Acne

Definition

Acne is a skin condition that causes whiteheads, blackheads, and inflamed red growths (papules, pustules, and cysts) to form. These growths are commonly called pimples or "zits."

Alternative Names

Acne vulgaris; Cystic acne; Pimples; Zits

Causes, incidence, and risk factors

Acne occurs when tiny holes on the surface of the skin, called pores, become clogged.

• Each pore is an opening to a follicle, which contains a hair and an oil gland. These oil glands help lubricate the skin and help remove old skin cells.
• When glands produce too much oil, the pores can become blocked. Dirt, debris, bacteria, and inflammatory cells build up. The blockage is called a plug or comedone.
• The top of the plug may be white (whitehead) or dark (blackhead).
• If the plug breaks open, the material inside causes swelling and red bumps to form.
• If the inflammation is deep in your skin, the pimples may enlarge to form firm, painful cysts.

Acne is a problem of swelling and inflammation, not a problem caused by bacteria.

Acne is most common in teenagers, but it can happen at any age, even in an infant. Three out of four teenagers have some acne. Hormonal changes probably cause increased oil in the skin. However, people in their 30s and 40s may also have acne.

Acne tends to run in families and can be triggered by:

• Hormonal changes related to menstrual periods, pregnancy, birth control pills, or stress
• Greasy or oily cosmetic and hair products
• Certain drugs (such as steroids, testosterone, estrogen, and phenytoin)
• High levels of humidity and sweating

Despite the popular belief that chocolate, nuts, and greasy foods cause acne, research does not confirm this idea. Diets high in refined sugars may be related to acne, though.

Symptoms

Acne commonly appears on the face and shoulders, but it may also occur on the trunk, arms, legs, and buttocks.

• Blackheads
• Crusting of skin bumps
• Cysts
• Papules (small red bumps)
• Pustules
• Redness around the skin eruptions
• Scarring of the skin
• Whiteheads

Signs and tests

Your doctor can diagnose acne based on the appearance of the skin. Testing is usually not required.

Treatment

SELF-CARE

Steps you can take to help your acne:

• Clean your skin gently with a mild, nondrying soap (such as Dove, Neutrogena, Cetaphil, CeraVe, or Basics). Remove all dirt or make-up. Wash once or twice a day, including after exercising. However, avoid scrubbing or repeated skin washing.
• Shampoo your hair daily, especially if it is oily. Comb or pull your hair back to keep the hair out of your face.

What NOT to do:

• Try not to squeeze, scratch, pick, or rub the pimples. Although it might be tempting to do this, it can lead to skin infections and scarring.
• Avoid wearing tight headbands, baseball caps, and other hats
• Avoid touching your face with your hands or fingers.
• Avoid greasy cosmetics or creams. Take off make-up at night. Look for water-based or "noncomedogenic" formulas. Noncomedogenic products have been tested and proven not to clog pores and cause acne.

If these steps do not clear up the blemishes, try over-the-counter acne medications. You apply these products directly to your skin.

• They may contain benzoyl peroxide, sulfur, resorcinol, or salicylic acid.
• They work by killing bacteria, drying up skin oils, or causing the top layer of your skin to peel.
• They may cause redness or peeling of the skin.

A small amount of sun exposure may improve acne a little, but mostly it just hides the acne. However, too much exposure to sunlight or ultraviolet rays is not recommended because it increases the risk for skin cancer.

PRESCRIPTION MEDICINES

If pimples are still a problem, a health care provider can prescribe stronger medications and discuss other options with you.

Antibiotics may help some people with acne:

• Oral antibiotics (taken by mouth) such as tetracycline, doxycycline, minocycline, erythromycin, trimethoprim, and amoxicillin
• Topical antibiotics (applied to the skin) such as clindamycin, erythromycin, or dapsone

Creams or gels applied to the skin may be prescribed:

• Retinoic acid cream or gel (tretinoin, Retin-A)
• Prescription formulas of benzoyl peroxide, sulfur, resorcinol, or salicylic acid
• Topical azelaic acid

For women whose acne is caused or made worse by hormones:

• A pill called spironolactone may help
• Birth control pills may help in some cases, though they may make acne worse

Minor procedures or treatments may also be helpful:

• A laser procedure called photodynamic therapy
• Your doctor may also suggest chemical skin peeling, removal of scars by dermabrasion, or removal, drainage, or injection of cysts with cortisone

People who have cystic acne and scarring may try a medicine called isotretinoin (Accutane). You will be watched closely when taking this medicine because of its side effects.

Pregnant women should NOT take Accutane, because it causes severe birth defects. Women taking Accutane must use two forms of birth control before starting the drug and enroll in the iPledge program. Your doctor will follow you on this drug and you will have regular blood tests.

Support Groups

Expectations (prognosis)

Acne usually goes away after the teenage years, but it may last into middle age. The condition often responds well to treatment after 6 - 8 weeks, but it may flare up from time to time.

Scarring may occur if severe acne is not treated. Some people, especially teenagers, can become very depressed if acne is not treated.

Complications

Calling your health care provider

Call your doctor or a dermatologist if:

• Self-care measures and over-the-counter medicine have not helped after several months
• Your acne is severe (for example, you have a lot of redness around the pimples or you have cysts)
• Your acne is getting worse
• You develop scars as your acne clears up

Call your baby's health care provider if your baby has acne that does not clear up on its own within 3 months.

Prevention

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References

Acne, rosacea, and related disorders. In: Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 7.