Overview

Types of Acne Scars

Scars caused by acne are much more common than doctors once believed, most people will have acne scars that are mild. However, some will have scars that look significant even to others. The best approach is prevention and to treat acne right away as sometimes even mild acne can cause scarring, this can minimize the risk of advancing acne scars. There are a number of different looking scars caused by acne.

They Can Be Classified As Follows:

Ice pick scars Deep pits, that are the most common and a classic sign of acne scarring.
Box car scars Angular scars that usually occur on the temple and cheeks, and can be either superficial or deep, these are similar to chickenpox scars.
Rolling scars Scars that give the skin a wave-like appearance.
Hypertrophic scars Thickened, or keloid scars.

In order to get rid of, or minimize acne scarring, a combination of treatments provides the best results for many people.

Acne Scarring

A detailed and comprehensive discussion of acne scars starts with causes of scarring, prevention of scarring, types of scars, and treatments for scars.

Before talking about scars, a word about spots that may look like scars but are not scars in the sense that a constant change has occurred. Even though they are not true scars and disappear in time, they are visible and can cause embarrassment.

Macules or "pseudo-scars" are flat, red or reddish spots that are the final stage of most inflamed acne lesions. After an inflamed acne lesion flattens, a macule may remain to "mark the spot" for up to 6 months. When the macule eventually disappears, no trace of it will remain—unlike a scar.

Post-inflammatory pigmentation is discoloration of the skin at the site of a healed or healing inflamed acne lesion. It occurs more frequently in darker-skinned people, but occasionally is seen in people with white skin. Early treatment by a dermatologist may minimize the development of post-inflammatory pigmentation. Some post-inflammatory pigmentation may persist for up to 18 months, especially with excessive sun exposure. Chemical peeling may hasten the disappearance of post-inflammatory pigmentation.

Causes of Acne Scars

In the simplest terms, scars form at the site of an injury to tissue. They are the visible reminders of injury and tissue repair. In the case of acne, the injury is caused by the body's inflammatory response to sebum, bacteria and dead cells in the plugged sebaceous follicle. Two types of true scars exist, as discussed later:

  • Depressed areas such as ice-pick scars, and
  • Raised thickened tissue such as keloids.

When tissue suffers an injury, the body rushes its repair kit to the injury site. Among the elements of the repair kit are white blood cells and an array of inflammatory molecules that have the task of repairing tissue and fighting infection. However, when their job is done they may leave a somewhat messy repair site in the form of fibrous scar tissue, or eroded tissue.

White blood cells and inflammatory molecules may remain at the site of an active acne lesion for days or even weeks. In people who are susceptible to scarring, the result may be an acne scar. The occurrence and incidence of scarring is still not well understood, however. There is considerable variation in scarring between one person and another, indicating that some people are more prone to scarring than others. Scarring frequently results from severe inflammatory nodulocystic acne that occurs deep in the skin. But, scarring also may arise from more superficial inflamed lesions. Nodulocystic acne that is most likely to result in scars is seen in these photos

The life history of scars also is not well understood. Some people bear their acne scars for a lifetime with little change in the scars, but in other people the skin undergoes some degree of remodeling and acne scars diminish in size.

People also have differing feelings about acne scars. Scars of more or less the same size that may be psychologically distressing to one person may be accepted by another person as "not too bad." The person who is distressed by scars is more likely to seek treatment to moderate or remove the scars.

Prevention of Acne Scars

As discussed in the previous section on Causes of Acne Scars, the occurrence of scarring is different in different people. It is difficult to predict who will scar, how extensive or deep scars will be, and how long scars will persist. It is also difficult to predict how successfully scars can be prevented by effective acne treatment.

Nevertheless, the only sure method of preventing or limiting the extent of scars is to treat acne early in its course, and as long as necessary. The more that inflammation can be prevented or moderated, the more likely it is that scars can be prevented. (Click on Acne Treatments for more information about treatment of mild, moderate and severe acne). Any person with acne who has a known tendency to scar should be under the care of a dermatologist. (Click on Find a Dermatologist to locate a dermatologist in your geographic area).

Types of Acne Scars

There are two general types of acne scars, defined by tissue response to inflammation:

  • Scars caused by increased tissue formation
  • Scars caused by loss of tissue.

