Acne

Acne is a skin condition that has a number of symptoms. It is not just limited to the red spots we know as pimples, but also includes a number of different skin irritations. Acne can be superficial (pimples without abscesses) or deep (when the inflamed pimples push down into the skin, causing pus-filled cysts that rupture and result in larger abscesses).

Acne can occur all over the body. It most often appears in areas where there’s a high concentration of sebaceous glands, including the face, chest, upper back, shoulders, and neck. Acne can also occur on the legs, arms and buttocks.

Common signs and symptoms of acne include:

• Whiteheads (closed pores that are filled with dead skin cells)

• Blackheads (open pores that fill with dead skin cells)

• Cysts (lesions that occur when a pore fills with oil, dirt and bacteria and goes deep into the skin, causing irritation)

• Nodules (hard, large bumps under the surface of the skin)

• Pustules (commonly called pimples; clogged, pus-filled pores)

• Redness

• Scarring

Acne is rarely a serious condition. However, if infection spreads or worsens after scratching or attempting to disrupt or pop pimples, it is possible to develop a deeper or more widespread infection of the skin. Seek prompt medical care if you, or someone you are with, have these symptoms:

• Generalized swelling, redness, or warmth of the skin

• High fever (higher than 101°F)

Knowing what type of acne you have is important for finding the right treatment. You can try over-the-counter acne treatments for some types of acne. However, if your acne is widespread or you have cystic or nodular acne, see a dermatologist for treatment.

	Pustules are white or yellow pus-filled lesions, commonly called pimples that may be red at the base.
Getty	Cystic lesions are large, painful, pus-filled lumps under the skin.
Getty	Blackheads are open pores filled with dead skin cells.
Getty	Whiteheads are closed pores (comedones) filled with dead skin cells and bacteria.

Acne is caused by clogged pores, which are tiny openings in the skin’s surface. An overproduction of oil (or sebum) by the oil glands (sebaceous glands) combined with rapidly growing skin cells can clog the pores. When the pores become plugged, ordinary skin bacteria begin to grow inside the pore. Complete blockage of the pore results in whiteheads; incomplete blockage results in blackheads.

Enzymes released by these trapped bacteria cause localized inflammation within the resulting plug called a comedone. The comedone can burst, spilling material into surrounding areas, intensifying the inflammation. Deeper infections, including painful cysts, can also develop under the skin.

Acne most often begins in puberty, when the male sex hormones (androgens) increase in both boys and girls. This causes the sebaceous glands to become more active, which results in increased production of oil, or sebum.

Rising hormone levels during puberty are one cause of acne. In addition, acne is often inherited. Other causes may include hormone-level changes during the menstrual cycle; certain drugs (such as corticosteroids, lithium, and barbiturates); oil and grease from the scalp, mineral or cooking oil, or certain cosmetics; and bacteria inside pimples.

Several factors increase the risk of developing acne, can trigger acne, or cause it to worsen:

• Family history of acne

• Medications, such as anticonvulsants, birth control pills, and steroids

• Menstruation or premenstrual syndrome (PMS)

• Pregnancy

• Stress

• Sweating or being in an area of high humidity

• Use of shampoos, soaps, lotions or makeup that may contain oils or block pores

Acne can be aggravated by squeezing the pimples or by scrubbing the skin too hard. Skin may also become irritated with friction or pressure from helmets, backpacks, or tight collars. Some environmental conditions, such as pollution or humidity can irritate the skin as well.

Contrary to popular myths, these factors have little effect on acne:

• Eating chocolate or greasy foods.

• Poor hygiene. Dirty skin does not cause acne. Using harsh chemicals and scrubbing too hard can actually irritate skin and worsen acne.

• Using cosmetics. Choose oil-free makeup (noncomedogenic) that doesn’t clog pores, and gently remove makeup daily.

