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 type 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:

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:

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

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:

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

Systemic medications to treat acne:

Systemic medications, or oral antibiotics, are often prescribed to treat moderate to severe acne, and may include the following:

Treatment for severe, cystic, or inflammatory acne:

Isotretinoin (Accutane®), an oral drug, may be prescribed for individuals with severe, cystic, or inflammatory acne that cannot be effectively treated by other methods to prevent extensive scarring. Isotretinoin reduces the size of the sebaceous glands that produce the skin oil, increases skin cell shedding, and affects the hair follicles, thereby reducing the development of acne lesions. Isotretinoin can clear acne in 85 percent of patients. However, the drug has major unwanted side effects, including psychiatric side effects. It is very important to discuss this medication with your physician.

Isotretinoin must not be taken by women who are pregnant or who are able to become pregnant, because there is a very high likelihood of birth defects occurring in babies whose mothers took the medication during pregnancy. Isotretinoin can also cause miscarriage or premature birth. Because of these effects and to minimize fetal exposure, isotretinoin is approved for marketing only under a special restricted distribution program approved by the US Food and Drug Administration (FDA). This program is called iPLEDGE.

The goal of the iPLEDGE program is to prevent pregnancies in females taking isotretinoin and to prevent pregnant females from taking isotretinoin. Requirements of the iPLEDGE program include:

Treatment for acne scars:

Specific dermatological procedures to minimize acne scars will be determined by your physician based on:

Although acne often is a chronic condition, even if it occurs only during adolescence, acne can leave life-long scars. Acne scars typically look like "icepick" pit scars or crater-like scars. Although proper treatment for acne may help minimize scarring, several dermatological procedures may help to further minimize any acne scars, including the following:

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