No single factor has been proven to cause acne. The sebaceous (skin oil) glands of most people with acne are especially sensitive to the blood levels of a male hormone called testosterone, which is present in both men and women.
Causes of Acne
Testosterone in genetically prone patients triggers the sebaceous glands to produce an excess of sebum. At the same time, the dead skin cells lining the hair follicles (miniature tubes that surround each hair) are not shed properly and clog up the follicles.
Acne is believed to be triggered by elevated levels of male hormones which stimulate the sebaceous glands attached to the hair follicles during puberty.
Sebum is a natural lubricant that keeps the skin moistened and protected against the elements. The way the skin cells mature is altered by an increased sebum production, the cells start clogging the follicles, and the clogged follicles gradually swell into bumps.
The enlarged follicles frequently rupture the skin walls, which allows irritating substances and normal skin bacteria access into the deeper skin layers causing inflammation. Inflammation near the skin’s surface produces a pustule.
Deeper inflammation results in a papule (pimple) while an even deeper one becomes a cyst. If the sebum penetrates to the surface of the skin it forms a “whitehead“. If it accumulates melanin pigment or becomes oxidized, it’s color changes from white to black forming a “blackhead“.
Blackheads are not dirt and do not reflect poor hygiene. In some people acne does not progress beyond this stage, while in others the sebum build-up inside the hair follicles creates an ideal environment for a Propionibacterium Acnes bacterium to start growing.
Factor’s contributing to acne
- Pressure: In some patients, pressure from helmets, chin straps, collars, suspenders, and the like can aggravate acne.
- Drugs: Some medications may cause or worsen acne, such as those containing iodides, bromides, or oral or injected steroids (either the medically prescribed prednisone [Deltasone, Orasone, Prednicen-M, Liquid Pred] or the steroids that bodybuilders or athletes take). Other drugs that can cause or aggravate acne are anticonvulsant medications and lithium (Eskalith, Lithobid), which is used to treat bipolar disorder. Most cases of acne, however, are not drug related.
- Occupations: Exposure to industrial products like cutting oils and harsh lubricants may also produce acne
- Cosmetics: Some cosmetics and skin-care products are comedogenic (causing pore clogging). If you are concerned about acne be sure to read the list of ingredients and choose only the products that have water listed first or second, because these water based products are usually safe.
Over long periods this can also result in acne scarring. Active acne heals significantly after laser treatments. Acne can be a very distressing condition and it is not restricted to teenage years; it affects people of all ages.
Acne Vulgaris is a common chronic inflammatory condition of the pilosebaceous duct (a duct is a tubular bodily canal or passage that carries glandular secretion). Pilosebaceous means of or relating to a hair follicle and its sebaceous gland).
The over-production of sebum and dead skin cells clog the hair follicle causing infection. It affects all skin areas that have the largest population of sebaceous follicles, which include the face, chest and back. Acne begins when a change occurs in the dead cells that line the sebaceous hair follicles.
The cells become thicker and more resistant to the process by which follicles normally flush the dead cells to the surface. They also begin to stick together and form an inner layer of dead cells.
The blockage traps the oil in the follicle where the bacteria (Propiobacterium Acnes – P. Acne) will thrive on the anaerobic conditions where oxygen is not present.
Laser acne treatment consists of laser light heating the targeted blood vessels. The heat causes the release of growth factors that stimulate the fibroblasts within the skin.
This process has two effects; first and most important in this application, the oxygen that is produced kills the anaerobic bacteria causing the acne. Second the skin is stimulated to produce collagen which helps to even out any scarring previously caused by the acne.
Factors that usually don’t affect acne:
- Heredity: With the exception of very severe acne, most people do not have the problem exactly as their parents did. Almost everyone has some acne at some point in their life.
- Food: Parents often tell teens to avoid spicy food, chocolate, greasy and fried foods, and junk food. While these foods may not be good for overall health they don’t cause acne or make it worse. Although some recent studies have implicated milk and pure chocolate in aggravating acne these findings are far from being scientifically proven.
- Dirt: As mentioned above, “blackheads” are oxidized oil, not dirt. Sweat does not cause acne, therefore, it is not necessary to shower instantly after exercise for fear that sweat will clog pores. On the other hand, excessive washing can dry and irritate the skin.
- Stress: Some people get so upset by their pimples that they pick at them and make them last longer. However, stress does not play a direct role in causing acne.
Acne Treatment Options
- Do nothing and hope or pray for no scars
- Variety of OTC washes, scrubs and creams
- Facial treatment by an aesthetician
- Micro-dermabrasion (expensive)
- Various prescription drugs including topicals, oral antibiotics and accutane like products
- Blue-U light treatments
- Laser treatments
Lasers and BLU-U light systems are FDA approved to treat a number of skin related conditions, including Acne Vulgaris, and two groups of light based FDA approved devices are currently available for the treatment of acne:
- Devices that target Sebaceous Glands
- Devices that target Bacterium Acne
Dr. Harwer has been using several light devices to treat acne with great results. If you have active acne or acne scars, call us for an appointment to discuss what treatment is best for your skin.