Scars Caused by Increased Tissue Formation

The scars caused by increased tissue formation are called keloids or hypertrophic scars. The word hypertrophy means "enlargement" or "overgrowth." Both hypertrophic and keloid scars are associated with excessive amounts of the cell substance collagen. Overproduction of collagen is a response of skin cells to injury. The excess collagen becomes piled up in fibrous masses, resulting in a characteristic firm, smooth, usually irregularly-shaped scar. The photo shows a typical severe acne keloid

The typical keloid or hypertrophic scar is 1 to 2 millimeters in diameter, but some may be 1 centimeter or larger. Keloid scars tend to "run in families"—that is, abnormal growth of scar tissue is more likely to occur in susceptible people, who often are people with relatives who have similar types of scars.

Hypertrophic and keloid scars persist for years, but may diminish in size over time.

Scars Caused by Loss of Tissue

Acne scars associated with loss of tissue—similar to scars that result from chicken pox—are more common than keloids and hypertrophic scars. Scars associated with loss of tissue are

Ice-pick scars usually occur on the cheek. They are usually small, with a somewhat jagged edge and steep sides—like wounds from an ice pick. Ice-pick scars may be shallow or deep, and may be hard or soft to the touch. Soft scars can be improved by stretching the skin; hard ice-pick scars cannot be stretched out.

Depressed fibrotic scars are usually quite large, with sharp edges and steep sides. The base of these scars is firm to the touch. Ice-pick scars may evolve into depressed fibrotic scars over time. Soft scars, superficial or deep are soft to the touch. They have gently sloping rolled edges that merge with normal skin. They are usually small, and either circular or linear in shape.

Atrophic macules are usually fairly small when they occur on the face, but may be a centimeter or larger on the body. They are soft, often with a slightly wrinkled base, and may be bluish in appearance due to blood vessels lying just under the scar. Over time, these scars change from bluish to ivory white in color in white-skinned people, and become much less obvious.

Follicular macular atrophy is more likely to occur on the chest or back of a person with acne. These are small, white, soft lesions, often barely raised above the surface of the skin—somewhat like whiteheads that didn't fully develop. This condition is sometimes also called "perifollicular elastolysis." The lesions may persist for months to years. acne scar treatment, acne scars laser

Treatments for Acne Scars

A number of treatments are available for acne scars through dermatologic surgery. The type of treatment selected should be the one that is best for you in terms of your type of skin, the cost, what you want the treatment to accomplish, and the possibility that some types of treatment may result in more scarring if you are very susceptible to scar formation.

A decision to seek cosmetic surgical treatment for acne scars also depends on:

The way you feel about scars. Do acne scars psychologically or emotionally affect your life? Are you willing to "live with your scars" and wait for them to fade over time? These are personal decisions only you can make.

The severity of your scars. Is scarring substantially disfiguring, even by objective assessment ?

A cosmetic surgeon's expert opinion as to whether scar treatment is justified in your particular case, and what scar treatment will be most effective for you.

Before committing to treatment of acne scars, you should have a frank discussion with your dermatologist regarding those questions, and any others you feel are important. You need to tell the dermatologist how you feel about your scars. The dermatologist needs to conduct a full examination and determine whether treatment can, or should, be undertaken.

The objective of scar treatment is to give the skin a more acceptable physical appearance. Total restoration of the skin, to the way it looked before you had acne, is often not possible, but scar treatment does usually improve the appearance of your skin.

The scar treatments that are currently available include

Collagen injection Collagen, a normal substance of the body, is injected under the skin to "stretch" and "fill out" certain types of superficial and deep soft scars. Collagen treatment usually does not work as well for ice-pick scars and keloids. Collagen derived from cows or other non-human sources cannot be used in people with autoimmune diseases. Human collagen or fascia is helpful for those allergic to cow-derived collagen. Cosmetic benefit from collagen injection usually lasts 3 to 6 months. Additional collagen injections to maintain the cosmetic benefit are done at additional cost.

Autologous fat transfer Fat is taken from another site on your own body and prepared for injection into your skin. The fat is injected beneath the surface of the skin to elevate depressed scars. This method of autologous (from your own body) fat transfer is usually used to correct deep contour defects caused by scarring from nodulocystic acne. Because the fat is reabsorbed into the skin over a period of 6 to 18 months, the procedure usually must be repeated. Longer lasting results may be achieved with multiple fat-transfer procedures.

