Health Information

common skin disorder that has the same causes and develops in the same way, no matter what color of skin it is affecting.  However, there is one type of acne that more commonly afflicts people of color.  It has been given the name pomade acne.

WHAT IS POMADE ACNE?

If a hair style involves straightening curly hair or molding the hair into shape, a thick, oily dressing called pomade is applied to facilitate this.  Where the pomade comes into contact with the skin, acne can occur.  This is commonly on the scalp, forehead and temples.  The heavy oil of the pomade can clog pores and start the formation of acne lesions.  At the same time, other chemicals in the pomade may irritate the skin and lead to inflammation.

THERE ARE THREE OPTIONS TO TREATING POMADE ACNE:

1. If the pomade is being used to moisturize the scalp, its’ application should begin one inch behind the hairline, in a effort to keep it off the facial skin.

2. If it’s being used to style hair or make it more manageable, it should be applied solely to the ends of the hair, again avoiding the scalp and skin.

3. If all else fails, the use of pomade will have to be discontinued.

Usually, once the pomade is no longer getting onto the skin or its use is stopped, pomade acne should clear on its own.  It if doesn’t, it can be treated just like any other acne.  The skin should be gently cleansed using a topical preparation such as benzyl peroxide.  If the acne still hasn’t cleared after 6-8 weeks, the person should see a dermatologist for advice.

WHAT ACNE TREATMENTS ARE AVAILABLE SPECIFICALLY FOR BLACK SKIN?

There are none, as acne treatments are generally safe on both dark and light skin.  Some forms of treatment for acne scarring may cause dark skin to lighten temporarily, however.

Black skin may not be as well moisturized as lighter skin and for this reason, any treatment that may be very drying (such as benzyl peroxide) should only be used with a doctor’s supervision or advice.

Black people who have severe acne may find that once the inflammation has gone, their skin is left with a darkened spot.  This is because dark skin develops something called ‘post-inflammatory hyperpigmentation’.  This means increased pigmentation following inflammation.  These spots go away in time but if they are distressing a dermatologist can prescribe topical retinoids which can help to fade the discoloration more quickly.

The removal of acne scars from black skin by dermabrasion or any form of chemical peel can cause temporary lightening (or darkening), in the areas that have been treated.  This sort of treatment should always be discussed with a dermatologist before it is undertaken.  Simply booking into a beauty salon is not recommended and may make the condition worse.

The dark pigment that gives skin its color is called melanin.  Alterations in that pigmentation such as vitiligo and melasma can be present at the same time as acne - although the conditions are not related.  They require specialist diagnosis and treatment from an experienced dermatologist.

Severe acne can make a person’s life truly miserable.  People suffering from it may limit their own social lives due to embarrassment and stress.  It can hamper romantic intent and work opportunities.  It may be disfiguring and need years of careful treatment - and for those reasons, it is best to be referred to a dermatologist who has in depth knowledge and experience of the condition.

WHAT IS ACNE CONGLOBATA?

Ordinary ‘teenage spots’ (acne vulgaris) are extremely common and blight the life of virtually every adolescent at one time or another.  Acne conglobata is rare and is a much more severe form.  It usually appears between the ages of 18 and 30 but it sadly leaves scars for life - physical, mental and emotional.  It affects more males than females and can even strike babies.  

The primary cause of acne conglobata is unknown although some things are recognized as triggers.  Toxic gases like dioxins or halogens and anabolic steroids can induce severe acne in susceptible individuals.  Stopping a course of testosterone can also cause it.  It can develop as a result of the deterioration in an existing pustular acne or may arise from a previous acne which has lain dormant for many years.

WHAT DOES ACNE CONGLOBATA LOOK LIKE?

The acne lesions (comedones) of this usually occur on the face, neck, chest, upper arms and buttocks.  They often occur in clumps of 2 or 3.  Inflamed nodules form around these clumps of comedones.  A nodule is an inflamed lesion of more than 5mm across.  They get bigger until they finally break down and discharge foul-smelling pus that returns once the nodule has drained. Deep ulcers may form under these nodules and may track under the skin to join up with others. Abcesses can leave deep, irregularly shaped scars.  

