Acne is a skin disorder occurring mainly in association with the hormonal changes of adolescence, although women may experience it for the first time when they are in their 20s or 30s. The increased amounts of androgen produced by both the male and female sex glands stimulate the sebaceous (oil) glands of the hair follicles to produce an increased amount of the fatty substance called sebum that is normally discharged through the pores to lubricate the skin. The overproduction of sebum results in oily skin.
The characteristic pimples, pustules, and blackheads of acne are formed when the pores become plugged by the sebum that has backed up, mixed with skin pigments, and leaked into surrounding areas.
Acne is not caused by junk food or faulty hygiene. The chief cause is the onset of puberty combined with the hereditary factors that control the oiliness of the skin. Mild cases usually clear up by themselves, especially when the affected areas are kept free of oily cosmetics by regular cleansing. Nonprescription products containing benzoyl peroxide are helpful. For more stubborn cases, vitamin A acid cream (Retin-A), sun lamp treatments, and tetracycline pills may be beneficial.
Unfortunately, long-term acne may leave scars and blemishes. In this case, a dermatologist can be consulted about the removal of them by dermabrasion. Dermabrasion is the removal of the outer layers of the skin.
Scars caused by acne can be improved by beveling the edges if they are not the deep-pitted "ice pick" type, although the abrasion may have to be repeated several times to achieve a skin surface that approaches normal in appearance. It is not always possible to estimate the depth of the scars, and therefore the results are not usually predictable. Dermabrasion can also be done to smooth fine wrinkles, especially of the upper lip. Because elevated levels of estrogen affect the pigmentation of the skin, the procedure should not be done on a woman who takes estrogen as replacement therapy or as a contraceptive.
The procedure can be done under local anesthesia or by topical refrigeration ( spraying on a solution that freezes the skin surface), but because dermabrasion takes a long time, many patients elect to have general or supplementary intravenous anesthesia. Most surgeons prefer to work on the entire face in order to blend margins at the hairline and beneath the jaw line. If spotty areas are done, blotches of depigmented skin may result. Sandpaper or a rotary diamond fraise or a rotary wire brush may be used.
If the skin is properly dressed with Vaseline gauze topped by dry gauze, there is no pain and no crusting. After the dressings are removed, redness may be present for six or more weeks. It is absolutely essential that for six weeks the patient totally avoid exposure to the sun by wearing a large-brimmed hat and using sun block. If the face is exposed to early, spotty pigmentation may appear. In general, treated skin is lighter than it was before surgery. If for some reason the skin has brown pigmentation, a local medication can be used. Sometimes there is a formation of milia (white papules caused by the retention of sebum). This can largely be prevented by cleansing the face with fine soap granules. |
