Acne is a disease that affects the skin's oil glands. The tiny holes in your skin (pores) connect to oil glands under the skin through a canal called a follicle. Inside the follicles, sebum (an oily substance the glands produce) carries dead skin cells to the surface of the skin. A thin hair also grows through the follicle and out to the skin. When the follicle of an oil gland becomes clogged with oil, skin cells, sebum, and bacteria, it's called a pimple.
The term "acne" simply refers to several pimples occurring together. Nearly 17 million people in the United States have this condition, making it the most common skin disease. Although it is not a serious health threat, severe acne can lead to disfiguring, permanent scarring. This can be upsetting to people who are affected by the disorder. Heredity, changing hormone levels, birth control pills and makeup can contribute to it. Fortunately, almost every case can be resolved with proper treatment. In some cases, it can even be prevented.
Most pimples (also known as zits) are found on the:
Face
Neck
Back
Chest
Shoulders.
There are many kinds of acne. The most common types are:
Whiteheads
Blackheads
Papules
Pustules
Nodules
Cysts.
The two most common types of acne are whiteheads and blackheads.
The basic acne lesion, called the comedo (KOM-e-do), is simply an enlarged and plugged hair follicle. If the plugged follicle, or comedo, stays beneath the skin, it's called a closed comedo and produces a white bump called a whitehead. 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 types of acne can develop, including:
Papules, which are inflamed lesions that usually appear as small, pink bumps on the skin and can be tender to the touch
Pustules (pimples), which are papules topped by pus-filled lesions that may be red at the base
Nodules, which are large, painful, solid lesions that are lodged deep within the skin
Cysts, which are deep, painful, pus-filled lesions that can cause scarring.
Three factors contribute to the formation of acne:
Overproduction of oil (sebum)
Irregular shedding of dead skin cells resulting in irritation of the hair follicles of your skin
Buildup of bacteria
Acne occurs when the hair follicles become plugged with oil and dead skin cells. Hair follicles are connected to sebaceous glands. These glands secrete an oily substance known as sebum to lubricate your hair and skin. Sebum normally travels up along the hair shafts and then out through the openings of the hair follicles onto the surface of your skin. When your body produces an excess amount of sebum and dead skin cells, the two can build up in the hair follicles and form together as a soft plug, creating an environment where bacteria can thrive.
This plug may cause the follicle wall to bulge and produce a whitehead. Or, the plug may be open to the surface and may darken, causing a blackhead. Pimples are raised red spots with a white center that develop when blocked hair follicles become inflamed or infected. Blockages and inflammation that develop deep inside hair follicles produce lumps beneath the surface of your skin called cysts. Other pores in your skin, which are the openings of the sweat glands onto your skin, aren't normally involved in acne.
These factors can trigger or aggravate an existing case of acne:
Hormones. Androgens are hormones that increase in boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy and the use of sinful oral contraceptives can also affect sebum production.
Certain medications. Drugs containing corticosteroids, androgens or lithium are known to cause acne.
Diet. Studies indicate that certain dietary factors, including dairy products and carbohydrate-rich foods — such as bread, bagels and chips, which increase blood sugar — may trigger acne.
Over 80% of cases of adult acne occur in women. It is thought that many cases of adult acne are caused by the changes in hormone levels that many women have at certain times.
These times include:
Periods. some women have a flare-up of acne just before their period is due.
Pregnancy. many women have symptoms of acne in pregnancy, usually during the first three months of their pregnancy.
Polycystic ovary syndrome. this poorly understood but common condition can cause acne as well as weight gain and the formation of small cysts inside the ovary.
In some people, acne can be a side effects of medication, such as steroid medication and lithium (which is often used to treat depression and bipolar disorder).
Despite being one of the most widespread skin conditions, acne is also one of the most poorly understood. There are many myths and misconceptions about it, including:
"Acne is caused by a poor diet." There is no evidence that diet plays a role in acne. Eating a healthy, balanced diet is recommended because it is good for your heart and your health in general. However, it will not help your acne.
"Acne is caused by having dirty skin and poor hygiene." Most of the biological reactions that trigger acne occur beneath the skin, not on the surface of the skin. Therefore, how clean your skin is will have little to no effect on your acne. You should wash every day and wash your face twice a day. More frequent washing will make no difference to your acne and could make symptoms worse by aggravating your skin.