Dermabrasion This is thought to be the most effective treatment for acne scars. Under local anesthetic, a high-speed brush or fraise used to remove surface skin and alter the contour of scars. Superficial scars may be removed altogether, and deeper scars may be reduced in depth. Dermabrasion does not work for all kinds of scars; for example, it may make ice-pick scars more noticeable if the scars are wider under the skin than at the surface. In darker-skinned people, dermabrasion may cause changes in pigmentation that require additional treatment.

Microdermabrasion This new technique is a surface form of dermabrasion. Rather than a high-speed brush, microdermabrasion uses aluminum oxide crystals passing through a vacuum tube to remove surface skin. Only the very surface cells of the skin are removed, so no additional wound is created. Multiple procedures are often required but scars may not be significantly improved.

Laser Treatment Lasers of various wavelength and intensity may be used to recontour scar tissue and reduce the redness of skin around healed acne lesions. The type of laser used is determined by the results that the laser treatment aims to accomplish. Tissue may actually be removed with more powerful instruments such as the carbon dioxide laser. In some cases, a single treatment is all that will be necessary to achieve persevering results. Because the skin absorbs powerful bursts of energy from the laser, there may be post-treatment redness for several months.

Skin Surgery Some ice-pick scars may be removed by "punch" excision of each individual scar. In this procedure each scar is excised down to the layer of subcutaneous fat; the resulting hole in the skin may be repaired with sutures or with a small skin graft. Subcision is a technique in which a surgical probe is used to lift the scar tissue away from unscarred skin, thus elevating a depressed scar.

Skin grafting may be necessary under certain conditions—for example, sometimes dermabrasion unroofs massive and extensive tunnels (also called sinus tracts) caused by inflammatory reaction to sebum and bacteria in sebaceous follicles. Skin grafting may be needed to close the defect of the unroofed sinus tracts. facial plastic surgery, cosmetic surgery specialist

Treatment of keloids Surgical removal is seldom if ever used to treat keloids. A person whose skin has a tendency to form keloids from acne damage may also form keloids in response to skin surgery. Sometimes keloids are treated by injecting steroid drugs into the skin around the keloid. Topical retinoic acid may be applied directly on the keloid. In some cases the best treatment for keloids in a highly susceptible person is no treatment at all.

In summary, acne scars are caused by the body's inflammatory response to acne lesions. The best way to prevent scars is to treat acne early, and as long as necessary. If scars form, a number of effective treatments are available. Dermatologic surgery treatments should be discussed with a cosmetic surgeon.

FAQ's

Acne is a very common disease. People who have it tend to have similar kinds of questions about it and its treatment. This section addresses some of the common questions asked by people with acne. Please remember that your cosmetic surgeon is always the best source of specific information about your individual health issues, including acne.

  • What causes acne?
    • The causes of acne are linked to the changes that take place as young people mature from childhood to adolescence (puberty).
    • The hormones that cause physical maturation also cause the sebaceous (oil) glands of the skin to produce more sebum (oil).
    • The hormones with the greatest effect on sebaceous glands are androgens (male hormones), which are present in females as well as males, but in higher amounts in males.
    • Sebaceous glands are found together with a hair shaft in a unit called a sebaceous follicle.
    • During puberty, the cells of the skin that line the follicle begin to shed more rapidly.
    • In people who develop acne, cells shed and stick together more so than in people who do not develop acne.
    • When cells mix with the increased amount of sebum being produced, they can plug the opening of the follicle.Meanwhile, the sebaceous glands continue to produce sebum, and the follicle swells up with sebum.
    • In addition, a normal skin bacteria called P. acnes, begins to multiply rapidly in the clogged hair follicle. In the process, these bacteria produce irritating substances that can cause inflammation.
    • Sometimes, the wall of the follicle bursts, spreading inflammation to the surrounding skin. This is the process by which acne lesions, from blackheads to pimples to nodules, are formed.
  • Am I a candidate for Microdermabrasion? The most ideal candidates for microdermabrasion are those people who are very active and don't want to take the longer recovery time needed for laser resurfacing, chemical peels, or dermabrasion. Other ideal candidates are those who are sensitive to the chemicals involved in other treatment methods, or those who are not responding well to acne medications.
  • How do I prepare for a treatment? When you arrive for your microdermabrasion treatment, you will be asked to remove your makeup because this prevents the even application of the microcrystals.
  • What should I expect during my treatment? The microdermabrasion treatment is performed in our treatment room, requires no anesthesia, and allows you to return to your normal daily activities immediately following the treatment.
  • What should I expect after my treatment?

