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When regular light is used immediately following the application of a sensitizing substance to the skin such as aminolevulinic acid or methyl aminolevulinate, the treatment is referred to as photodynamic therapy (PDT). Many different types of nonablative lasers (i.e., lasers that do not vaporize the top layer of the skin but rather induce a physiologic response in the skin from the light) have been used to treat acne, including those that use infrared wavelengths of light. Ablative lasers (such as CO2 and fractional types) have also been used to treat active acne and its scars. When ablative lasers are used, the treatment is often referred to as laser resurfacing because, as mentioned previously, the entire upper layers of the skin are vaporized. Ablative lasers are associated with higher rates of adverse effects compared with nonablative lasers, with examples being postinflammatory hyperpigmentation, persistent facial redness, and persistent pain. Physiologically, certain wavelengths of light, used with or without accompanying topical chemicals, are thought to kill bacteria and decrease the size and activity of the glands that produce sebum. Disadvantages of light therapy can include its cost, the need for multiple visits, time required to complete the procedure(s), and pain associated with some of the treatment modalities. Typical side effects include skin peeling, temporary reddening of the skin, swelling, and postinflammatory hyperpigmentation.
From the What to Expect editorial team and Heidi Murkoff, author of What to Expect the First Year. Health information on this site is based on peer-reviewed medical journals and highly respected health organizations and institutions including ACOG (American College of Obstetricians and Gynecologists), CDC (Centers for Disease Control and Prevention) and AAP (American Academy of Pediatrics), as well as the What to Expect books by Heidi Murkoff.
How to Handle It: Speaking of touching, don't! Picking it, squeezing it, or poking at it will only worsen the situation. These may disappear on their own after a few days. Otherwise, Zeichner suggests visiting your dermatologist for a shot of cortisone, which will reduce inflammation and shrink it in just 24 to 48 hours. But if a last-minute appointment isn't in the cards, play mad scientist. First, ice the area, and then apply salicylic acid gel, benzoyl peroxide gel, and 1 percent hydrocortisone cream. The combo will calm skin, kill bacteria, and draw out excess oil from the pimple — all things necessary to take this down, says Zeichner.
Several scales exist to grade the severity of acne vulgaris, but no single technique has been universally accepted as the diagnostic standard. Cook's acne grading scale uses photographs to grade severity from 0 to 8 (0 being the least severe and 8 being the most severe). This scale was the first to use a standardized photographic protocol to assess acne severity; since its creation in 1979, the scale has undergone several revisions. The Leeds acne grading technique counts acne lesions on the face, back, and chest and categorizes them as inflammatory or non-inflammatory. Leeds scores range from 0 (least severe) to 10 (most severe) though modified scales have a maximum score of 12. The Pillsbury acne grading scale simply classifies the severity of the acne from grade 1 (least severe) to grade 4 (most severe).
Like baby acne, eczema is very common in newborns, but it’s usually caused by dry (not oily) skin. Mild eczema can cause lots of small bumps, similar to baby acne. Since it often starts on the cheeks, it’s easy to confuse with baby acne. But, if it spreads into a rash that covers the skin or develops in other areas of your baby’s body, such as the folds of his elbows and knees, then it’s probably eczema, not acne. Eczema isn’t usually serious. You can treat it by using a gentle hydrating lotion on your baby’s skin after bathtime.
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Acne vulgaris is diagnosed based on a medical professional's clinical judgment. The evaluation of a person with suspected acne should include taking a detailed medical history about a family history of acne, a review of medications taken, signs or symptoms of excessive production of androgen hormones, cortisol, and growth hormone. Comedones (blackheads and whiteheads) must be present to diagnose acne. In their absence, an appearance similar to that of acne would suggest a different skin disorder. Microcomedones (the precursor to blackheads and whiteheads) are not visible to the naked eye when inspecting the skin and can only be seen with a microscope. There are many features that may indicate a person's acne vulgaris is sensitive to hormonal influences. Historical and physical clues that may suggest hormone-sensitive acne include onset between ages 20 and 30; worsening the week before a woman's period; acne lesions predominantly over the jawline and chin; and inflammatory/nodular acne lesions.
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Acne usually improves around the age of 20, but may persist into adulthood. Permanent physical scarring may occur. There is good evidence to support the idea that acne and associated scarring negatively affect a person's psychological state, worsen mood, lower self-esteem, and are associated with a higher risk of anxiety disorders, depression, and suicidal thoughts. Another psychological complication of acne vulgaris is acne excoriée, which occurs when a person persistently picks and scratches pimples, irrespective of the severity of their acne. This can lead to significant scarring, changes in the affected person's skin pigmentation, and a cyclic worsening of the affected person's anxiety about their appearance. Rare complications from acne or its treatment include the formation of pyogenic granulomas, osteoma cutis, and solid facial edema. Early and aggressive treatment of acne is advocated by some in the medical community to reduce the chances of these poor outcomes.
Antibiotics are frequently applied to the skin or taken orally to treat acne and are thought to work due to their antimicrobial activity against C. acnes and their ability to reduce inflammation. With the widespread use of antibiotics for acne and an increased frequency of antibiotic-resistant C. acnes worldwide, antibiotics are becoming less effective, especially macrolide antibiotics such as topical erythromycin. Therefore, they are not recommended for use alone but are preferred as part of combination therapy. Commonly used antibiotics, either applied to the skin or taken orally, include clindamycin, erythromycin, metronidazole, sulfacetamide, and tetracyclines such as doxycycline and minocycline. Doxycycline 40 milligrams daily (low-dose) appears to have similar efficacy to doxycycline 100 milligrams daily and has fewer gastrointestinal side effects. When antibiotics are applied to the skin, they are typically used for mild to moderately severe acne. Antibiotics taken orally are generally considered to be more effective than topical antibiotics, and produce faster resolution of inflammatory acne lesions than topical applications. Topical and oral antibiotics are not recommended for use together.
Benzoyl peroxide is an antibacterial ingredient, and it’s very effective at killing the P. acnes bacteria that causes breakouts. But benzoyl isn’t without its downsides. The leave-on creams and cleansing treatments can dry out sensitive skin types and bleach clothing if you aren’t careful. Board-certified dermatologist Eric Meinhardt, M.D., previously told SELF that it's best to stick to formulations that have no more than 2 percent of benzoyl peroxide listed on the active ingredients chart; stronger concentrations are harder on your skin without being any tougher on bacteria.
The main hormonal driver of oily sebum production in the skin is dihydrotestosterone. Another androgenic hormone responsible for increased sebaceous gland activity is DHEA-S. Higher amounts of DHEA-S are secreted during adrenarche (a stage of puberty), and this leads to an increase in sebum production. In a sebum-rich skin environment, the naturally occurring and largely commensal skin bacterium C. acnes readily grows and can cause inflammation within and around the follicle due to activation of the innate immune system. C. acnes triggers skin inflammation in acne by increasing the production of several pro-inflammatory chemical signals (such as IL-1α, IL-8, TNF-α, and LTB4); IL-1α is known to be essential to comedo formation.
Bacteria. Excess sebum clogs the openings to hair follicles -- especially those on the face, neck, chest, and back. Bacteria grow in these clogged follicles. This makes blackheads or whiteheads, also known as ''comedones,'' form on the skin's surface. Sometimes, this clogging causes the follicle wall to break under the pressure of this buildup. When this happens, sebum leaks into nearby tissues and forms a pustule or a papule -- this is called inflammatory acne. Larger, tender pustules are called nodules.