"Squeezing blackheads, whiteheads and spots is the best way to get rid of acne." Squeezing or picking your acne could make your symptoms worse and may leave you with permanent scarring.
"Sunbathing, sunbeds and sunlamps help improve the symptoms of acne." There is no conclusive evidence that prolonged exposure to sunlight or using sunbeds or sunlamps can improve acne. However, many medications used to treat acne can make your skin more sensitive to light, so prolonged exposure could cause painful damage to your skin. There is also an increased risk of getting skin cancer.
"Acne is infectious." You cannot pass acne on to other people and it is not infectious.
Acne typically appears on your face, neck, chest, back and shoulders, which are the areas of your skin with the largest number of functional oil glands. Acne can take the following forms:
Noninflammatory lesions
Comedones (whiteheads and blackheads) are created when the openings of hair follicles become clogged and blocked with oil secretions, dead skin cells and sometimes bacteria. When comedones (koe-muh-DOE-neez) are open at the skin surface, they're called blackheads because of the dark appearance of the plugs in the hair follicles. When comedones are closed, they're called whiteheads — slightly raised, skin-colored bumps.
Inflammatory lesions
Papules are small raised bumps that signal inflammation or infection in the hair follicles. Papules may be red and tender.
Pustules (pimples) are red, tender bumps with white pus at their tips.
Nodules are large, solid, painful lumps beneath the surface of the skin. They're formed by the buildup of secretions deep within hair follicles.
Cysts are painful, pus-filled lumps beneath the surface of the skin. These boil-like infections can cause scars.
When to see a doctor
Acne usually isn't a serious medical condition. But you may want to seek medical treatment from a dermatologist for persistent pimples or inflamed cysts to avoid scarring or other damage to your skin. If acne and the scars it may have left are affecting your social relationships or self-esteem, you may also want to ask a dermatologist if your acne can be controlled or if your scars can be diminished.
Acne treatments work by reducing oil production, speeding up skin cell turnover, fighting bacterial infection, reducing the inflammation or doing all four. With most prescription acne treatments, you may not see results for four to eight weeks, and your skin may get worse before it gets better.
If you just have a few
blackheads, whiteheads and spots, you should be able to treat them
successfully with over-the-counter gels or creams (topical
treatments) that contain benzoyl peroxide.
Some self-help
techniques may also be useful:
Do not wash affected areas of skin more than twice a day. Frequent washing can irritate the skin and make symptoms worse.
Wash the affected area with a mild soap or cleanser and lukewarm water. Very hot or cold water can make acne worse.
Don't try to "clean out" blackheads or squeeze spots. This can make them worse and cause permanent scarring.
If dry skin is a problem, use a fragrance-free, water-based emollient.
Regular exercise cannot improve your acne but it can boost your mood and improve your self-esteem. Shower as soon as possible once you finish exercising as sweat can irritate your acne.
Regularly wash your hair and try to avoid letting your hair fall across your face.
Treatments can take up to three months to work, so don't expect overnight results.
If your acne is more widespread, for example if you have a large number of papules and pustules, or if over-the-counter medication hasn't worked, your doctor or dermatologist may recommend a prescription medication you apply to your skin (topical medication) or take by mouth (oral medication). Don't use oral prescription medications for acne if you are pregnant , especially during the first trimester, or you think you are pregnant.
If you have severe acne, such as a large number of papules and pustules on your chest and back as well as your face, or if you have painful nodules, your doctor can refer you to an expert in treating skin conditions (dermatologist).
A combination of antibiotic tablets and topical treatments is usually the first treatment option for severe acne. If this doesn't work, a medication called isotretinoin may be prescribed.
Hormonal therapies can also be effective in women who have acne.
Many of these treatments can take two to three months before they start to work. It's important to be patient and persist with a recommended treatment even if there is no immediate effect.
Types of acne treatments include:
Over-the-counter topical treatments. Acne lotions may dry up the oil, kill bacteria and promote sloughing of dead skin cells. Over-the-counter (OTC) lotions are generally mild and contain benzoyl peroxide, sulfur, resorcinol, salicylic acid or sulfur as their active ingredient. These products can be helpful for very mild acne. OTC acne medications may cause initial side effects — such as skin irritation, dryness and flaking — that often improve after the first month of therapy.
