bumps on the backs of their arms (known as keratosis pilaris). They may also be intolerant of some topical acne preparations.

About sensitive skin

"Sensitive skin" is a term often incorrectly applied by those who have experienced some sort of irritation from a skin care product. As a result, we find many cosmetic companies have product lines specifically for sensitive skin. These do not contain well-known irritating agents. While you may benefit from using these products, it doesn't necessarily follow that you meet the medical definition of sensitive skin.

The medical definition is more precise. There is a lot of variation in how sensitive skin reactions appear; there may be redness, tightness, dryness and blemishes. There may also be blotchiness, dry patches, itching and stinging. Sensitive skin has been classified into four general categories.

Type 1: Redness associated with diet, alcohol, stress, emotion and temperature changes. The medical term for this is rosacea, and it is believed to be a genetic condition.

Type 2: Redness, scaling and tightness associated with environmental factors, such as cold, wind, air conditioning and excessive heat.

Type 3: Redness, tightness, stinging and small papules associated with cosmetic use, soap and detergents, and hard water.

Type 4: Red patches associated with hormonal changes, such as the menstrual cycle.

How to care for sensitive skin

If you believe your skin is sensitive, read labels and use caution with new products. And remember that your skin covers your entire body - not just your face. Use fragrance-free and hypoallergenic products with the fewest number of ingredients.

If you have been able to identify an ingredient you know causes irritation, it makes sense (of course!) to avoid any product that contains that ingredient. Keep in mind that ingredients are listed in order of the quantity of that ingredient in the product; if the ingredient is at the top of the list, its volume is most likely sufficient to cause irritation. If it's at the bottom of the list, your skin may be able to tolerate it, but proceed with caution. Always do a patch test first.

It's important to know what kind of skin you have - oily, dry, combination, sensitive - so you can select the best products and skin care regimen for maximum skin health. The goal in treating acne (or any skin condition) is to try and stabilize, protect and repair the barrier function provided by the epidermis. Assaulting this top layer increases susceptibility to infection and environmental irritants and can result in a wide range of skin conditions (most worse than acne!), including impetigo, herpes eczema and contact allergic dermatitis.

The texture, pore size and oiliness/dryness of your skin is largely determined by genes, and regulated by hormones. There's nothing you can do about your body's natural inclination to be oily or dry; all you can do is recognize the skin type you possess and do whatever is necessary to regulate nature.

Your skin also changes as you age. While you might have oily skin as a teenager, you may have dry skin as an adult. As these changes take place, you need to recognize them and alter your skin care regimen accordingly. The routine that serves well during teen years may actually be damaging in someone past their 30s.

What if my skin is mostly dry?

You can still have dry skin, even if it's covered with acne. It's a common notion that the best form of treatment is to strip all oil from the skin, or that acne is caused by an excess of oil. That is not the case, however. Acne has its causes in several factors and stripping the skin of what is perceived as excessive oil causing acne can produce nothing more than skin that is parched, irritated and more susceptible to infection. Don't indiscriminately strip your skin of excess oil until you understand the types of acne, which type you are and what treatment plan is best.

If your skin is mostly dry, humectant agents, or moisturizers, can help relieve dryness. A humidifier in the bedroom at night can also help, especially if you live where the weather is very dry, or you have an air conditioning or forced air heating system that zaps the moisture out of your skin. Some medications also dry out the skin; if you just started taking a new medication and notice a change in your skin, ask the prescribing physician if the medication is known to have dry skin as a side effect.

What if my skin is mostly oily?

Most of us have probably experienced those teenager years when we were quite certain we could've provided all the oil necessary for the french fryer at the local hangout. Women are especially susceptible, due the skin's sensitivity to changes in hormones. Oil production constantly changes; again, it isn't the root cause of acne. You can have oily skin and terrible acne, or oily skin and acne.

Living in a hot, humid climate will stimulate oil gland production, Exercise, stress and hormones such as testosterone and DHEA-S will also increase oil flow. Loose,k oil-free powders and medicated clay-based masks will help. Remember that excessive stripping of lubrication may actually increase production of oil, as your glands respond to perceived dryness.

Combination Skin and the T Zone

In reality, almost everyone has combination skin. The greatest density of oil glands is in what is known as the "T zone," so called because it comprises a "T" shape of the forehead, down the nose, and ending at the chin. Even if you have oily skin in the T zone, you are likely to have dry skin elsewhere.

Once you've made yourself aware of the different types of skin, it makes it easier to work out a plan to get rid of your acne.

Your skin is an amazing organ. Most of us don't think of skin as an organ, but it is - it's the largest organ you have! If you are suffering from acne, it can be difficult to appreciate the marvels of skin.

