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Acne

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(Pimples; Blackheads; Whiteheads; Acne Vulgaris)

Definition

Acne occurs when the pores of the skin become clogged, inflamed, and sometimes infected. These clogged pores can result in blackheads, whiteheads, or pimples. Acne is common in teenagers, but can also occur in adults.

Causes

Acne starts in the skin's sebaceous glands. These glands secrete an oily substance called sebum. The sebum normally travels through a tiny hair follicle from the gland to the skin's surface. Sometimes the sebum becomes trapped and mixes with dead skin cells and bacteria. This causes clogged pores called comedones.
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Blackheads are comedones that reach the skin's surface. Whiteheads are comedones that stay beneath the surface of the skin. Small red bumps, pimples, and cysts may also develop.
The main causes of acne include:
  • Changes in levels of male hormones called androgens
  • Increased sebum production
  • Changes inside the hair follicle
  • Bacteria

Risk Factors

A risk factor is something that increases your chances of getting a disease or condition. Risk factors for acne include:
  • Age: 12-24 years old
  • Race: Caucasian
  • Changes in hormone levels, such as during:
    • Puberty
    • Pregnancy
    • Before a menstrual period
  • Stress
  • Certain medicines (such as, androgens, lithium, and barbiturates)
  • Certain cosmetic products

Symptoms

Acne symptoms vary from person to person and can range from mild to severe. They include:
  • Excess oil in the skin
  • Blackheads
  • Whiteheads
  • Papules—small, pink bumps that may be tender to the touch
  • Pimples—inflamed, pus-filled bumps that may be red at the base (also called pustules)
  • Nodules—large, painful, solid lumps that are lodged deep within the skin
  • Cysts—deep, inflamed, pus-filled lumps that can cause pain and scarring

Diagnosis

The doctor will examine the areas of your skin with the most sebaceous glands. These areas include the face, neck, back, chest, and shoulders. If your acne is severe, you may be referred to a dermatologist (skin specialist).

Treatment

Acne may require a combination of treatments. Most acne does not require surgery. Some treatments may take several weeks to work. Your skin may actually appear to get worse before it gets better.

Medications

  • Over-the-counter topical medicines (such as, cleansers, creams, lotions, and gels)—to reduce the amount of oil and/or bacteria in the pores. These medicines may contain one or more of the following ingredients:
    • Benzoyl peroxide
    • Salicylic acid
    • Sulfur
    • Resorcinol
  • Prescription topical medicine—includes cleansers, creams, lotions, and gels to reduce the amount of oil and/or bacteria in the pores. Examples include:
    • Antibiotics, such as clindamycin (Cleocin T), erythromycin
    • Tretinoin (Retin-A, Avita)
    • Adapalene (Differin)
    • Azelaic acid (Azelex)
    • Tazarotene (Tazorac)
    • Dapsone (Aczone)
  • Oral antibiotics—to control the amount of bacteria in pores, including:
    • Doxycycline
    • Minocycline
    • Tetracycline
    • Erythromycin
    • Clindamycin
    • Amoxicillin
    • Cephalosporins
    • Sulfamethoxazole and trimethoprim
  • Oral medicines—to control androgen levels, including:
    • Birth control pills—Pills that have a combination of hormones (estrogen and progestin) may be the most effective in improving acne.
    • Spironolactone
  • Oral retinoids—to reduce the size and secretions of sebaceous glands. This medicine is only used for severe cases of cystic acne.
    • Isotretinoin (Accutane)—must not be taken by women who are pregnant or who may become pregnant due to the risk of serious birth defects.

Procedures

There are a number of procedures that can be used to treat acne, examples include:
  • Corticosteroids—the injection of corticosteroid directly into the cyst; mostly used for large, cystic acne lesions
  • Acne surgery—specialized extractors are used to open, drain, and remove contents of acne lesions
  • Acne scar revision—procedures done to minimize acne scars, such as:
    • Chemical peels—uses glycolic acid and other chemical agents to loosen blackheads and decrease acne papules
    • Dermabrasion—"sandpapers" the skin to smooth it out
    • Scar excision—uses a tiny punch tool or a scalpel to remove scars
    • Collagen fillers—fill the pits of scars with a collagen substance
    • Laser resurfacing—removes scars and tightens underlying skin
  • Phototherapy—skin is exposed to an ultraviolet (UV) light source for a set amount of time to treat acne
Some of the procedures have risks, such as scarring and infection.

Prevention

It can be difficult to prevent acne from occurring. It can be difficult to control the factors that cause acne. But, there are some things you can do to keep your acne from getting worse:
  • Gently wash your face with mild soap and warm water twice a day (no more than twice) to remove excess oil. Scrubbing or washing too often can make acne worse.
  • When washing your face:
    • Use your hands rather than a washcloth.
    • Use mild soap.
    • Allow your face to dry before applying any lotion.
  • Do not pick at or squeeze blemishes.
  • Use lotions, soaps, and cosmetics labeled noncomedogenic. This means it won't clog your pores.
  • Use topical acne treatments only as directed. Using them more often could make your condition worse.
  • Recognize and limit emotional stress.
  • Wear sunscreen year-round. This is especially important if you are using medicine that can make your skin more sensitive to the sun.

RESOURCES

The Acne Resource Center Online http://www.acne-resource.org

The American Academy of Dermatology http://www.aad.org

CANADIAN RESOURCES

Canadian Dermatology Association http://www.dermatology.ca

Dermatologists.ca http://www.dermatologists.ca

References

Acne. American Academy of Dermatology website. Available at: http://www.aad.org/skin-conditions/dermatology-a-to-z/acne. Accessed October 29, 2012.

Acne. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/. Updated August 27, 2012. Accessed October 29, 2012.

Phototherapy. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary. Updated December 30, 2011. Accessed October 29, 2012.

Questions and answers about acne. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Acne/default.asp. Updated October 2010. Accessed October 29, 2012.

9/2/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Arowojolu A, Gallo M, Lopez L, Grimes D, Garner S. Combined oral contraceptive pills for treatment of acne. Cochrane Database Syst Rev. 2009;(3):CD004425.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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