Definition

Acne occurs when the pores of the skin become clogged, inflamed, and sometimes infected. These clogged pores can result in blackheads, whiteheads, or pimples. Acne tends to occur in teenagers, but can also occur in adults.

Causes

Acne starts in the skin's sebaceous glands. These glands secrete an oily substance called sebum. The sebum normally travels through a tiny hair follicle from the gland to the skin's surface. Sometimes the sebum becomes trapped, mixing with dead skin cells and bacteria. This causes a clogged pore called a comedo (plural: comedones).

Pimple

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Blackheads are comedones that reach the skin's surface. Whiteheads are comedones that stay beneath the surface of the skin. Small red bumps, pimples, and cysts may also develop.

The main causes of acne include:

  • Changes in levels of male hormones called androgens
  • Increased sebum production
  • Changes inside the hair follicle
  • Bacteria

Risk Factors

A risk factor is something that increases your chances of getting a disease or condition.

  • Age: between 12-24 years old
  • Race: Caucasian
  • Changes in hormone levels, such as during:
    • Puberty
    • Pregnancy
    • Before a menstrual period
  • Stress
  • Certain medications (such as androgens, lithium , and barbiturates)

Symptoms

Acne symptoms vary from person to person and can range from mild to severe. They include:

  • Excess oil in the skin
  • Blackheads
  • Whiteheads
  • Papules—small pink bumps that may be tender to the touch
  • Pimples—inflamed, pus-filled bumps that may be red at the base (also called pustules)
  • Nodules—large, painful, solid lumps that are lodged deep within the skin
  • Cysts—deep, inflamed, pus-filled lumps that can cause pain and scarring

Diagnosis

The doctor will examine the areas of your skin with the most sebaceous glands like the face, neck, back, chest, and shoulders. If your acne is severe, you may be referred to a dermatologist, a skin specialist.

Treatment

There are several over-the-counter and prescription medications for acne. They may be applied directly to the skin (topical medication), taken by mouth (oral medication), or injected into the acne cysts or pustules.

Acne may require a combination of treatments but, most acne does not require surgery. Some treatments may take several weeks to work. Your skin may actually appear to get worse before it gets better.

Medications

  • Over-the-counter topical medicines—include cleansers, creams, lotions, and gels. Their goal is to reduce the amount of oil and/or bacteria in the pores. They may contain one or more of the following ingredients:
    • Benzoyl peroxide
    • Salicylic acid
    • Sulfur
    • Resorcinol
  • Prescription topical medicines—include cleansers, creams, lotions, and gels to reduce the amount of oil and/or bacteria in the pores. They include:
    • Benzoyl peroxide
    • Salicylic acid
    • Sulfur
    • Resorcinol
    • Antibiotics, such as clindamycin (Cleocin T), erythromycin , tetracycline
    • Tretinoin (Retin-A, Avita)
    • Adapalene (Differin)
    • Azelaic acid (Azelex)
    • Tazarotene (Tazorac)

Prescription oral medicine include antibiotics, medications for hormone-related acne, and vitamin A derivatives called retinoids. They are generally used for moderate to severe cases of acne.

  • Oral Antibiotics—aimed at controlling the amount of bacteria in pores, including:
    • Erythromycin
    • Tetracycline
    • Doxycycline
    • Minocycline
    • Clindamycin
    • Ampicillin
    • Cephalosporins
    • Trimethoprim-sulfamethoxazole
  • Oral medications—aimed at controlling androgen levels, including:
    • Birth control pills
    • Spironolactone
  • Oral retinoids—aimed at reducing the size and secretions of sebaceous glands. Only for severe cases of cystic acne.
    • The main drug is isotretinoin (Accutane). It must not be taken by women who are pregnant or who may become pregnant, because of the risk of serious birth defects.

Procedures

  • Intralesional corticosteroids—the injection of a steroid preparation directly into the cyst. This treatment is mostly used for large, cystic acne lesions.
  • Acne surgery—specialized (comedo) extractors are used to open, drain, and remove contents of acne lesions. Repeated sessions maybe required.
  • Acne scar revision—these are procedures done to minimize acne scars. Scar revision procedures include:
    • Chemical peels—the application of glycolic acid and other chemical agents to loosen blackheads and decrease acne papules
    • Dermabrasion —"sandpapers" the skin to smooth it out
    • Scar excision—uses a tiny punch tool or a scalpel to remove scars
    • Collagen fillers—fill the pits of scars with a collagen substance
    • Laser resurfacing—a laser is used to remove scars and tighten underlying skin

    Risks associated with scar revision and surgery include scarring and infection. Talk with your doctor or surgeon about the risks and benefits of the procedure.

Prevention

It can be difficult to prevent acne from occurring, because it can be difficult to control the factors that cause it. But there are some things you can do to keep your acne from getting worse:

  • Gently wash your face with mild soap and warm water twice a day (no more than twice) to remove excess oil. Scrubbing or washing too often can make acne worse.
  • When washing your face:
    • Use your hands rather than a washcloth
    • Use mild soap rather than a harsh acne cleanser
    • Allow your face to thoroughly dry before applying any topical preparations
  • Don't pick at or squeeze blemishes.
  • Use lotions, soaps, and cosmetics labeled noncomedogenic. This means it won't clog your pores.
  • Use topical acne treatments only as directed. Using them more often could make your condition worse.
  • Recognize and limit emotional stress.
  • Wear sunscreen year-round. This is especially important if you are using medications, which can make your skin more sensitive to the sun.