Acne

CAUSES

Perhaps one of the downsides of puberty (and even adulthood) is acne.  Acne is caused by oily skin and shedding skin cells which can create a breeding ground for bacteria to infect the pores of the skin.  Oil production in the skin increases with a rise in androgens like testosterone.  Since young men going through puberty have the highest levels of testosterone, it makes sense that they also have the highest rates of acne.  However, adult men still have high circulating levels of testosterone and can also have acne.  These clogged pores create comedones (“pimples”).  Whiteheads are a type of pimple that develop closer to the surface while pimples that occur deeper within the skin layers and don’t “pop” are caused by hormones.  These deeper acne lesions can create scarring. 

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The most common areas for acne to occur are the face, neck, back, and chest.  Pimples are not only caused by oily skin, but by oily hair.  For young men going through puberty this creates more pimples in the new zones of skin where hair is beginning to grow, such as the beard and chest.  Pimples can also be caused by pores clogged with greasy skin products.  In fact, acne on the neck, back, and forehead can be caused or worsened by hair products like conditioner.  As a young man rinses conditioner out of his hair, it can stream onto the face, back and chest.  Hot showers open the pores allowing conditioner to enter the pores from the rinse water.  If a young man jumps out of the shower shortly after rinsing their hair, it can cause the pores to contract and trap hair products in the pores and clog them.

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Some acne may also be worsened in the beard-line with shaving creams and foams that clog pores or overly dry the skin.  Again, most men that shave will heat the beard area with hot water before shaving which opens pores allowing shaving products to enter the pores and potentially clog them.  The same can be true of young men who shave their chest or abs.  So, shaving first and fully rinsing the shaved area before getting out of the shower can help reduce acne in these areas. 

TREATMENT

There are multiple treatments for acne.  The goal in treatment is to reduce bacterial build-up, remove excess oil and skin, and prevent pores from clogging.

The first level of treatment involves non-drug therapies.  Bacteria and oil can be reduced by washing the skin regularly with a mild, non-oily soap.  These types of soaps can also be used as a lathering agent for shaving if acne appears to be caused from shaving products.  Using a non-greasy shaving cream or gel can reduce facial acne.  In addition, shaving with a blade rather than an electric shaver can help remove dead skin from the face and thus reduce acne.   Washing the face after shaving can also remove excess shaving product as well as dead skin that have been lifted from the razor.  Washing with a scrub or washcloth can remove dead skin from the skin surface even more effectively – preventing it from clogging pores.  For chest, and even facial hair, trimming hair short with clippers rather than shaving can eliminate the need for shaving products and can also prevent ingrown hairs.

 

For chest and back acne; using a non-oily shower gel rather than shower soap, as well as skipping conditioner can be helpful.  If using conditioner, simply bending over to rinse shampoo and conditioner instead of standing can help significantly – causing all of the greasy rinse water to go directly from the head into the drain rather than running down the neck, back, and chest.  These small, simple steps can often have a big impact on acne.

 

The next step in treating acne is using over-the-counter products. 

  • Benzoyl peroxide works to both decrease bacteria as well as help dead skin turnover and sluff off more easily so it doesn’t clog pores.  However, it is extremely drying and can actually cause the skin to produce more oil to relieve the dryness if used too often or using too potent of a product.  Using a lower strength product such as 2.5% or 5% solution or gel works well without being over drying – 10% products often over-dry skin.  It is also a good idea to use a non-oily, anti-acne formulated moisturizer to prevent over-drying of the skin and to prevent clogged pores.

  • Salicylic Acid works to increase skin turnover, which helps new skin rise to the surface faster.  This can prevent pores from remaining clogged long enough to cause a pimple.  Lower strengths between 2 to 6% are designed for acne – stronger strengths can cause more damage than good (in fact stronger strengths are used to remove warts).

  • Sulfur products cause the skin to dry and peel.  These products should not be used regularly because they can cause over-drying of the skin leading to more oil production.  Rather, sulfur products can be used on individual pimples to help dry them out and allow them to peel off.  This is “spot treatment” for a pimple.  Applying a layer or mask of sulfur product can be done, but should only be done once a week at most.

 

Prescription medications can also be used to treat acne.  These include antibiotics and retinoids.  Antibiotics obviously decrease bacteria build-up.  Many prescribers begin with topical antibiotics such as erythromycin or clindamycin gels or solutions.  If this is not successful or acne is covering large portions of the body, oral antibiotics may be used. 

 

Retinoids, on the other hand, work to increase skin turnover.  They are a derivative of vitamin A and work by decreasing how well skin cells bind together, thus making it easier for new skin to rise to the surface.  Retinoids have multiple side effects.  The skin can become irritated, red, and dry then peel.  This can occur for both topical and oral medications.  It can also cause the skin to sunburn faster.  Topical therapy (i.e. tretinoin, adapalene, tazoratene) is often used first.  Only in severe acne is the oral agent isotretinoin used.  The oral agent can cause severe depression and even suicidal behavior.  It can also cause birth defects when women take it during pregnancy.

 

Females respond to the same therapies as above, but controlling female hormones is a little easier than controlling men’s hormones.  Estrogen actually helps acne, so girls are often given certain types of oral birth control pills with estrogen to help acne.  Obviously, giving estrogens to young men is a bad idea.  In addition, females can also be given anti-androgen medications like spironolactone to decrease androgen hormone production which can cause pimples.  Since androgens are necessary for young men to go through puberty appropriately, these options are not a choice for younger men with acne.

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