    Results are noticeable after the first treatment. Your skin will appear light pink with a soft texture. More aggressive treatments may cause the pinkness to persist for the remainder of the day of treatment. However, it is safe to reapply your makeup and/or facial moisturizer following the procedure.

    You should wear a sunscreen and avoid direct sun exposure of the treated area for the first 24 hours following a treatment, because the treated area is initially more sensitive to the effects of ultraviolet radiation. Otherwise, your normal daily activities may be resumed immediately.

  • I wash my face several times a day. Why do I still get acne?
    • Many people still believe that acne is caused by dirty skin. The truth is, washing alone will not clear up or prevent acne.
    • Washing does, however, help remove excess surface oils and dead skin cells. Many people use all kinds of products, including alcohol-based cleansers, and scrub vigorously, only to irritate the skin further and worsen their acne.
    • Washing the skin twice a day gently with water and a mild soap is usually all that is required.
    • However, acne is actually caused by a variety of biologic factors that are beyond the control of washing. For that reason, you should use appropriate acne treatments for the acne.
  • Does stress cause acne?
    • Stress is commonly blamed for the development of acne. Stress can have many physiologic effects on the body, including changes in hormones that may theoretically lead to acne.
    • In some cases the stress may actually be caused by the acne lesions, not the other way around! If the acne is being treated effectively, stress is not likely to have much impact on the majority of people.
  • I never had acne as a teenager. Why am I now getting acne as an adult ?
    • Usually, acne begins at puberty and is gone by the early 20s. In some cases, acne may persist into adulthood. Such types of acne include severe forms that affect the body as well as the face (which afflict males more than females) and acne associated with the menstrual cycle in women.
    • In other cases, acne may not present itself until adulthood. Such acne is more likely to affect females than males.
    • There are several reasons for this. As females get older, the pattern of changes in hormones may itself change, disposing sebaceous glands to develop acne. Ovarian cysts and pregnancy may also cause hormonal changes that lead to acne.
    • Some women get acne when they discontinue birth control pills that have been keeping acne at bay. Sometimes young women may wear cosmetics that are comedogenic-that is, they can set up conditions that cause comedones to form.
  • What role does diet play in acne?
    • Acne is not caused by food. Following a strict diet will not, clear your skin.
    • While some people feel that their acne is aggravated by certain foods, particularly chocolate, colas, peanuts, shellfish and some fatty foods, there is no scientific evidence that suggests food causes or influences acne.
    • Avoid any foods which seem to worsen your acne and, for your overall health, eat a balanced diet--but diet shouldn't really matter if the acne is being appropriately treated.
  • Does the sun help acne?
    • Many patients feel that sunlight improves their acne lesions and go to great lengths to find sources of ultraviolet light. There is no proven effect of sunlight on acne.
    • In addition, ultraviolet light in sunlight increases the risk of skin cancer and early aging of the skin.
    • It is, therefore, not a recommended technique of acne management, especially since there are many other proven forms of treatment for acne.
    • Moreover, many acne treatments increase the skin's sensitivity to ultraviolet light, making the risk of ultraviolet light exposure all the worse.
  • What is the best way to treat acne?
    • Everyone's acne must be treated individually. If you have not gotten good results from the acne products you have tried, consider seeing a cosmetic surgeon. Your cosmetic surgeon will decide which treatments are best for you.
  • What kind of cosmetics and cleansers can an acne patient use?
    • Look for "noncomedogenic" cosmetics and toiletries. These products have been formulated so that they will not cause acne.
    • Some acne medications cause irritation or pronounced dryness particularly during the early weeks of therapy, and some cosmetics and cleansers can actually worsen this effect.
    • The choice of cosmetics and cleansers should be made with your cosmetic surgeon.
    • Heavy foundation makeup should be avoided.
  • Is it harmful to squeeze my blemishes?
    • Yes. In general, acne lesions should not be picked or squeezed by the patient. In particular, inflammatory acne lesions should never be squeezed.
    • Squeezing forces infected material deeper into the skin, causing additional inflammation and possible scarring.
  • Can anything be done about scarring caused by acne?
    • Scarring is best prevented by getting rid of the acne. Cosmetic surgeons can use various methods to improve the scarring caused by acne.
    • The treatment must always be individualized for the specific patient.
    • Chemical peels may be used in some patients, while dermabrasion or laser abrasion may benefit others. It is important that the acne be well controlled before any procedure is used to alleviate scarring.
  • How long before I see a visible result from using my acne medication?
    • The time for improvement depends upon the product being used, but in almost all cases it is more a matter of weeks or months instead of days.
    • Most cosmetic surgeons would recommend the use of a medication or combination of medications daily for 4 to 8 weeks before they would change the treatment. It is very important for patients to be aware of this time frame so they do not become discouraged and discontinue their medications.
    • Conversely, if you see no change whatsoever, you might want to check with your cosmetic surgeon regarding the need to change treatments.
  • Would using my medication more frequently than prescribed speed up the clearing of my acne?
    • No--always use your medication exactly as your cosmetic surgeon instructed. Using topical medications more often than prescribed may actually induce more irritation of the skin, redness and follicular plugging, which can delay clearing time.
    • If oral medications are taken more frequently than prescribed, they won't work any better, but there is a greater chance of side effects.
