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Acne

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Almost everyone experiences some sort of acne, or skin break-out, during their lifetime. In most cases, its severity can be reduced through proper skin care and the use of medications.

Acne is an extremely common condition that develops from the inflammation of glands that are found in the skin-most frequently on the face, upper chest, and upper back. It occurs in several stages and in variable degrees of severity.

Read or print our fact sheet on Acne (pdf).


Who gets acne?

Everyone gets at least an occasional whitehead, or blackhead, or pimple during the teenage or young adult years. Many people can manage acne with over-the-counter medications. For some, however, acne can be more serious and require prescription medication.


What causes acne?

Acne is a disease of the sebaceous hair follicles. Each follicle contains a tiny hair plus sebaceous glands, which produce an oily substance called sebum. Under normal circumstances, sebum travels up the hair follicle and out onto the skin's surface. Sometimes, sebum may become trapped within the follicle, forming a microcomedome, which is the precursor of acne.


What causes the trapping of sebum?

  • Hormones cause the sebaceous glands to enlarge, and acne may develop from the over-stimulation of these glands. In women, acne flare-ups may coincide with the hormonal changes associated with the menstrual cycle.
  • Changes inside the follicle occur as a result of increased hormone production and enlarged sebaceous glands. The cells of the inner lining of the hair follicle shed more rapidly during puberty, and tend to stick together and block the follicle when they mix with sebum.
  • Bacteria which are normally present on the skin multiply rapidly in the clogged gland and can cause inflammation of the area and rupture of the gland.


Other causes

Cosmetics
Certain cosmetics and toiletries contain ingredients that can clog pores and may cause a comedome. Products that are labeled "noncomedogenic" won't clog pores. Cosmetic acne is usually minor and doesn't cause scarring, but it can be persistent. Applying makeup to cover up the problem may aggravate it further.

Skin Irritation
Anything that can irritate acne-prone areas of the skin such as rubbing and friction from clothing, hair, and sporting equipment may make acne worse. Airborne grease in a fast food restaurant can also be comedogenic, as can motor oil.

Food
No research has proven that specific foods cause acne. However, if your personal experience shows that a particular food is associated with acne flare-ups, avoid that food.


What are the stages of acne?

Whiteheads (closed comedones)
Accelerated sloughing off of cells in the follicle and sebum production leads to blockage of the follicle, with buildup of this debris within the follicle. From the skin surface, one sees a slightly raised, light-colored lesion commonly known as a whitehead.

Blackheads
(open comedones)
A whitehead may continue to enlarge and progress until eventually the "plug" emerges from the surface of the skin. The debris comprising the plug (sloughed cells and sebum) is dark in color. As it protrudes through the surface of the skin, the whitehead becomes a blackhead.

Inflammatory acne
Sometimes a whitehead will rupture internally rather than through the pore, leading to partial or complete destruction of the follicle or gland. The contents of the follicle irritate the surrounding skin, resulting in local redness, pain, and swelling.

Nodules and cysts

These form when the tissue around a follicle is damaged by a severely ruptured sebaceous gland. Scarring may also result.


Basic guidelines for the management of acne

  • Do not pop, pinch, squeeze, or pick at acne. This can spread inflammation.
  • Gently wash your face twice-a-day with a mild soap, and pat dry. Avoid vigorous rubbing or scrubbing: friction can exacerbate acne.
  • Use noncomedogenic cosmetics and toiletries.
  • Avoid things that aggravate acne, such as airborne grease, irritating clothing, or hair rubbing against skin.
  • Give acne products time to do their job. Some medications must be used for 4 weeks or longer before results are seen. Some medications may appear to aggravate the condition before they start to work. Check with a clinician or pharmacist about the expected results and potential side effects of various medications.
  • Some acne products can increase your sensitivity to sunlight. Always use protective clothing and sunscreens, or avoid sun exposure when using these medications.


Is acne genetic?

Although almost everyone gets acne to some degree, some people are born with a predisposition for acne. The exact genetics have not been worked out yet, but a person who has a parent or sibling with a history of severe acne is more likely than others to have severe acne. 


Acne medication

Nonprescription cleansers
Most special cleansers are unnecessary if acne is being treated properly. Some can even aggravate acne by irritating the skin. Always avoid vigorous scrubbing and washing.

Benzoyl peroxide
This chemical works by destroying the bacteria associated with acne. It usually takes about 2 weeks to work and must be used continuously to keep acne at bay. It is available in a wide range of creams, lotions, and gels. Works well for milder cases.

Salicylic acid
On the skin, salicylic acid helps to correct the abnormal shedding of cells. For milder acne, it helps unclog pores to resolve and prevent lesions. Salicylic acid must be used continuously since its effects are only temporary. It is available in lotions, creams, and pads.

Prescription antibiotics
Prescription antibiotics used on top of the skin or taken orally, clear the skin of bacteria. Topical cream or gel antibiotics are limited in penetration but have fewer side effects.

Vitamin A derivatives
Also called retinoids, these drugs help unclog pores and normalize the way skin grows and sheds. They can be used with other acne products.

Oral contraceptives
Female hormones can help to counteract the effects of male hormones on acne. For obvious reasons, this treatment is limited to female patients.

Other medications
Anti-inflammatory medications called corticosteroids may be injected by a dermatologist into severely inflamed acne lesions to help them heal and are dedicated to preserving the power of antibiotics.