What Causes Acne
According to the American Academy of Dermatology, acne develops when hormonal shifts (like the kind that occur during puberty, and in women, before a menstrual cycle and sometimes prior to menopause) cause an overproduction of oil and cells inside a skin follicle. Together, they form a kind of biological traffic jam that plugs the opening of the pore and causes the follicle beneath to swell.
This allows for the overgrowth of bacteria found normally on skin -- Propionibacterium acnes (P. acnes) -- producing irritating chemical substances, which further fuel the inflammation. The end result is acne.
"It can be characterized by anything from whiteheads and blackheads, to tiny hard pimples you barely see, to pus-filled nodules, even fluid-filled cysts with roots deep in the skin," says Sumayah Jamal, MD, PhD, an assistant professor of dermatology and microbiology at the NYU Medical Center in New York City.
Signs and Symptoms:
There are several types of acne lesions:
According to the American Academy of Dermatology, acne develops when hormonal shifts (like the kind that occur during puberty, and in women, before a menstrual cycle and sometimes prior to menopause) cause an overproduction of oil and cells inside a skin follicle. Together, they form a kind of biological traffic jam that plugs the opening of the pore and causes the follicle beneath to swell.
This allows for the overgrowth of bacteria found normally on skin -- Propionibacterium acnes (P. acnes) -- producing irritating chemical substances, which further fuel the inflammation. The end result is acne.
"It can be characterized by anything from whiteheads and blackheads, to tiny hard pimples you barely see, to pus-filled nodules, even fluid-filled cysts with roots deep in the skin," says Sumayah Jamal, MD, PhD, an assistant professor of dermatology and microbiology at the NYU Medical Center in New York City.
Signs and Symptoms:
There are several types of acne lesions:
- Closed comedone (whitehead) -- a clogged follicle. Whiteheads usually appear on the skin as small, round, white bumps
- Open comedone (blackhead) -- a plugged follicle that opens and turns dark at the surface of the skin. Blackheads do not indicate the presence of dirt.
- Papules -- inflamed lesions that appear as small, pink bumps on the skin.
- Pustules (pimples) -- inflamed pus filled lesions that are red at the base.
- Cysts and nodules -- large, inflamed, pus filled lesions deep under the skin that can cause pain and scarring.
Acne Trearment
The newest over-the-counter acne treatment is not a cream or lotion, but a device -- a tiny electronic pimple "zapper" with the high-tech name of "Zeno."
Recently cleared by the FDA, Zeno resembles a tiny cell phone or a large cigarette lighter. It purportedly works by supplying a small amount of controlled heat directly to the acne lesion for two to three minutes, causing the bacteria to self-destruct and ultimately the pimple to clear.
According to the manufacturer, most zits require a single treatment and are completely gone in just hours. Others, they say, may require up to three treatments in 24 hours to see results.
It sounds impressive, but does it work?
"If the lesion is not too large -- and not too severely inflamed -- it can work. But it's not for widespread acne, or moderate to severe breakouts," says Jamal. She says it's best for the occasional pimple and perfect for zit-phobes who want to keep their skin blemish-free without having to run to the dermatologist every week.
The Zeno device sells for about $215, and the company offers a free 30-day trial.
New Laser Treatments
But what if your acne is causing more than just an occasional pimple? Then you may be a candidate for one of several new laser treatments -- professional medical procedures that use laser light to heat up and destroy bacteria, as well as shut down excess oil production.
"One type of laser works to inhibit the growth of 'bugs' -- the bacteria that cause acne; the second type shrinks the oil glands and has an 'Accutane-like' effect, but without the side effects," says Goldberg. Both lasers also have antiaging benefits including encouraging collagen production, making it an excellent treatment for midlife acne.
Although treatment is pretty much painless, it is expensive, costing between $500 and $800 per session, with at least five to seven treatments necessary to see results. Moreover, those results are frequently not permanent.
"The laser that works on the bugs, usually requires five or six treatments, which may need to be repeated in about two months; the lasers that work on the oil glands have a longer-lasting effect, but flare-ups do generally occur again within six months to a year," Goldberg tells WebMD.
Jamal says because they are so costly, lasers should only be used when topical antibiotic preparations aren't enough.
"The lasers don't do a better job than the topical treatments, and they are more expensive. I use them only as an adjunct, when the topicals alone don't work, or to treat large areas such as the back," she says.
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