What is acne?

Acne is a disorder of the hair follicles and sebaceous glands. The glands become clogged, leading to pimples and cysts.

Acne is very common--people of all races and ages have acne. In fact, the majority of individuals in the U.S. between 11 and 30 years old will be affected by this condition. Even people in their forties and fifties can have acne. However, acne most often begins in puberty. During puberty, the male sex hormones (androgens) increase in both boys and girls, causing the sebaceous glands to become more active, resulting in increased production of oil (sebum).

How does acne develop?

The sebaceous glands produce sebum that normally travels via hair follicles to the skin surface. However, skin cells can plug the follicles, blocking the sebum coming from the sebaceous glands. When follicles become plugged, skin bacteria (called Propionibacterium acnes, or P. acnes) begin to grow inside the follicles, causing inflammation and pimples. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the most common types of pimples are:

1.  Whiteheads--these pimples stay under the skin's surface

2.  Blackheads--these rise to the surface of the skin; Although these pimples are black, the color is not from dirt

3.  Papules--tender, small pink bumps

4.  Pustules--these pimples have pus on the top and are red on the bottom of the lesion

5.  Nodules--hard, large, painful pimples that are deep in the skin

6.  Cysts--pus-filled, deep, painful pimples that result in scars 

The basic acne lesion is called a comedo.

Acne can be superficial (pimples without abscesses) or deep (when the inflamed pimples push down into the skin, causing pus-filled cysts that rupture and result in larger abscesses).

What causes acne?

Rising hormone levels during puberty may cause acne. In addition, acne is often inherited. Other causes of acne may include the following:

  • Hormone level changes during the menstrual cycle in women

  • Hormone changes during pregnancy

  • Starting or stopping birth control pills

  • Certain drugs (such as corticosteroids, lithium, and barbiturates)

  • Oil and grease from the scalp, mineral or cooking oil, and certain cosmetics

Acne can be aggravated by squeezing the pimples or by scrubbing the skin too hard. Skin may also become irritated with friction or pressure from helmets, backpacks, or tight collars. Some environmental conditions such as pollution or humid conditions can also irritate the skin.

What are the symptoms of acne?

Acne can occur anywhere on the body. However, acne most often appears in areas where there is a high concentration of sebaceous glands, including the following:

  • Face

  • Chest

  • Upper back

  • Shoulders

  • Neck

The following are the most common types of acne pimples. However, each individual may experience acne symptoms differently. Symptoms may include:

  • Blackheads

  • Whiteheads

  • Pus-filled lesions that may be painful

  • Nodules (solid, raised bumps)

The symptoms of acne may resemble other skin conditions. Always consult your physician for a diagnosis.

Treatment of acne:

Specific treatment for acne will be determined by your physician based on:

  • Your age, overall health, and medical history

  • Severity of the acne

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

The goal of acne treatment is to minimize scarring and improve appearance. Treatment for acne will include topical or systemic drug therapy. Depending upon the severity of acne, topical medications (applied to the skin) or systemic medications (taken orally) may be prescribed by your physician. In some cases, a combination of both topical and systemic medications may be recommended.

Topical medications to treat acne:

Topical medications are often prescribed to treat acne. Topical medication can be in the form of a cream, gel, lotion, or solution. Examples include:

Benzoyl peroxide

Kills the bacteria (P. acnes)

Antibiotics

Helps stop or slow down the growth of P. acnes and reduces inflammation

Tretinoin

Stops the development of new acne lesions (comedones) and encourages cell turnover, unplugging pimples

Adapalene

Decreases comedo formation

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Americans spend more than $100 million a year on nonprescription acne treatments--and that figure doesn't even include money spent on special soaps and cleansers.