Is Acne a Physical Change?
Dermatologists understand the physiological process behind acne breakouts, but identifying specific causes has remained elusive. Some breakouts happen randomly, while others are concentrated around times of great physical change such as adolescence or pregnancy. Treatment options are plentiful, but sometimes they are of limited effect once the process begins.
An acne lesion erupts when sebum, an oily substance produced at the root of hair follicles, is trapped by an accumulation of dead skin cells. Proper cleansing can reduce the likelihood of a severe outbreak, but during adolescence, an increase in hormonal activity prompts an overproduction of sebum. According to the American Academy of Dermatology, 100 percent of the population has at least an occasional blemish or pimple during adolescence.
Acne, called acne vulgaris by dermatological professionals, is mild for most people, but severe cases can cause lasting physical changes to the appearance of the sufferer. Severe acne comes in four main types, according to the AAD: acne conglobata, acne fulminans, gram negative folliculitis and nodulocystic acne.
Each type is characterized by a particular type of lesion. Conglobata presents with deep lesions that can severely damage the skin and cause scarring. Acne fulminans is characterized by sudden, severe outbreaks that can actually cause a fever and aching joints in the afflicted individual. Gram-negative acne occurs when an acne patient undergoes prolonged antibiotic treatment for severe acne and the bacteria in the follicles develops resistance. Finally, nodulocystic acne is a rare condition characterized by cysts, sometimes infected and filled with pus, that develop from smaller acne lesions. Cysts close together can merge above and below the surface of the skin.
Adolescence and other times of increased hormonal activity like pregnancy bring physical changes that can cause acne eruptions, but researchers at the Wake Forest University School of Medicine have linked periods of high stress to acne outbreaks in adolescents. In the 2007 Wake Forest study, researchers found that 95 percent of males and 92 percent of females who self-reported high stress levels suffered from acne outbreaks. The cause seemed to be unrelated to increased stress hormone production, as sebum levels in those affected were consistent with those who were not affected. Researchers hypothesized that the body's inflammatory reaction to high-stress situations might be the cause, but allowed that more research is needed.
Most mild cases of acne are treatable at home with proper cleansing and a topical solution of benzoyle, according to Dr. Richard P. Usatine of the University of California, Los Angeles. More severe cases require dermatological intervention. Treatment usually begins with a topical retinoid, an ointment derived from vitamin A, but it can progress to oral antibiotics like erythromicin, doxycycline or minocycline as needed. Isotretinoin, another vitamin A derivative, is prescribed only in severe cases. Women undergoing treatment with isotretinoin must agree to use birth control because the drug can cause severe, life-threatening birth defects, according to Drugs.com.
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