Getting acne....Q&A............(part 3 of 5)

I’ve started getting acne spots. How long do they last?
This depends on what type of spots they are and, even then, it can
be very difficult to predict what will happen. Some spots will
appear and then disappear during the course of a day but others
will evolve more gradually through the various stages. Comedones
can be very persistent if they don’t get inflamed. Mildly inflamed
spots will last 5–10 days before settling down, but can leave a flat
red mark (macule) for several weeks. Nodules and cysts may last
for weeks or months unless you get some treatment.

What is the difference between a whitehead and a yellow-
head spot?
These two common terms describe quite different types of spot.
A whitehead is a closed comedone where the pore is blocked and
not open to the air. There is no inflammation (redness). A yellow-
head suggests a spot with pus in it. The medical term is a ‘pustule’.
Whiteheads may become yellowheads if the blocked pore becomes
infected.

My daughter is only 9 but she seems to have developed some
blackheads around her nose. Can this be acne – like I had?

Girls seem to be starting puberty earlier and earlier, and many
9-year-olds have started to develop some hormone changes.
Blackheads are one of the types of spots that occur in acne so,
yes, this could well be the start of it. Almost all children will get
some blackheads and other spots as they start and go through
puberty, so your daughter will not necessarily get worse but this
might depend on how bad your own acne was. We don’t fully
understand the role of genes in acne but there is some inherited
factor that makes acne more likely in some families. If you had
severe acne, it is worth starting a simple treatment approach to
reduce the number of blackheads on your daughter’s nose.

I am an identical twin and I have acne but my sister
doesn’t – weird or what? Can you explain why?
Answering questions like this is always difficult. We can’t give you a
reason why your twin doesn’t have acne, because the precise cause
and triggers are not fully understood. However, studies of twins
have helped to work out that some genetic inheritance is involved,
as identical twins tend to produce similar amounts of the skin
grease called sebum. This is not the case for non-identical twins.
You don’t say how old you are – it may be that your sister will
go on to develop acne. She is certainly more likely to have acne
than if she were not your twin.

I have been having problems with my skin for about two years. Can you tell me what the difference is between spots and acne? I think that to have acne you must have at least 20 spots but my mum thinks otherwise.
There is no real difference between spots and acne, assuming
that the type of spots fits into the pattern we have described withblackheads, whiteheads, papules and pustules. What is most
important is the effect the spots have on you and whether you
have any of the more serious types of spot that might cause long-
term scars. If you are upset by the appearance of your skin, it
doesn’t really matter how many spots you have – you have a
problem that is worth seeking some treatment for.

Why am I the only one in my class who has spots? I heard
it was very common but I don’t think it is really.
The most important spots are the ones that you have, and you
will be much more aware of them than anyone else. Other
students might have spots that you can’t see – on their back or
chest – or they might be using some treatment or camouflaging
make-up. Don’t worry about them; just talk to your pharmacist or
doctor if you are not already using some creams.DBE6SCXAA5WF

How Does Acne Develop?

Doctors describe acne as a disease of the pilosebaceous units. Found over
most of the body, pilosebaceous units consist of a sebaceous (oil) gland
connected to a hair-containing canal called a follicle (see below). These units
are largest and most numerous on the face, upper back, and chest—areas
where acne tends to occur. The sebaceous glands make an oily substance
called sebum that normally empties onto the skin surface through the
opening of the follicle.
Acne is believed to result from a change in the inner lining of the follicle that
prevents the sebum from passing through. For reasons not understood, cells
from the lining of the follicle are shed too fast and clump together. The
clumped cells plug up the follicle’s opening so sebum cannot reach the
surface of the skin. The mixture of oil and cells causes bacteria that normally
live on the skin, called Propionibacterium acnes (P. acnes), to grow in the
plugged follicles. These bacteria produce chemicals and enzymes that can
cause inflammation. (Inflammation is a characteristic reaction of tissues to
disease or injury and is marked by four signs: swelling, redness, heat, and
pain.) When the plugged follicle can no longer hold its contents, it bursts and
spills everything onto the nearby skin—sebum, shed skin cells, and bacteria.
Lesions or pimples develop as a result of the skin’s being irritated.

People with acne frequently have a variety of lesions, some of which are
shown below. The basic acne lesion, called the comedo (kom´-e-do) or
comedone, is simply an enlarged hair follicle plugged with oil and bacteria.
This lesion is often referred to as a microcomedo because it cannot be seen by
the naked eye. If the plugged follicle, or comedo, stays beneath the skin, it is
called a closed comedo or whitehead. Whiteheads usually appear on the skin
surface as small, whitish bumps. A comedo that reaches the surface of the
skin and opens up is called a blackhead because it looks black on the skin’s surface. This black discoloration is not due to dirt. Both whiteheads and
blackheads may stay in the skin for a long time.
Other troublesome acne lesions can develop, including the following:
       Papules—inflamed lesions that usually appear as small, pink bumps
on the skin and can be tender to the touch.
       Pustules (pimples)—inflamed, pus-filled lesions that can be red at the
base.
       Nodules—large, painful, solid lesions that are lodged deep within the
skin.
       Cysts—deep, inflamed, pus-filled lesions that can cause pain and
scarring.