WHAT TREATMENT IS AVAILABLE?

The main treatment is called isotretinoin.  This is a derivative of vitamin A and is made under the brand name of Accutane.  Doctors will only prescribe it for anyone with severe nodula acne that has not responded to any other treatments.  It is a pill taken orally for a course of 15-20 weeks.  A single course has been shown to completely clear acne and give long-term remission to many people.  

It works by reducing the amount of oil produced by the sebaceous glands and because of this, Accutane has many side effects.  These include dry and cracked lips, dry skin, a dry nose and mouth and mild to moderate aches in the joints or muscles.

iPLEDGE

However, the main side effect is potentially devastating.  There is an extremely high risk that if pregnancy occurs while the person is taking Accutane (in any amount and even for a short time) that a miscarriage or a deformed baby can result.  For that reason, a special programme called iPLEDGE has been set up in America.  Patients can only get Accutane if they are registered with iPLEDGE and if their prescribing doctor and pharmacy are both registered.

these are the natural cures for acne that anyone’s grandmother had in mind. And perhaps the term ‘cure’ should be used very loosely… However, home acne remedies remain very popular - perhaps out of a sense of frustration from those suffering from the dreaded zit. Whether toothpaste, urine therapy, or apple cider vinegar actually work, is debatable. This article will look at the premise behind each of these options, and whether they are truly worth your time.

There are several variations to the toothpaste acne remedy. Some people swear that it alone, dabbed onto the offending zits, will clear them up. Others prefer mixing toothpaste in with several other ingredients, forming mixtures that range from simple to complex. For example, one teenager washed her face with salty water, left it on, added more salt to her face until it was entirely covered, then washed all of that off. Finally, toothpaste was applied to the pimples, and left on for a few hours, but preferably overnight.

Most of these remedies were multi-step processes, and even when other ingredients were used, they were not mixed in with the toothpaste. Like in the example above, the other steps often cleansed the face, perhaps rinsed with cold water to close the pores. Then toothpaste was added as a final step.

There were even instructions on which types of toothpaste to use. According to some, gels don’t work as well, and whitening toothpastes were either unnecessary, or should be avoided. Given that baking soda also features in some other remedies, perhaps a toothpaste containing that could be used?

Will it work? Well, some of the reports from satisfied acne sufferers seem to indicate it may be worth a try, provided it isn’t too harsh and irritating to your skin. It certainly isn’t expensive. Some people saw results overnight, some took a few days, others longer. So, it may not be a once-off solution. One thing to be aware of is that any type of hard scrubbing of the skin can make acne worse.

Urine therapy is one that can elicit such revulsion (in me!), that it is almost hard to write about it. The theory is that one’s own urine is packed with antibodies, hormones, and other goodies that are beneficial for our health. This includes vitamins and minerals that the body has excreted, because it didn’t need. One article I read made the very good point that if they weren’t needed the first time, they will likely be excreted again the second time. That same article points out that just because urine is not toxic, does not mean it is beneficial.

Urine therapy had its’ origins amongst some Indian mystics, and seems to be particularly associated with the tantric philosophy. As an acne remedy, it is suggested that one massages one’s urine over the affected areas. Some people leave it on overnight, assuming their partners and family can stand the smell.

The problem with urine therapy is that a lot of the justification is very unscientific and poorly supported. It is bolstered by conspiracy theories as to why this supposedly wonderful substance is ignored by the medical profession, except where scientists have extracted and tested certain elements of urine for therapeutic purposes. This does not mean, however, that therapeutic concentrations are to be found in one’s own urine.

Bottom line for urine therapy with acne? There are a lot of other good alternatives out there, that don’t smell, and don’t have waste products mixed in with them. And people on any medications should not try urine therapy.

Apple cider vinegar is usually diluted with water, and sometimes mixed with other things, including honey and jojoba oil. There are very mixed reviews about it. Some people love it, others say that at first it seemed to make their acne worse, but then it really helped to turn it around. And others, quite a few others, say it made their skin, dry, very irritated, painful, and flakey. Those with sensitive skin seem to fare the worst, so if you do have sensitive skin, avoid apple cider vinegar at all costs.