  • My topical treatment seems to work on the spots I treat, but I keep getting new acne blemishes. What should I do ?
    • Topical acne medications are made to be used on all acne-prone areas, not just individual lesions. Part of the goal is to treat the skin before lesions can form and to prevent formation, not just to treat existing lesions.
    • Patients are generally advised to treat all of the areas (forehead, cheeks, chin and nose) that tend to break out rather than just individual lesions.
  • My face is clear! Can I stop taking my medication now?
    • If your cosmetic surgeon says you can stop, then stop--but follow your cosmetic surgeon's instructions.
    • Many times patients will stop their medication suddenly only to have their acne flare up several weeks later.
    • If you are using multiple products, it may be advisable to discontinue one medication at a time and judge results before discontinuing them all at once. Ask your cosmetic surgeon before you stop using any of your medications.
  • MDoes it matter what time I use my medication?
    • Check with your cosmetic surgeon. If you were taking one dose a day of an antibiotic, you could probably take it in the morning, at midday or in the evening, although you should pick one time of day and stay with it throughout your treatment.
    • With oral medications prescribed twice a day or three times a day, you should try your best to spread out the doses evenly.
    • Some antibiotics should be taken on an empty or nearly empty stomach. For optimal results with topical treatments, you should strictly follow your cosmetic surgeon's recommendations.
    • For example, if instructed to apply benzoyl peroxide in the morning and a topical retinoid at bedtime, it is important to follow these directions strictly.
    • If the two were applied together at bedtime, for example, you could decrease the efficacy of the treatment because of chemical reactions that make them less effective.
  • I have trouble remembering to take my oral medication every day. What's a good way to remember ? What should I do if I forget a dose ?
    • This is a common problem. Many patients try to associate taking their medication with a routine daily event such as brushing teeth or applying makeup.
    • It also helps to keep the medication close to the area where the reminder activity is carried out.
    • In most cases, if you miss a day of your oral treatment, do not double up the next day; rather, get back to your daily regimen as soon as possible--but there may be different instructions for different oral medications.
    • Ask your cosmetic surgeon or pharmacist about what to do if you miss a dose of your particular medication.
    • I have been using topical benzoyl peroxide and an oral antibiotic for my acne and have noticed blue-black and brown marks developing on my face and some discoloration on my body. The marks are especially noticeable around acne scars and recently healed lesions.
  • Is this a side effect of medication?
    • It is not possible to make general statements about side effects of medications that apply to individual cases.
    • A cosmetic surgeon should be consulted. The facial marks and body discoloration described by the patient in this case do fall within the range of side effects of some antibiotics.
    • Unique patterns of pigmentation are sometimes seen in acne patients treated with certain oral antibiotics—particularly minocycline. The pigmentation patterns that appear may include:
      • Localized blue-black or brown marks in and around acne scars and in areas of previous acne inflammation
      • A "muddy skin" appearance that may cover much of the body
      • Diffuse brownish pigmentation of the feet and lower legs.
  • The pigmentation side effect gradually disappears after the therapy is discontinued?
    • Any side effect of a medication should be noted by the patient and brought to the attention of the physician. While most side effects are temporary they should be discussed with the physician and monitored.
    • My doctor is prescribing a topical retinoid for my acne. He said a retinoid is a substance related to vitamin A.
  • If the drug is related to vitamin A, shouldn't vitamin A dietary supplements be helpful in getting rid of acne?
    • Dietary vitamin A is essential to good health, especially vision. It has healthful effects in the skin. Large doses of vitamin A for the treatment of acne is not recommended on grounds of safety.
    • The retinoids and retinoid-like substances used as topical treatments for acne are prepared especially for their potent effect on the shedding of cell lining in the sebaceous follicle. Their use should be monitored by a cosmetic surgeon.
    • Dietary vitamin A has multiple health effects in the human body. Vitamin A is essential for good vision.
    • Extreme vitamin A deficiency can result in blindness, usually accompanied by dry, scaly skin. Vitamin A overdose that far exceeds the Recommended Dietary Allowance (RDA) of 5,000 IU can have effects nearly as catastrophic.
    • Extreme vitamin A overdose can cause the skin to blister and peel—an effect first seen in early North Pole explorers who nearly died after eating polar bear liver that has an extraordinarily high vitamin A content.
    • Topical retinoids are usually prescribed as a treatment for moderate to severe acne. Side effects are chiefly dermatologic, including redness, scaling and dryness of the skin, itching and burning.
    • These side effects can usually be managed by adjustment of the amount and timing of retinoid applied to the skin. Dose adjustment must be discussed with the cosmetic surgeon
  • who prescribed the treatment Are there any acne treatments specifically for people with dark skin? Are there any treatments specifically harmful to dark skin?
    • There are no acne treatments specifically for use on dark skin. Acne treatments are generally as safe and effective on dark skin as on light skin. Some treatments for acne scars may cause temporary lightening of dark skin.
    • Acne is a common skin disease that has the same causes and follows the same course in all colors of skin.
    • Very dark or black skin may be less well-moisturized than lighter skin. Topical anti-acne agents such as benzoyl peroxide that have a drying effect on the skin should be used under the supervision of a cosmetic surgeon.
