What Is Acne?

Acne is a common skin disorder that’s characterized by clogged pores and pimples. People often associate it with teenagers. And it’s true that more than four out of five people between the ages of 12 and 24 experience acne. But it can affect people of all ages. It’s not uncommon for acne to occur in people in their 20s and 30s. And, some people continue to have acne in their 40s and 50s. Many adult women experience mild to moderate acne due to hormonal changes associated with pregnancy, their menstrual cycles, or starting or stopping birth control pills.

Acne occurs when the hair follicles of your skin become plugged with oil and dead skin cells. Each follicle is connected to sebaceous glands that secrete an oily substance known as sebum to lubricate your hair and skin. Sebum normally travels up along the hair shafts and then out through pores onto the skin surface. When your body produces an excess amount of sebum and dead skin cells in a pore, the two can become trapped and solidify as a soft, white plug.

This plug may block the pore, causing the follicle wall to bulge and produce a whitehead. If the pore stays open and traps dirt, the top surface of the plug may darken, causing a blackhead. Pimples are raised red spots with a white center that develop when blocked pores become inflamed or infected. Blockages and inflammation that develop deep inside hair follicles produce lumps beneath the surface of the skin called cysts. Other pores in your skin, which are the openings of the sweat glands onto the skin, aren’t normally involved in acne.

Acne is rarely serious, but it often causes emotional distress and can lead to scarring of the skin. With the right treatment, you can often keep acne under control. Measures can also be taken to reduce scars left by acne.

Causes

Three factors contribute to the formation of acne:

• Overproduction of oil (sebum)
  
  
• Irregular shedding of dead skin cells
  
  
• Buildup of bacteria

It’s not known what causes the increased production of sebum that leads to acne. But a number of factors — including hormones, bacteria, certain medications, heredity and stress — are thought to play a role.

Contrary to what many people think, foods have little affect on acne. Neither chocolate nor greasy foods like french fries are likely to cause or aggravate acne. Acne also is not caused by dirt. In fact, scrubbing the skin too hard or cleansing with harsh soaps or chemicals can cause irritation, which may make acne worse.

Risk Factors

Hormonal changes in the body can provoke or aggravate acne. Such changes are common in:

• Teenagers, both boys and girls
  
  
• Women and girls, 2 to 7 days before their periods
  
  
• Pregnant women
  
  
• People under stress
  
  
• People using certain medications, including cortisone

Other risk factors include:

• Exposing your skin directly to greasy or oily substances.
  
  
• Having a family history of acne. If your parents had acne, you may be likely to develop it too.

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When to Seek Medical Advice

Acne is not a serious medical condition. But you may want to seek medical treatment from a dermatologist for persistent pimples or inflamed cysts to avoid scarring or other damage to your skin. If acne or the scars it may have left are affecting your social relationships or self-esteem, you may also want to see a dermatologist to see if your acne can be controlled or scars can be diminished.

In rare cases, a sudden onset of severe acne in an older adult may signal an underlying disease. If acne strikes suddenly or without explanation in later years, you may want to see your doctor.

Treatment

Acne treatments work by reducing oil production, speeding up skin cell turnover, fighting bacterial infection or doing all three. With most prescription acne treatments, you may not see results for 6 to 8 weeks, and your skin is likely to get worse before it gets better. Oral prescription medications for acne should not be used during pregnancy, especially during the early stages.

Your doctor or dermatologist may recommend one or more of the following treatments for acne:

• Lotions. Acne lotions may dry up the oil, kill bacteria and promote sloughing of dead skin cells. Over-the-counter lotions are generally mild and contain benzoyl peroxide, sulfur, resorcinol or salicylic acid as their active ingredient. These products can be helpful for very mild acne. If your acne doesn’t respond to these treatments, you may want to see a doctor or dermatologist to get a stronger prescription lotion. Tretinoin (Retin-A, Renova) and adapalene (Differin) are topical prescription products derived from vitamin A. They work at the skin pore level to prevent plug formation. A number of topical antibiotics also are available. They work by killing excess skin bacteria. Often, a combination of such products is required to achieve optimal results.
  
  
• Antibiotics. For moderate to severe acne, prescription oral antibiotics may be needed to reduce bacteria and fight inflammation. You may need to take these antibiotics for months and often need to use them in combination with topical products.
  
  
• Isotretinoin. For deep cysts, antibiotics may not be enough. Isotretinoin (Accutane) is a powerful medication available for scarring cystic acne or acne that doesn’t respond to other treatments. This medicine is reserved for the most severe forms of acne. It’s very effective, but patients who take it require close monitoring by a dermatologist because of the possibility of severe side effects.
  
  
• Oral contraceptives. Oral contraceptives, including a combination of norgestimate and ethinyl estradiol (Ortho-Cyclen, Ortho Tri-Cyclen,), have been shown to improve acne in women. Oral contraceptives may cause other side effects that you’ll want to discuss with your doctor. Cosmetic surgery. Doctors may be able to use cosmetic surgery to diminish scars left by acne. Procedures include peeling away damaged skin with chemicals or by freezing it, dermabrasion and laser resurfacing. Peeling procedures eliminate superficial scars. Dermabrasion, which is usually reserved for more severe scarring, involves removing the top layers of skin with a rapidly rotating wire brush. Laser resurfacing involves using short pulses of intense light to remove the outer layer of your skin. If your skin tends to form scar tissue, these procedures can make your complexion worse.

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Self-Care

Most acne can be avoided or controlled with good basic skin care and the following self-care techniques:

• Wash problem areas with a gentle cleanser. Products such as facial scrubs, astringents and masks generally aren't recommended because they tend to irritate skin, which can aggravate acne. Excessive washing and scrubbing also can irritate skin.
  
  
• Try over-the-counter acne lotion to dry excess oil and promote peeling. Look for products containing benzoyl peroxide, resorcinol or salicylic acid as the active ingredient.
  
  
• Avoid irritants. You may want to avoid oily or greasy cosmetics, sunscreens, hair- styling products or acne concealers. Use products labeled "water-based" or "noncomedogenic." If the sun worsens your acne, protect yourself from sunlight — which is a good idea in general. If stress causes outbreaks, work on reducing your stress level.
  
  
• Watch what touches your face. Keep your hair clean and off your face. Also avoid resting your hands or objects on your face. Tight clothing or hats also can pose a problem, especially if you’ll be sweating. Sweat, dirt and oils can contribute to acne.
  
  
• Don't pick or squeeze blemishes. Picking or squeezing can cause infection or scarring. Most acne will clear up without this kind of intervention. If aggressive treatment is needed, see your doctor or dermatologist.

— March 08, 2002 —