Acne

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Introduction

What is acne?

Acne is a very common skin condition in the United States. Most of us, at one point or another, have probably had acne. It affects 40 to 50 million people in the United States each year. It is most common during adolescence, affecting three out of four teenagers. However it can also affect people in their 30s and 40s; pregnant women are also prone to breakouts (Source: AAD).

Many myths are associated with the cause and treatment of acne. For example, the belief that chocolate or greasy foods cause acne is a misconception. Acne occurs when our pores, or openings in the skin, become clogged with dead skin cells. An overproduction of oil traps these skin cells inside the pore. The backed-up ducts become filled with dirt and bacteria, forming a plug known as a comedone. The top of the plug has a white tip, which if punctured, releases oil and bacteria into the skin. The inflammation can go deep into the skin, causing a cyst or nodule.

People with acne often feel stigmatized and embarrassed about their condition. It can cause anxiety, low self-esteem, and depression.

There are a variety of treatments for acne, including self-care, topical medications, prescription medications, and surgery. You should not attempt to pop or disrupt the pimples, as this can lead to a worsening of the condition. Acne often resolves on its own, especially as people grow out of adolescence.

Seek prompt medical care if you develop signs of a spreading or deeper infection that is associated with acne, such as swelling, warmth and redness of the involved area, or fever and chills.

Symptoms

What are the symptoms of acne?

Acne is a skin condition that has a number of symptoms. It is not just limited to the red spots we know as pimples, but also includes a number of different skin irritations. These can occur all over the body, including the face, which is the most common location, as well as the legs, arms, back, shoulders and buttocks.

Common symptoms of acne

Common signs and symptoms of acne include:

  • Blackheads (open pores that fill with dead skin cells)

  • Cysts (lesions that occur when a pore fills with oil, dirt and bacteria and goes deep into the skin, causing irritation)

  • Nodules (hard, large bumps under the surface of the skin)

  • Pustules (commonly called pimples; clogged, pus-filled pores)

  • Redness

  • Scarring

  • Whiteheads (closed pores that are filled with dead skin cells)

Symptoms that might indicate a serious condition

Acne is rarely a serious condition. However, if infection spreads or worsens after scratching or attempting to disrupt or pop pimples, it is possible to develop a deeper or more widespread infection of the skin. Seek prompt medical care if you, or someone you are with, have these symptoms:

  • Generalized swelling, redness, or warmth of the skin

  • High fever (higher than 101 degrees Fahrenheit)

Causes

What causes acne?

Acne is caused by clogged pores, which are tiny openings in the skin’s surface. An overproduction of oil by the oil glands combined with rapidly growing skin cells can clog the pores. The accumulated cellular debris contains bacteria that normally reside on healthy skin. Enzymes released by these trapped bacteria cause localized inflammation within the resulting plug called a comedone. The comedone can burst, spilling material into surrounding areas, intensifying the inflammation. Deeper infections, including painful cysts, can also develop under the skin.

What are the risk factors for acne?

A number of factors increase the risk of developing acne. Not all people with risk factors will get acne. Risk factors for acne include:

  • Family history of acne

  • Medications, such as anticonvulsants, birth control pills, and steroids

  • Menstruation or premenstrual syndrome (PMS)

  • Pregnancy

  • Stress

  • Sweating or being in an area of high humidity

  • Use of shampoos, soaps, lotions or makeup that may contain oils or block pores

Reducing your risk of acne

Some risk factors for acne are more controllable than others. For example, you can establish and maintain good hygiene practices to reduce acne. These include:

  • Avoiding greasy creams or cosmetics

  • Ensuring that your skin is clean, oil-free, and clear of makeup before going to bed

  • Keeping your hands and fingers away from your face

  • Shampooing your hair often (if oily)

Treatments

How is acne treated?

Although acne cannot be cured, many effective treatments are available to reduce its symptoms. These include over-the-counter (OTC) medications, prescription medications, and surgeries. Fortunately, with time, most young people with acne will outgrow the condition.

OTC medications

You can buy a number of topical medications in stores without a prescription. These medications typically dry out the pimples and kill bacteria. The following products are available in both OTC and prescription strengths:

  • Benzoyl peroxide (Clearasil)

  • Salicylic acid (Noxzema Anti-Acne Gel, Neutrogena)

Prescription medications

If these OTC medications do not work, your doctor or dermatologist (skin doctor) can prescribe something stronger. These medications treat the infection and causes of oil buildup. They include:

  • Antibiotics, either oral (taken by mouth) or topical (applied to the skin), such as erythromycin (Ery-tab or Erythra-derm), minocycline (Dynacin, Minocin), or tetracycline (Acnecycline, Tetra-bac)

  • Birth control pills or other hormonal treatments

  • Topical or oral retinoids (tretinoin, adapalene, tazarotene)

    Other treatments

    • Chemical or laser skin treatments to remove scars

    • Cyst removal or drainage

    What you can do to improve your acne

    There are several self-care measures you can take to improve your acne. These include:

    • Changing your pillowcases frequently

    • Keeping your hair away from your face

    • Keeping your hands and fingers away from your face and other areas of eruption

    • Washing your hair and face often, especially if you have oily skin

    What are the potential complications of acne?

    Although untreated acne is not associated with life-threatening complications, it can produce both mental and physical scars. These include:

    • Anxiety

    • Depression

    • Embarrassment

    • Scarring and dark spots long after original eruptions have cleared

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    Medical Reviewer: William C. Lloyd III, MD, FACS
    Last Review Date: 2019 Jan 4
    1. Acne. American Academy of Dermatology. http://www.aad.org/dermatology-a-to-z/diseases-and-treatments/a---d/acne
    2. Acne. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000873.htm
    3. Acne. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/acne/symptoms-causes/syc-20368047
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