All About Acne

Acne, the most common skin condition in the United States, isnít just something that plagues teenagers. It can bother people at any age. The good news is, itís easy to treat and few people need to suffer with it anymore.

Acne is "a skin condition that consists of pimples, deeper lumps (cysts or nodules), and plugged pores (blackheads and whiteheads), that occur on the face, neck, chest, back, shoulders, and even the upper arms," according to the American Academy of Dermatology (AAD). Forty to 50 million Americans are affected by acne, which is more common in girls and women than boys and men. It usually begins during puberty when oil glands are over-productive, but itís not uncommon for people to have flare ups during their 20s, 30s, and beyond.

The Causes of Acne

The most common cause of acne is clogged pores, which result from:

  • Over production of oil glands.
  • Blockage of hair follicles that release oil.
  • Bacterial growth within a hair follicle.

The clog might begin with an accumulation of dead skin cells. When excess oil causes these cells to clump together and get trapped inside a pore, it might form a black head. If bacteria accumulate inside the clogged pore, a classic pimple with inflammation, swelling, pain and redness might develop. It might form a pustule (white head) as the body attempts to eliminate the inflammation, or, it might form a deeper cyst under the skin (cystic acne).

But what about hormones? Donít those cause acne, too? Yes, according to the AAD, hormones can cause acne flare-ups in some people. While many women complain of breakouts around the time of their periods, itís actually androgens, or male hormones, that cause the problem. Androgens are naturally present in both men and women, and can over-stimulate oil glands and affect skin cells in and around hair follicles. Most women with acne have normal androgen levels. But some women with hormonal imbalances caused by conditions like polycystic ovarian syndrome might have more acne than others.

Treating the Condition

While acne may seem like an insurmountable problem, actually, there are many options. In fact, "I love seeing acne patients. Itís such a treatable condition," says Joyce Davis, MD, a dermatologist in private practice in New York City. "Nobody really has to suffer from acne anymore and we donít see the kinds of scarring we saw just a generation ago."

How is acne treated? "There are different types of acne and a wide range of treatments prescribed based on the predominant pattern of the acne," Davis explains. "If we start with blackheads (which are called comedones), some people will be able to prevent or treat them with abrasive granules or sponges, but for those who need more help, my favorite way to treat blackheads is with retinoids," which are drugs derived from vitamin A, such as Retin-A. "Thereís a wide range of retinoids too, so weíre more able than ever to find a product that works for individual patients. Whereas older retinoids were very drying, newer drugs, like Atralin, are much less harsh."

The AAD breaks acne treatments into three categories:

  1. Topical medications. These treatments, which are applied to the skin, include over-the-counter products like salicylic acid (aka beta hydroxyl acid, or BHA), benzoyl peroxide, and prescription medications like the retinoids Davis prescribes, as well as topical antibiotics.
  2. Treatments that work throughout the body. Used to treat inflammatory and cystic acne, these oral medications include antibiotics, birth control pills, and for severe acne, Accutane (isotretinoin, available under various brand names). However, "Weíre getting away from using antibiotics because of concerns about antibiotic resistance," Davis says.

    And for patients with stubborn acne, "When other treatments arenít enough, Accutane is a wonderful drug. It turns oil glands off for the course of treatment (they resume functioning once treatment is over) and essentially cures the patient of acne," Davis says. "It takes five to eight months of treatment, but it works so well, I rarely see an Accutane patient again once theyíve finished treatment."
  3. Procedures performed by a dermatologist. These may include chemical peels, laser and light therapies, physical extraction of blackheads, drainage and extraction of large cysts, and cortisone shots into cysts. While an aesthetician or facialist can perform some acne-specific procedures, it's recommended that these treatments be done by, supervised by, or after consultation with a dermatologist, since many of them can aggravate acne.

The Big Question

Everyone who has ever picked a pimple (or been tempted to) wants to know: Should you or shouldnít you? The answer? No! "You really shouldnít try to pick and drain a pimple at home because you can cause an infection which can lead to a scar," Davis says. "Instead, use your acne treatment for a few days and if that doesnít work, go see your dermatologist. Thatís why weíre not seeing people with acne scarring as often anymore. A good dermatologist can find the right treatment so you donít have to worry about acne."

Joyce Davis, MD, reviewed this article.


Joyce Davis, MD. General and Cosmetic Dermatology.

"Acne." American Academy of Dermatology. Page accessed February 11, 2015.