Topical treatments available by prescription. If your acne doesn't respond to OTC treatments, consider seeing a doctor or dermatologist to get a stronger prescription lotion. Tretinoin (Avita, Retin-A, others), adapalene (Differin) and tazarotene (Tazorac, Avage) are examples of topical prescription products derived from vitamin A. They work by promoting cell turnover and preventing plugging of the hair follicles. A number of topical antibiotics also are available. They work by killing excess skin bacteria.
Often, a combination of such products is required to achieve optimal results. A number of benzoyl peroxide and antibiotic combination medications are available, including different dose combinations of benzoyl peroxide and clindamycin (Benzaclin, Duac, Acanya) and benzoyl peroxide and erythromycin (Benzamycin). Dapsone gel (Aczone) is a newer acne treatment that's particularly effective in treating inflammatory acne. Prescription topical treatments for acne may cause skin side effects, such as stinging, burning, redness or peeling. Your doctor may recommend steps to minimize these side effects, including using a gradually increased dose, washing off the medication after a short application or switching to another medication.
Antibiotics. For moderate to severe acne, you may need a short course of prescription oral antibiotics to reduce bacteria and fight inflammation. Since oral antibiotics were first used to treat acne, antibiotic resistance has increased significantly in people with acne. For this reason, your doctor likely will recommend tapering off these medications as soon as your symptoms begin to improve, or as soon as it becomes clear the drugs aren't helping — usually, within three to four months. In most cases, you'll use topical medications and oral antibiotics together. Studies have found that using topical benzoyl peroxide along with oral antibiotics may reduce the risk of developing antibiotic resistance. Antibiotics may cause side effects, such as an upset stomach, dizziness or skin discoloration. These drugs also increase your skin's sun sensitivity.
Isotretinoin. For deep cysts, antibiotics may not be enough. Isotretinoin (Amnesteem, Claravis, Sotret) is a powerful medication available for scarring cystic acne or acne that doesn't respond to other treatments. This medicine is reserved for the most severe forms of acne. It's very effective, but people who take it need close monitoring by a dermatologist because of the possibility of severe side effects. Isotretinoin is associated with severe birth defects, so it can't be taken by pregnant women or women who may become pregnant or by women of reproductive age or by women who are married.
Isotretinoin commonly causes side effects — such as dry eyes, mouth, lips, nose and skin, as well as itching, nosebleeds, muscle aches, sun sensitivity and poor night vision. The drug may also increase the levels of triglycerides and cholesterol in the blood and may increase liver enzyme levels.
In addition, isotretinoin may be associated with an increased risk of depression and suicide. Although this causal relationship has not been proved, doctors remain on alert for these signs in people who are taking isotretinoin. If you feel unusually sad or unable to cope while taking this drug, tell your doctor immediately.
Laser and light therapy. Laser- and light-based therapies reach the deeper layers of skin without harming the skin's surface. Laser treatment is thought to damage the oil (sebaceous) glands, causing them to produce less oil. Light therapy targets the bacteria that cause acne inflammation. These therapies can also improve skin texture and lessen the appearance of scars. More research is needed to understand the most effective use of light and laser therapies in acne treatment, and experts currently recommend these approaches as stand-alone therapy only in people who can't tolerate approved acne medications. These therapies may be uncomfortable and may cause temporary skin problems that mimic a severe sunburn.
Cosmetic procedures. Chemical peels and microdermabrasion may be helpful in controlling acne. These cosmetic procedures — which have traditionally been used to lessen the appearance of fine lines, sun damage and minor facial scars — are most effective when used in combination with other acne treatments. They may cause temporary, severe redness, scaling and blistering, and long-term discoloration of the skin.
Doctors may be able to use certain procedures to diminish scars left by acne. These include fillers, dermabrasion, intense light therapy and laser resurfacing.
Soft tissue fillers. Collagen or fat can be injected under the skin and into scars to fill out or stretch the skin, making the scars less noticeable. Results from this acne scar treatment are temporary, so you need to repeat the injections periodically.
