Acne affects almost everyone, with more than 90% of all teens experiencing some form of acne. Acne is prevalent in both males and females and is present in all ethnic backgrounds making it one of the most widespread medical conditions in the world.

Acne Background
Acne is a disease of the sebaceous hair follicles. At the base of each hair follicle is a gland called the sebaceous gland, which makes sebum. Sebum is an oily substance, which under normal circumstances travels along the hair follicle to the surface of the skin. Sebaceous glands are most numerous on the face, chest, back, neck and scalp; consequently, these are the most common sites of Acne.

In Acne the normal transport of sebum out of the follicle is impeded which leads to an accumulation of sebum providing an enriched breeding ground for bacteria. Cleansing with soap is not capable of removing the bacteria entrapped at the base of the hair follicle. The rapid growth of the bacteria in combination with the accumulated sebum cause the follicle to enlarge and can result in a mild form of Acne called comedones (blackhead, open comedone or whitehead, closed comedone) both of which are non-inflammatory. Acne may progress to an inflammatory type of Acne lesions that are red in color called papules, pustules and nodules. Papules are the earliest stage in the development of what are normally considered the typical "pimple". Papules are an intermediate in the progression of Acne between the non-inflammatory and inflammatory stages.

The most common factors that cause Acne: - Hormones - Increased sebum production - Bacteria (Propionibacterium Acnes) - Changes inside of the hair follicle

The next stage is the development of a clearly inflammatory lesion called the pustule, which contains limited number of bacteria and pus below the surface of the skin. Nodules or cysts are the most advanced and severe form of Acne. Nodules result when the contents of a comedone expand from the follicular region to the surrounding tissue causing a local inflammatory reaction that may damage the skin


Teenage (Adolescent) Acne
Most cases of acne that require treatment occur in individuals 9 to 19 years of age. Boys and girls are equally affected but the condition is usually more severe in boys. No ethnic groups are predisposed to acne, but certain cultural practices, such as the use of oily grooming agents can lead to a specific pattern of lesions. Internal factors that may cause adolescents acne include endogenous hormones (androgens, progesterone) and specific drugs (oral contraceptives, isoniazid, phenytoin, corticosteroids, lithium-containing compounds). External factors include skin bacteria, especially Propionibacterium acnes; industrial chemicals (petroleum, animal and vegetable oils); oil- or wax-containing cosmetics; greasy sunscreen or suntan preparations; and local pressure from objects such as headbands, shoulder pads, or helmets. Excessive perspiration and emotional stress can also aggravate acne.

Androgens (testosterone) will increase the size of sebaceous glands and in people prone to Acne increase the production of sebum. Pores can become clogged with dead skin, sebum and bacteria leading to the formation of a micro-comedone (microscopic lesion). In women fluctuations in estrogen during the menstrual cycle change the sensitivity of sebaceous glands to androgens. During puberty the skin cells lining the follicle shed more quickly, mix with the increased levels of sebum and increase the likelihood of the pores becoming clogged. The clogged pore replete with sebum provides an ideal environment for the rapid growth of skin bacteria; Propionibacterium Acnes (P. acnes) which secrete chemicals into the skin that stimulate an inflammatory response.

Teenage Acne Hormonal Acne               Cystic Acne Body Acne Back Acne Work-out Acne

Managing Teenage Acne
The first step in treating teenage acne is aimed at educating teenagers about the nature of acne, the necessity to treat and prevent the formation of acne and some general principals of hygiene and warnings about avoiding manipulation of individual lesions. "Picking" or "popping" pimples only increases inflammation and the potential for scarring.

An integral part of the successful management of adolescent acne is good hygiene. Adolescents (especially males) between the ages of 12 and 14 years often lack basic information about skin care. Acne is not a problem of dirt on the skin, as many people believe. Twice-daily washing is sufficient. More frequent use of water, soap and harsh cleansers can cause over-drying and rebound secretion of sebum. A mild, non-medicated soap is usually the best. Strong deodorant soaps, which are effective on the body, can be too irritating to facial skin. Abrasive sponges or cloths (such as the popular "buff puff") will cause microscopic abrasions and open the "gates" for the entry of bacteria. Astringents containing alcohol or higher levels of salicylic acid, may increase skin dryness and sometimes worsen skin irritation and inflammation.


Common Acne Treatments.
Currently there are no FDA approved drugs to treat the causes of Acne nor products that cure Acne. Readily available Over The Counter (OTC) products are topical and only address the overt clinical manifestation of Acne (pimples). With the exception of Accutane, which helps to decrease sebaceous gland secretions, systemically administered Acne treatment drugs are restricted to broad-spectrum antibiotics, which non-specifically kill bacteria associated with Acne.

Systemic use of retinoids (Accutane) is often considered the "last option" for the treatment of Acne due to its numerous side effects and in particular its teratogenic potential in women and inducement of depression in young men.

Overall the treatment of Acne can be divided into two separate strategies.

The first strategy is the use of antibiotics such as tetracycline and minocycline, that kill the microbes associated with Acne. These products are either administered either topically or orally. The oral antibiotics in particular are not specific for Acne and have systemic effects and side effects. The indiscriminate use of antibiotics is being strongly discouraged in the medical field due to the increasing appearance of bacterial resistance.

For severe, persistent cases of Acne, Retin-A (tretinoin) Cream or Accutane (isotretinoin) oral tablets are often recommended. Both products are retinoid derivatives and have a multitude of side effects. Accutane is a known potent teratogen and strictly contraindicated in women not practicing a proven method of birth control.

The second strategyincludes the use of topical cleansing or drying agents, and topical retinoids. Only the retinoids are thought to directly effect the over-secretion of the sebaceous glands, which is considered the primary cause of Acne. They have numerous side effects such as dryness, redness, sun restrictions, skin discolorations etc.

Topical treatments such as Benzoyl peroxide available over-the-counter in preparations of 2.5% to 10% strengths in forms of liquid, lotion, cream or gel target bacteria in the skin. Salicylic acid products, are also available over-the-counter and have the same temporary cleansing yet not treatment effect.