    • Benzoyl peroxide also is a strong bleach and therefore must be applied carefully to avoid inadvertent decolorization of a patch of hair, towels or clothing
    • Darker skin has a tendency to develop post-inflammatory hyperpigmentation (excessive skin darkening at places where the skin was inflamed). Severe inflammatory acne may result in dark spots. The spots resolve over time; a cosmetic surgeon may be able to recommend cosmetic measures to make the spots less apparent until they resolve.
    • Some acne treatments, such as topical retinoids and azelaic acid, may also help fade the discoloration.
    • Removal of acne scars by dermabrasion or chemical peeling may cause temporary lightening or darkening of dark skin in the areas of treatment.
    • Scar treatment should be discussed with a cosmetic surgeon or dermatologic surgeon before it is undertaken.
    • Alterations of melanin (dark pigments that give the skin its color) pigmentation such as vitiligo and melasma are not related to acne, but they may be present simultaneously with acne.
    • The diagnosis and treatment of melanin pigmentation disorders such as vitiligo requires a cosmetic surgeon with knowledge and experience in treating these conditions.
  • Is acne that appears for the first time in adulthood different from acne that appears in adolescence?
    • Acne has a specific definition as a disease of sebaceous follicles. This definition applies to acne that occurs at any age. However, it may be important to look for an underlying cause of acne that occurs for the first time in adulthood.
    • Current understanding of the causes of acne vulgaris is described in the Main Text section Why and how acne happens.
    • In brief summary, acne vulgaris develops when excessive sebum production and abnormal growth and death of cells in the sebaceous follicle result in plugging of follicles with a mixture of sebum and cellular debris and formation of comedones (blackheads and whiteheads).
    • Bacteria in the follicles—chiefly Propionibacterium acnes, the most common bacterial colonist of sebaceous follicles—may contribute to the inflammation of acne by release of metabolic products that cause inflammatory reaction.
    • The pathogenic events, which cause disease, in the sebaceous follicle are believed to be due in large degree to changes in levels of androgenic (male) hormones in the body—a circumstance usually associated with growth and development between ages 12 and 21.
    • Some acne investigators believe that although this understanding is generally correct, there is more yet to be learned about the causes of acne vulgaris.
    • Acne that appears after the age of 25-30 years is
      • A recurrence of acne that cleared up after adolescence
      • A flare-up of acne after a period of relative quiet—for example, during pregnancy
      • Acne that occurs for the first time in a person who had never previously had acne.
    • Acne that occurs in adulthood may be difficult to treat if there are multiple recurrences. Some patients with severe recurrent acne have undergone repeated courses of treatment with the potent systemic drug isotretinoin.
    • Acne flares in association with pregnancy or menstruation are due to changes in hormonal patterns.
    • Acne that appears for the first time in adulthood should be investigated for any underlying cause.
    • Drugs that can induce acne include anabolic steroids (sometimes used illegally by athletes to "bulk up"), some anti-epileptic drugs, the anti-tuberculosis drugs isoniazid and rifampin, lithium, and iodine-containing drugs.
    • Chlorinated industrial chemicals may induce the occupational skin disorder known as chloracne. Chronic physical pressure on the skin—for example, by a backpack and its straps, or a violin tucked against the angle of the jaw and chin—may induce so-called acne mechanica.
    • Some metabolic conditions may cause changes in hormonal balance that can induce acne.
    • Some lesions that appear to be acne may be another skin disorder such as folliculitis—infection and inflammation of hair follicles—that require different treatment than acne. Acne that appears for the first time in adulthood should be examined and treated by a cosmetic surgeon.
    • My 15-year-old daughter has what I would describe as a very mild case of acne. She has made it much worse by constant picking and squeezing. She looks in the mirror for hours, looking for some blackhead or blemish she can pick or squeeze.
  • Does she need psychological counseling?
    • Excessive picking and squeezing of otherwise mild acne is a condition called excoriated acne, seen most often in young women. A cosmetic surgeon may provide effective counseling.
    • The typical person with excoriated acne is a person—often a young women—who is so distressed with her appearance due to acne that she literally tries to "squeeze the acne out of existence."
    • The acne is often very mild, but the person's face may constantly be covered with red marks from squeezing, and open sores where lesions have been picked open
    • The word excoriate means to scratch or abrade the skin. Excoriated acne is a medically recognized condition that should be discussed with a cosmetic surgeon. Occasionally giving in to a temptation to squeeze a blackhead is not defined as excoriated acne.
    • Hours in front of a mirror, squeezing and picking every blemish, is a definition of excoriated acne.
    • A cosmetic surgeon may be able to counsel the patient regarding a course of treatment in which the patient can participate, but keep "hands off."
  • Can the rate of secretion or the composition of sebum be altered by diet? If it can, shouldn't alteration of diet be considered a treatment for acne?
    • Diet has never been proven to have a role in the cause or treatment of acne. Dietary manipulation may have a role in the treatment of some scaling diseases of the skin, but not in the treatment of acne.
    • Dietary cause is one of the most persistent myths about acne. Foods, such as chocolate or greasy foods, do not cause acne, but certain foods seem to make some people's acne worse.The following can bring on or worsen it
      • Hereditary factors
      • An increase in male hormones found in both males and females
      • Menstruation
      • Emotional stress
    • Oil and grease from cosmetics, work environment.No food has been shown to be effective in preventing or treating acne. A healthy diet is, of course, necessary for good general health.