Chemical peels. High-potency acid is applied to your skin to remove the top layer and minimize deeper scars. Some stronger peels reach even deeper into the skin.
Dermabrasion. Usually reserved for more severe scarring, dermabrasion involves removing the top layer of skin with a rapidly rotating wire brush. Surface scars may be completely removed, and deeper acne scars may appear less noticeable. Dermabrasion may cause pigmentation changes for people with darker skin.
Microdermabrasion. This newer acne scar treatment involves a hand-held device that blows crystals onto skin. These crystals gently abrade or "polish" the skin's surface. Then, a vacuum tube removes the crystals and skin cells. Because just the surface cells are removed, the skin isn't damaged. However, results are subtle and scars may still be noticeable, even after several sessions.
Laser, light source and radiofrequency treatments. In laser resurfacing, a laser beam destroys the outer layer of skin (epidermis) and heats the underlying skin (dermis). As the wound heals, new skin forms. Less intense lasers (nonablative lasers), pulsed light sources and radiofrequency devices don't injure the epidermis. These treatments heat the dermis and cause new skin formation. After several treatments, acne scars may appear less noticeable. This means shorter recovery times, but treatment typically needs to be repeated more often and results are subtle.
Skin surgery. A minor procedure (punch excision) cuts out individual acne scars. Stitches or a skin graft repairs the hole left at the scar site.
Some studies suggest that taking the following supplements may help treat acne:
Tea tree oil. Gels containing 5 percent tea tree oil may be as effective as are lotions containing 5 percent benzoyl peroxide, although tea tree oil might work more slowly. Tea tree oil may cause a skin reaction known as contact dermatitis. There's also some concern that topical products containing tea tree oil might cause breast development in young boys. Don't use tea tree oil if you have acne rosacea because it can worsen symptoms.
Alpha hydroxy acids. These natural acids — found in foods such as citrus fruits, sugar cane, apples and grapes — help remove dead skin cells and unclog pores when applied topically. Alpha hydroxy acids may also improve the appearance of acne scars. Adverse reactions to alpha hydroxy acids include redness, mild stinging and skin irritation.
Azelaic acid. This naturally occurring acid is found in whole-grain cereals and animal products and has antibacterial properties. A 20 percent azelaic acid cream seems to be as effective as many other conventional acne treatments, including 5 percent benzoyl peroxide and oral tetracycline.
Zinc supplements. The mineral zinc plays a role in wound healing and reduces inflammation, which could help improve acne. Taking a zinc supplement with food may reduce side effects, including a bad taste in your mouth and nausea. Zinc can also be added to lotions or creams and may reduce acne breakouts.
Brewer's yeast. A specific strain of brewer's yeast, called CBS 5926, seems to help decrease acne. Brewer's yeast may cause migraines in susceptible people and may cause intestinal upset.
More research is needed to understand the potential role of these and other dietary supplements in the treatment of acne.
Always talk with your doctor before trying a natural remedy. Dietary supplements can cause side effects and may alter the safety and effectiveness of certain medications.
Once your acne improves or clears, you may need to continue your acne medication or other treatment to prevent new acne breakouts. In some cases, you might need to use a topical medication on acne-prone areas, continue oral medications or attend ongoing light therapy sessions to keep your skin clear. Talk to your doctor about how you can prevent new eruptions.
You can also prevent new acne breakouts with self-care measures, such as washing your skin with a gentle cleanser and avoiding touching or picking at the problem areas. Other acne-prevention tips include:
Wash acne-prone areas only twice a day. Washing removes excess oil and dead skin cells. But too much washing can irritate the skin. Wash areas with a gentle cleanser and use oil-free, water-based skin care products.
Use an over-the-counter acne cream or gel to help dry excess oil. Look for products containing benzoyl peroxide or salicylic acid as the active ingredient.
Avoid using makeup. Makeup irritates the skin.
Wear loosefitting clothing. Tightfitting clothing traps heat and moisture and can irritate your skin. Also, whenever possible, avoid tightfitting straps, backpacks, helmets or sports equipment to prevent friction against your skin.
Shower after exercising or doing strenuous work. Oil and sweat on your skin can trap dirt and bacteria.