One important point is that apple cider vinegar should be diluted. And be prepared for a rather off smell. It’s probably not as noxious as urine however!

One feature of acne home remedies is that they do not work for everyone. This is true of medicine and over the counter treatments as well though. Those with sensitive skin should be the most careful, as many of these home-made treatments can be very harsh. This includes both toothpaste and apple cider vinegar. Urine therapy may work best with those who have a strong belief in it, although there are many other effective options to explore. It’s worth keeping in mind that although some people report success with certain things, those successes have not been compared to other treatments in a controlled trial. It may be that other remedies may have been more effective after all.

teenagers develop acne blemishes at some point and it could be seen as a normal part of growing up.  The hormones in our bodies at this time stimulate excess oil and skin cell production which can block pores.  These blocked pores are great places for bacteria to thrive, and inflammation and spots are the result.

However, there are a few things that we can do to keep those acne blemishes under control.  The following tips will ensure minimum blemishes for most people suffering from mild forms of acne, although those with more severe acne should always consult a dermatologist for specific treatment.

It is a common myth that acne is caused by poor diet, which is not true.  Eating fatty foods and chocolate, while they may not be healthy in other ways, will not cause acne.  On rare occasions an allergy to certain foods may make your acne worse, so if you notice a pattern between what you eat and outbreaks of acne, you should avoid those foods.  You should also make sure you drink plenty of water each day to cleanse your skin from the inside.

Some people associate having acne with being unclean, another myth that we need to discuss.  Washing your face twice a day with a mild soap and warm water can help to remove the oil and skin cells that cause acne blemishes.  However, using strong alcohol based cleansers, or scrubbing your face to hard or too often can irritate your skin and actually make your acne worse. 

Oil from your hands can contribute to the blocked pores that cause acne, so you need to be careful not to touch your face too much.  Now you are aware of this you will be surprised how often you do touch your face during the day, and how many of your spots are concentrated in the areas you typically touch.  You want to keep your hair off your face as well because this can also transfer oil.

Be careful about the skin products you use on your face.  If you are prone to acne and want to use specific products to prevent it, you can buy over the counter treatments containing low concentrations of benzoyl peroxide. This is an effective way to dry out any blemishes and unblock pores so the acne doesn’t form in the first place.

If you use moisturizers or face creams make sure they are water based and not oil based.  The type of products you should use is described as non-comedogenic.  You should avoid heavy foundation make-up, particularly oil based varieties.  If you have blemishes it may be tempting to heap on the foundation to cover them up, but you can buy products designed to give good coverage without making your acne worse.

If you use make-up applicators or brushes, you need to wash them regularly in hot soapy water to ensure bacteria don’t build up on them and transfer to your face.  This also applies to face cloths or anything else you use to wash your face.  If they contain oil and bacteria they will be doing more harm than good.

Many people believe that exposure to the sun clears up their acne blemishes.  Although the sun may temporarily dry out existing blemishes, it will stimulate extra oil production causing worse acne in the long run.  Exposing your skin to the sun also increases your risk of getting ski cancer so can never be recommended.

The final and most important thing to remember when you are trying to control your acne blemishes is not to squeeze them!  It is very tempting, but it will push the bacteria deeper into the skin and will make the blemish worse and longer lasting.

Cystic acne is one type of acne vulgaris, and can be more difficult to remove than other forms of acne as it occurs deep in the skin rather than on the surface.  It is caused when oil glands under the skin become blocked and then burst, causing inflammation of the tissue around them.  If you have cystic acne you will experience large painful bumps similar to cysts, but not necessarily white or blackheads on the skin’s surface.

There are a number of ways to remove cystic acne, but the first thing to make sure of is that you don’t squeeze the spots.  This may cause a deeper infection and further tissue inflammation which will take longer to heal.

