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General Dermatology


Acne

Acne is the most frequent skin condition in the United States. It is characterized by pimples that appear on the face, back and chest. Every year, about 80% of adolescents have some form of acne and about 5% of adults experience acne. Acne occurs when the hair follicle becomes plugged with oil (sebum), dead skin cells and bacteria. Each follicle is connected to a Sebaceous gland which secretes oil to lubricate the hair and skin. Normally, oil is excreted onto the surface of the skin however with acne prone skin an excessive amount of oil, dead skin cells and bacteria build up forming a plug in the follicle. This plug leads to whiteheads and blackheads. Red raised spots develop when the hair follicles become inflamed, infected or traumatized by picking. Inflammation that develops deep inside the hair follicle results in cysts. Severe acne can cause residual scars due to damaged skin.

Acne is made up of two types of blemishes:

  • Whiteheads/Blackheads, also known as comedones, are non-inflammatory and appear more on the face and shoulders. As long as they remain uninfected, they are unlikely to lead to scarring.
  • Red Pustules or Papules are inflamed pores that fill with pus. These can lead to scarring.

There are three levels of acne:
  • Mild acne the result of bacterial infection or inflammation close to the surface of the skin and result in whiteheads and/or blackheads
  • Moderate acne is the result of bacterial infection and inflammation deeper in the pore. This results in papules or pustules, more commonly known as pimples
  • Severe acne occurs when the infection is very deep in the pore and results in Nodules and Cysts.Nodules are hard, painful bumps under the skins surface and left untreated they can flare up repeatedly. Cystsare similar to nodules, but they are generally larger lesions filled with pus and just like nodules can be painful as well as cause scarring. Always remember that squeezing a nodule or cyst will not speed up the healing process, it will in fact prolong it and can cause more damage to the skin.

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Causes

In normal skin, oil glands under the skin, known as sebaceous glands, produce an oily substance called sebum. The sebum moves from the bottom to the top of each hair follicle and then spills out onto the surface of the skin, taking with it sloughed-off skin cells. With acne, the structure through which the sebum flows gets plugged up. This blockage traps sebum and sloughed-off cells below the skin, preventing them from being released onto the skinís surface. If the poreís opening is fully blocked, this produces a whitehead. If the poreís opening is open, this produces blackheads. When either a whitehead or blackhead becomes inflammed, they can become red pustules or papules.

It is important for patients not to pick or scratch at individual lesions because it can make them inflamed and can lead to long-term scarring.

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Treatment

Treating acne is a relatively slow process; there is no overnight remedy. Acne treatment options include:

  • Cleansing products Gentle cleansing with Medical Grade Skin Care products designed specifically for acne prone skin to remove excess oil and dead skin cells
  • Topical Products Topical products including exfoliating acids and benzoyl peroxide help diminish bacteria and dead skin cells causing irritation and blockage of the hair follicle
  • Retin A (Tretinion) Retin A is derived from vitamin A. It works by increasing the cell turnover rate, ex foliating the skin and decreasing the build-up of dead cells within the follicle
  • Antibiotics antibiotics work by decreasing the bacteria in the hair follicle as well as reducing the inflammatory response. They can be used topically or orally
  • Oral Contraceptives Birth control pills reduce the amount of testosterone within the body which suppresses the amount of oil produced by the sebaceous glands reducing the blockage of pores
  • Facial Treatments Facial treatments with our medical aesthetician help keep the pores cleared of excess oil and cellular debris making blemishes less likely to form, improving inflammatory acne.
  • Photodynamic Light Therapy Photodynamic light therapy has been shown to improve mild to moderate acne. The application of both blue and red light has been shown to reduce bacteria and inflammation to the follicle.
  • Nutritional Evaluation Nutrition plays an important role in the control of acne. Although no foods cause acne, certain foods may cause acne flares. Evaluation with an expert in nutrition may assist with acne control.
  • Acne Scars can be treated with multiple medical modalities including Co2 fractionated resurfacing laser (Total F X) or radio frequency sublative rejuvenation (eMatrix).




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