Some risk factors for acne are more controllable than others. You may be able to lower your risk for acne flare ups by:

• Avoiding greasy creams or cosmetics

• Ensuring that your skin is clean, oil-free, and clear of makeup before going to bed

• Keeping your hands and fingers away from your face

• Shampooing your hair often (if oily)

Some studies indicate that a diet high in carbohydrates—such as breads, cookies, bagels, chips—may worsen acne. However, more research is needed to determine if people with acne would benefit from a specific diet.

Overall, healthy diet tips include:

• Avoiding alcohol and caffeine

• Focusing on fresh fruits, vegetables, and whole grains and avoiding processed foods

• Limiting red meat in favor of lean poultry, fish, and plant-based proteins

• Including healthy fats, such as those found in avocado, chia seeds, olive oil, and fatty fish like salmon

Ask your healthcare provider for guidance before making significant changes to your diet.

You should see a doctor if self-care and over-the-counter treatments do not clear your acne or if your acne is severe. Your primary care doctor or a dermatologist—a doctor who specializes in diagnosing and treating skin conditions—can prescribe stronger medications.

Women may experience acne for decades, with flare-ups a week before menstruation. Contraceptives may help clear up this type of acne.

A sudden onset of severe acne in older adults may indicate an underlying disease requiring additional medical attention.

Because acne can lead to pitted skin (acne scars), thick scars (keloids), and changes in skin color, it’s important to receive an accurate diagnosis and follow your treatment plan.

Seek emergency medical care if you experience these allergy symptoms after using a skincare product:

• Difficulty breathing

• Swelling of the face, lips, tongue or eyes

• Throat tightness

• Faintness

Acne is usually a clinical diagnosis, based on the doctor looking at your skin. To diagnose your acne, and to understand more about your skin health, your doctor or dermatologist may ask you several questions including:

• Do you have a family history or acne or other skin conditions?

• What are your symptoms, when do they occur, and how long have you had these symptoms?

• For girls or women, do your symptoms change around your menstrual cycle?

• What medications, if any, do you take regularly?

• What over-the-counter acne treatments, if any, have you tried?

Your doctor may order lab work to determine if another condition is causing your symptoms.

The goal of acne treatment is to reduce the occurrence of new pimples, minimize scarring, and improve appearance. Although acne cannot be cured, many effective treatments are available to reduce its symptoms. These include over-the-counter (OTC) medications, prescription medications, and surgeries. Fortunately, with time, most young people with acne will outgrow the condition. However, some women experience acne into adulthood due to hormonal changes. Adult men may also experience acne.

You and your doctor can design a treatment plan based on your age, the type of acne, how severe your acne is, and what you are willing to do as part of your regimen. Your doctor may prescribe topical medications (applied to the skin) or systemic medications (taken orally). In some cases, a combination of topical and systemic medicine may be recommended.

You can buy topical medications in stores without a prescription. These medications typically dry out the pimples and kill bacteria. The following products are available in both OTC and prescription strengths:

• Benzoyl peroxide (Clearasil)

• Salicylic acid (Noxzema Anti-Acne Gel, Neutrogena)

If OTC medications do not work, your doctor or dermatologist (skin doctor) can prescribe something stronger. These medications treat the infection and causes of oil buildup. They include:

• Antibiotics, either oral (taken by mouth) or topical (applied to the skin), such as erythromycin (Ery-tab or Erythra-derm), minocycline (Dynacin, Minocin), or tetracycline (Acnecycline, Tetra-bac)

• Birth control pills or other hormonal treatments

• Topical or oral retinoids (tretinoin, adapalene, tazarotene)

• Chemical or laser skin treatments to remove scars

• Cyst removal or drainage

There are several self-care measures you can take to improve your acne. These include:

• Changing your pillowcases frequently

• Keeping your hair away from your face

• Keeping your hands and fingers away from your face and other areas of eruption

• Washing your hair and face often, especially if you have oily skin

Although untreated acne is not associated with life-threatening complications, it can produce both mental and physical scars. These include:

• Anxiety

• Depression

• Embarrassment

• Scarring and dark spots long after original eruptions have cleared