The first treatment that you should try is benzoyl peroxide which you can buy yourself over the counter, or have prescribed by your dermatologist, and which should be applied directly to the pimples over a period of time. If this doesn’t work it may be time to move onto a more intense form of cystic acne treatment.

The most effective treatment of severe cystic acne is isotretinoin, also known as accutane.  This oral medication should be taken regularly over a period of up to twenty weeks and works by reducing the size of the oil producing glands, as well as limiting the shedding of skin cells.  It also makes the skin cells less sticky so they are less likely to cause a blockage.        

Isotretinoin is a strong drug and has various side effects, so your dermatologist will give you a thorough assessment before prescribing it and at various times throughout the course of treatment.  Physically it can cause inflamed lip and eye membranes, dry skin, mouth or nose, muscle aches, nose bleeds and vision problems.  It can even cause increased blood cholesterol and changes in liver function. 

Mental risks associated with it include depression, psychosis and suicidal thoughts.  For this reason it will not be subscribed to anyone with a history of depression, and you will be closely monitored whist you are taking the drug.

A final risk associated with this medication is the development of birth defects in unborn babies.  It will never be prescribed to pregnant women and women of child bearing age are encouraged to use at least two methods of contraception whilst taking the drug.

Another possibility for treating cystic acne is intra-lesional corticosteroid therapy.  This involves an injection of dilute cortisone solution directly into the cyst.  It provides fast relief from pain and clears the pimple quickly.  However, it is not a long term cure and does not necessarily prevent the acne from returning.

Your final option to remove cystic acne would be acne surgery which is the physical removal of the material forming the blockages and causing the lesions.  This needs to be done by a professional dermatologist and followed up by a course of antibiotics to ensure it does not cause further infection.

Salicylic acid is a beta hydroxyl acid, derived from the bark of the willow tree, that has a wide variety of uses related to skin care.  Beta hydroxyl acids are better at treating surface skin conditions than their alpha hydroxyl acid relations, as they have larger molecules which do not penetrate the layers of skin so easily. Because alpha hydroxyl acids pass deep into the skin, they can cause further irritation, making skin conditions worse.

The main use of salicylic acid is to reduce the symptoms of mild acne.  Acne is caused by excess oil production and skin cells shedding in hair follicles. This blocks the follicle and provides a place for bacteria to grow, resulting in inflammation and a pimple. This over-the-counter treatment works by slowing down the rate at which the skin cells shed, and breaks down the material that creates the spot.

You can combine salicylic acid with a variety of other substances to increase its’ acne fighting properties; one good example is retinol.  However, you should not combine this acid with sulfur, benzoyl peroxide or resorcinol as this will be too irritating for the skin. It will stimulate oil production, making your condition worse.

You will often find salicylic acid used in chemical peels used to reduce the appearance of mild acne scarring, and to generally purify the skin.  The concentration of this acid will have an impact on the effectiveness of the peel.  Up to 20% can be used, but this may cause extensive skin peeling for around three days, and may be too strong to be used in weekly peels.

Salicylic acid can be used as a remedy for various other skin conditions.  It is often an active ingredient in anti-dandruff shampoos, and is used to treat skin disorders such as psoriasis.  It also has collagen boosting properties that make it ideal for slowing the development of wrinkles.  

Applying this topical treatment in gel form to warts and verrucas has two benefits.  Firstly it softens the layers of skin that make up the wart, enabling removal with a pumice stone.  Secondly it irritates the wart or verucca, which stimulates the immune system to fight harder to get rid of it.     

So what are the negative effects of salicylic acid?  The first you may have heard about - it can cause birth defects when taken by pregnant women.  The truth is that women would need to take large doses of this acid orally for their baby to be in any danger.  Even so, it is advisable for pregnant women to avoid using it, as it does penetrate the skin and enter the blood stream to some degree. Another potential side effect of salicylic acid is that it can cause hyper-pigmentation, when used in high concentrations on darker skin. 

Overall it is a fairly safe and cheap way to treat mild skin complaints. As a rule you should always start with a low concentration of the acid, and build up if it is not having the desired effect.  You should also ensure that it only comes into contact with affected skin and not healthy skin when used in higher concentrations.