By: Dr. Jere J. Mammino, D.O.

Acne is a common skin condition that afflicts most people, to a varying degree, during the teen years. However, the disease is by no means restricted to this age group; adults in their 20's or 30's may have acne. Don't think that because acne is common, treatment is unnecessary. Waiting to "outgrow" acne can be a serious mistake. Medical treatment can improve your appearance and self esteem, and prevent the development of lifelong pitted scars.



Acne is actually caused by a combination of several factors:

1. Rising hormone levels during adolescence cause enlargement and overactivity of the oil glands in the skin.
2. The canals that bring this oil to the surface become blocked with keratin (a protein that is part of the skin).
3. When these oil glands are overactive and the canals are blocked, the bacteria that normally live on the skin and in the oil multiply, and inflame the skin.



Even though you may be told to wash frequently, acne is not a disease caused by dirt. For example, the blackness of a blackhead is not dirt, but is due to the drying and oxidation of the oil in the oil gland ducts.

Wash your face with a mild antibacterial soap recommended by your dermatologist twice a day. If one's skin is very oily, it may be washed more often. Overwashing or scrubbing tends to irritate the skin and will make acne worse. Therefore, do not use any abrasive cleaners or cleansing pads, like Buff Puff.

Shampooing is also important in acne therapy. The oilier your hair is, the more often you should shampoo it. Also, it is best to keep hair off the face as much as possible to avoid hair oils.

For covering blemishes, many preparations have been formulated to match skin color. These cosmetics should be water based (i.e. the first ingredient on the label should be water). Greasy applications such as Vaseline, cocoa butter, cold cream, and vitamin E oil should be avoided. If the face is dry, your dermatologist can recommend a moisturizer for your type skin.


A generation ago, it was widely believed that greasy type foods aggravated acne. Since then, well controlled studies have shown that in the great majority of people there is no relationship between diet and acne. So in addition to a well balanced diet, pizza, fried foods, chocolate, potato chips, and soft drinks may be eaten. If you are allergic to any of these, or they do not agree with you, don't eat them.


Acne need not be feared as something untreatable. In recent years many effective forms of therapy have been developed. Dermatologists want to prevent scars that acne can leave. Years of untreated acne can leave a lifelong imprint on a person's face and can have an effect on his or her self-image. While acne may not be curable, it is usually controllable.

Mild acne is treated with one or a combination of creams and solutions. The purpose of these topical medicines is to prevent new blemishes from forming. Therefore, apply these all over your affected areas, not just directly on the present pimples. In addition, in some people these creams may cause the face to become a little dry, pink or feel taught. This is normal. If your face becomes too irritated or 'raw' feeling, don't stop the creams, just decrease the frequency of application (i.e. apply every second or third day).


Moderate and severe acne is usually treated by topical medicines with the addition of antibiotic pills. Since different combinations work better for some patients than others, you are usually re-evaluated every four to six weeks until the acne is well controlled. In addition to this conventional therapy, your dermatologist may recommend one or more of these treatments to speed healing and clearing of your acne:


This procedure greatly speeds acne clearing and appearance by manually removing blackheads and whiteheads. A round loop extractor is used to apply uniform smooth pressure to dislodge the material. Lesions that offer resistance are loosened by inserting a pointed instrument to carefully expose the contents.


If one or several painful acne cysts develop, fast relief is available with this relatively painless procedure. Each cyst is given a single injection of a dilute cortisone solution, using an ultrathin needle.


In 1982 a new oral medication, isotretinoin (Accutane), became available for the treatment of patients with severe acne not responsive to conventional treatments. The duration of treatment is usually 5 months, and one such course is often curative of acne forever. Use of this medication does require a thorough understanding of its side effects and precautions (e.g. the prevention of pregnancy).


Prior to correcting acne scarring, it is generally advisable to wait until acne activity has been low or absent for several months. Scars improve with time as the body softens their appearance. The color contrast is often the most troublesome aspect of resolving large acne blemishes. These lesions may leave a flat or depressed red scar that is so obvious, patients mistake the mark for an active lesion. The color will fade and approach skin tones in 4 to 12 months. Many patients are self-conscious about the pitted and crater-like scars that do not fade. These remain as a permanent record of previous severe acne. Cosmetic Surgeons offer a variety of procedures to remove or revise these marks:


Superficial acne scarring, and irregular pigmentation of the skin are easily treated with this technique. Chemical agents are applied to the skin that cause the outer layer to be removed. Different chemicals and concentrations are used, depending on a patient's skin type and degree of scarring.


More prominent scarring from acne is best treated by this technique. The top several layers of skin are removed with this high energy light. This action evens out the skin to give it a smoother, more pleasing contour.


Some narrow pitted scars are too deep to be removed by laser resurfacing. These can be removed with a surgical instrument called a punch. The resulting defect is closed, either primarily or with a tiny skin graft, with gratifying results. Sometimes this procedure is followed by chemical peel or laser resurfacing for patients with a mixed type of scarring.


Patients with a few soft depressed scars with smooth edges respond well to collagen. This natural protein is injected under the lesion to elevate it to the level of the skin.


Treatment of acne is a continuing process if the disorder is to be controlled successfully. You must follow your dermatologist's instructions, since you are the only one who can accomplish the necessary daily care. If you are willing to spend the time and extend the effort, "You shall overcome".