Acne Myths

  • Acne is caused by poor hygiene. If you believe this myth, and wash your skin hard and frequently, you can actually make your acne worse. Acne is not caused by dirt or surface skin oils. Although excess oils, dead skin and a day's accumulation of dust on the skin looks unsightly, they should not be removed by hand scrubbing. Vigorous washing and scrubbing will actually irritate the skin and make acne worse. The best approach to hygiene and acne: Gently wash your face twice a day with a mild soap, pat dry--and use an appropriate acne treatment for the acne.
  • Acne is caused by diet. Extensive scientific studies have not found a connection between diet and acne. In other words, food does not cause acne. Not chocolate. Not french fries. Not pizza. Nonetheless, some people insist that certain foods affect their acne. In that case, avoid those foods. Besides, eating a balanced diet always makes sense. However, according to the scientific evidence, if acne is being treated properly, there's no need to worry about food affecting the acne.
  • Acne is just a cosmetic disease. Yes, acne does affect the way people look and is not otherwise a serious threat to a person's physical health. However, acne can result in long-term physical scars--plus, acne itself as well as its scars can affect the way people feel about themselves to the point of affecting their lives.
  • You just have to let acne run its course. The truth is, acne can be cleared up. If the acne products you have tried haven't worked, consider seeing a dermatologist. With the products available today, there is no reason why someone has to endure acne or get acne scars.
*Disclaimer - Results may vary from person to person.