BLU-U® Blue Light Acne Treatments
BLU-U® Light Treatment of Moderate Acne
Teenagers and many young adults in their 20’s and 30’s have trouble with acne that is hard to control. If you have moderate acne and are uncomfortable taking antibiotics or are unhappy with your current topical treatment results, BLU-U® blue light therapy – using light without drugs or antibiotics – may be a viable option.
What is BLU-U Blue Light Treatment?
The BLU-U is a unique blue light that kills the P. acnes bacteria in your skin. Treatments are simple – you sit with your face close to the light for a short time at a schedule set up by your doctor, approximately a 20-minute session about once or twice per week.
The treatments may go on for five weeks or more as required. It is safe, does not generate heat and is is not painful. After several weeks the BLU-U blue light can help control your acne.
The BLU-U blue light is available in our office at your convenience.
Find out more at: https://www.levulanhcp.com/blu-u.html
Many men and women who have had cystic acne during their lives are left with deep, depressed scars that give the skin a crater-like or orange-peel appearance. These scars are the result of collagen and epidermal damage and do not go away without treatment. Er:YAG-1064 laser resurfacing is one of the most successful treatments used for acne scars today.
In the late 1980s laser technology for skin resurfacing achieved more predictable depths of injury than other methods. First skin resurfacing laser was a modified pulsed carbon dioxide (Fitzpatrick et al). Its cosmetic uses were initially limited to the periorbital and perioral regions, but dramatic clinical results quickly led to its use for full-face resurfacing.
Although long-term skin tightening and improvement of facial rhytides is unparalleled, marked erythema persists for several weeks and permanent hypopigmentation occurs at a rate unacceptable to many patients. Most frequently seen are “white upper lip moustache” which is an area of upper lip seen after a treatment of upper lip lines.
Nd: YAG 1064 laser
CO2 lasers successfully pioneered laser skin resurfacing pioneered which allowed rapid proliferation of other ablative resurfacing devices including erbium lasers, microdermabrasion, and RF ablation. Nd: YAG laser now offers a non-ablative skin treatment for patients who are not good candidates for ablative procedures, or for patients who had resurfacing in the past.
Nd: YAG laser was developed to allow physicians to more selectively heat a thin layer of tissue below the epidermis. Researchers met significant challenges creating such a system since current laser light sources were inappropriate as they penetrate too deeply into the skin, and the energy at these wavelengths is selectively absorbed in melanin and hemoglobin, which makes uniform heating of subsurface tissue impractical.
Infrared lasers such as erbium at 2.9 micrometers, holmium at 2.1 micrometers, and CO2 lasers at 10.6 micrometers deposit all of their energy in the epidermis making them useless for selective heating of subsurface tissue.
The Nd: YAG laser provides a unique non-invasive modality for patients who are not candidates for resurfacing because of pigmentation, other contraindications, or personal choice. The treatment requires less than an hour with at most a topical anesthetic cream.
topical anesthetic cream. Collagen contraction during lasing is 1% to 2%, and it may only reach 14% in the long term. No char is formed and only minor transient white discoloration of the wound bed occurs. Dermal vessels treated with the laser dilate and cause transudation of fluid, which increases the water (chromophore) content in the treated area and allows for consistent ablation with each subsequent pass.
Clinical manifestations of laser treatment depend on the ability of the skin to resurface itself. After lasing, the vaporized, atypical, disorganized epidermal cells are replaced with normal, well-organized keratinocytes from the follicular adnexa.
The irregular, disorganized collagen and elastin of the upper papillary dermis are replaced with normal, compact collagen and elastin organized in parallel configurations which results in a more youthful appearance and improved skin texture.
Patients in the most favorable preoperative categories generally show a 50% improvement in rhytides and skin lesions. While collagen remodeling and further clinical improvement often continue for up to 18 months after CO2 laser resurfacing, the reduced photothermal effect of the Er: YAG laser allows the resurfacing process to end before 12 months.
The Laser Scar Removal Procedure
Erbium: YAG 2940nm laser module is used to remove the top layer of the skin. The depth of the peel depends on the power settings and the number of passes used.
The Erbium laser peel can provide a partial to full epidermal removal (20-50 microns deep), as opposed to microdermabrasion which acts only on the stratum coronium layer of the skin (10-15 microns deep).
In addition to its beneficial effects on the outer layers of the skin, it also stimulates collagen production and remodeling in the deeper layers.
Acne scar improvement most often requires special combinations of treatments. Some patients will respond well to a collagen remodeling laser, while others will need Er: YAG Laser resurfacing or Dermal Fillers.