Skin has an almost magical ability to repair itself, which we seem to take for granted. It constantly replenishes itself. It covers an amazing 20 square feet and is 15% of our total body weight. In the three layers of one square inch of skin, you'll find 19 yards of blood vessels, 65 hairs, 78 yards of nerves, 100 sebaceous glands, 650 sweat glands, 1300 nerve endings, 20,000 sensory cells, 129,040 pores and 9.5 million pores.

Your skin's top layer - the epidermis

This microscopically thin layer of your skin is a mere 7 to 10 cells thick; in a young adult, it completely renews itself every 28 days. Almost 95% of this layer is composed of new cells called keratinocytes. The rest (5%) is made up of cells that product melanin, which gives your skin color, and Langerhan cells, which work with the immune system to help fight infections. The renewal rate of the epidermis diminishes with age. As a result, the pores pack up with dead skin cells, which makes them look larger. This slowing down with age is also the reason for the epidermis being less resiliant and bright as we get older.

Your skin's middle layer - the dermis

Most of the skin's volume is found in the middle layer. The dermis is composed of collagen and elastin fibers; nerve endings that sense temperature and pressure; blood vessels that supply nutrients to keep everything replenished and renewed; sweat glands, which function to cool you down; muscles that contract and cause you to "shiver" and make your hand "stand up;" hair follicles, and oil glands. However pesky you may find them when you're having an outbreak of acne, you can't live without oil glands. They produce the sebum that keeps your skin soft, pliable and waterproof.

Your skin's bottom layer - the subcutaneous layer

In this layer there are lots of fat cells. These provide insulation and protection for your fragile organs. Rooted in these fat cells are most of your hair follicles. The hair follicle and attached sebaceous, or oil, gland share space in what is known as the pilosebaceous gland. The pore is the passage from the base of the hair follicle to the surface of the skin (the epidermis). Sebum is an oily substance composed of free fatty acids, cholesterol, triglycerides and wax. It is released from the gland, into the pore and travels to the skin's surface to keep it pliable and protected. Without sebum, your skin would be dry and itchy.

Understanding this vital organ

It's important to understand how your skin works and what can go wrong with it, just as it's important to understand how any other organ in your body works. We tend to take our skin for granted, not realizing that it is an organ performing functions just as vital to our health as our hearts, lungs and other organs. Knowing how skin works is the first step to understanding the causes of acne and how to reduce or prevent outbreaks of acne.

When I was a teenager and well into my young adult years, I suffered from horrible acne. I spent a lot of time (and money) at the dermatologist's office, undergoing a variety of treatments, and he used to joke with me that it was taking longer for me to grow out of acne than most of his patients. No matter what I did, the treatment would only alleviate the acne somewhat, or for a short time, then it would be back with a vengeance.

Now, there are many more effective treatment options available. Understanding acne and how it can be treated is the first step in having the kind of skin you want - free of blemish.

What is acne?

Acne is a common skin disease that results when pores get blocked and bacteria form inside them. It comes in a variety of familiar forms and affects nearly everyone at some stage, particularly in their teen years. The inflamed, red bumps that sometimes form can be painful, and even painless white pimples are unsightly.

In the surface of the skin are pores, tiny openings called a hair follicle. Deeper inside the pore, near the base of the follicle, there are sebaceous glands that produce sebum, a natural type of oil. That oil helps keep the skin flexible and protected.

Hair continues to grow through the surface, while oil or sebum oozes out the side and is spread around the area. Skin cells grow and die and are sloughed off through washing, rubbing or spontaneously. But that process can be interrupted when the pores close and when bacteria form inside them. The result is acne.

The white pimples that sometimes form are usually a combination of dead skin cells, white blood cells and bacteria. The trapped pus often creates an inflamed, red area around it. The term 'pus' is an adaptation of 'pustule', a type of acne that results when the follicle wall bursts and the white blood cells rush into the area as part of a healing process.

When the tiny bumps or spots appear black they're called blackheads, naturally enough. They're a non-inflamed form of acne that come from the material having poked through the surface. Their dark color isn't the result of contact with dirt on the skin. It's a combination of dead skin cells and sebum that have oxidized. Oxygen in the air causes a chemical reaction that turns them black.

Often, however, the material doesn't break the skin, but simply pushes it up, forming a small, white bump called whiteheads. One form are known as 'milia'. Normally dead skin cells will get washed off or simply fall off the surface. But they can get trapped underneath the surface. This type of acne is common among infants, but can affect people at any age.

All these variations go by a general medical term called 'comedones', and whether that formation is open or closed is part of the clinical difference between them.

As the acne develops it can variously form what are called papules, nodules or cysts. A papule forms when the walls holding the hair follicle burst near the surface. They're small and don't contain pus. A nodule is a hardened lump under the skin, resulting from a break at the base of the follicle. A cyst is a larger, reddened bump. They're soft, but can be very painful.

Naturally, while it's helpful to know what acne is, the most important thing is to be able to treat it. In order to do that, it's necessary to know what type we have. We hope you find the information you need here to help you determine the type of acne you have and the best treatment options.