Acne is a disorder resulting from the action of hormones and other substances on the skin's oil glands (sebaceous glands) and hair follicles. These factors lead to plugged pores and outbreaks of lesions commonly called pimples or zits. Acne lesions usually occur on the face, neck, back, chest, and shoulders. Although acne is usually not a serious health threat, it can be a source of significant emotional distress. Severe acne can lead to permanent scarring.
It is common during puberty, as testosterone levels rise in both sexes. Hormonal changes related to pregnancy, birth control, and stress can also cause it in women, as can any medication that increases testosterone or estrogen. Greasy and oily cosmetics and hair products can also contribute.
Many people think that acne is just pimples. But a person who has acne can have any of these blemishes:
- Pustules (what many people call pimples).
Acne appears on the face but it can appear on other areas of the body. Acne can appear on the back, chest, neck, shoulders, upper arms and buttocks.
Acne can cause more than blemishes. Studies show that people who have acne can have:
- Low self-esteem: Many people who have acne say that their acne makes them feel bad about themselves. Because of their acne, they do not want to be with friends. They miss school and work. Grades can slide, and absenteeism can become a problem because of their acne.
- Depression: Many people who have acne suffer from more than low self-esteem. Acne can lead to a medical condition called depression. The depression can be so bad that people think about what it would be like to commit suicide. Many studies have found that teens who believe that they have “bad” acne were likely to think about committing suicide. Dark spots on the skin: These spots appear when the acne heals. It can take months or years for dark spots to disappear.
- Scars (permanent): People who get acne cysts and nodules often see scars when the acne clears. You can prevent these scars. Be sure to see a dermatologist for treatment if you get acne early — between 8 and 12 years old. If someone in your family had acne cysts and nodules, you also should see a dermatologist if you get acne. Treating acne before cysts and nodules appear can prevent scars.
Diagnosis is made by physical exam, and treatment is primarily preventive (careful face washing, not popping zits, avoiding cosmetics). Many over the counter products contain benzoyl peroxide, sulfur, resorcinol, or salicylic acid which will kill bacteria and dry the skin, leading to clearing of the face.
To diagnose acne, a dermatologist will first examine your skin to make sure you have acne. Other skin conditions can look like acne. If you have acne, the dermatologist will:
- Grade the acne. Grade 1 is mild acne. Grade 4 is severe acne.
- Note what type, or types, of acne appear on your skin.
Questions to Discuss with Your Doctor:
- At what age did your problem with acne begin?
- Do you have blackheads, whiteheads, pustules, or cysts?
- If so, what areas are involved: your face, chest, back?
- What is your skin-care routine?
- What products do you use? Do any of them help?
- What medications have you tried (e.g., benzoyl peroxide, Retin-A, antibiotics, Accutane)?
- If you are female, does your acne get worse around the time of your menstrual period and do you have regular menstrual periods?
- What medicines do you take, including over-the-counter medicines and birth-control pills?
- Have you been developing extra body or facial hair?
Acne is often treated by dermatologists (doctors who specialize in skin problems). These doctors treat all kinds of acne, particularly severe cases. Doctors who are general or family practitioners, pediatricians, or internists may treat patients with milder cases of acne.
The goals of treatment are to heal existing lesions, stop new lesions from forming, prevent scarring, and minimize the psychological stress and embarrassment caused by this disease. Drug treatment is aimed at reducing several problems that play a part in causing acne:
- abnormal clumping of cells in the follicles
- increased oil production
All medicines can have side effects. Some medicines and side effects are mentioned in this booklet. Some side effects may be more severe than others. You should review the package insert that comes with your medicine and ask your health care provider or pharmacist if you have any questions about the possible side effects. Depending on the extent of the problem, the doctor may recommend one of several over-the-counter (OTC) medicines and/or prescription medicines. Some of these medicines may be topical (applied to the skin), and others may be oral (taken by mouth). The doctor may suggest using more than one topical medicine or combining oral and topical medicines.
Prescription medications are available for severe cases, usually oral or topical antibiotics, topical retioic acid (Retin-A) and prescrition strength benzoyl peroxide. Severe cystic acne can be treated with isotretinoin (Accutane) but severe side effects have been reported for some populations.
The exact cause of acne is unknown, but doctors believe it results from several related factors. One important factor is an increase in hormones called androgens (male sex hormones). These increase in both boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy or starting or stopping birth control pills can also cause acne.
Another factor is heredity or genetics. Researchers believe that the tendency to develop acne can be inherited from parents. For example, studies have shown that many school-age boys with acne have a family history of the disorder. Certain drugs, including androgens and lithium, are known to cause acne. Greasy cosmetics may alter the cells of the follicles and make them stick together, producing a plug.
Factors That Can Make Acne Worse
Factors that can cause an acne flare include:
- Changing hormone levels in adolescent girls and adult women 2 to 7 days before their menstrual period starts
- Oil from skin products (lubricants or cosmetics) or grease encountered in the work environment (for example, a kitchen with fry vats)
- Pressure from sports helmets or equipment, backpacks, tight collars, or tight sports uniforms
- Environmental irritants, such as pollution and high humidity
- Squeezing or picking at blemishes
- Hard scrubbing of the skin
- Myths About the Causes of Acne
There are many myths about what causes acne. Chocolate and greasy foods are often blamed, but there is little evidence that foods have much effect on the development and course of acne in most people. Another common myth is that dirty skin causes acne; however, blackheads and other acne lesions are not caused by dirt. Stress doesn't cause acne, but research suggests that for people who have acne, stress can make it worse.
When to Contact a Doctor
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.
Acne affects between 40 to 50 million people in the United States, and is almost universal among the adolescent population as they go through puberty and often lasts into early adulthood.
Hidradenitis Suppurativa Foundation
Do you have acne in your armpits, on your groin, or under your breasts that just won’t clear? Or does it clear and then return? A skin disease called hidradenitis suppurativa (HS) can look like everyday acne.
In fact, another name for HS is “acne inversa.” HS is not the everyday acne that we know. It is a long-term skin disease, which often goes undiagnosed. The earlier HS is diagnosed, the better the outcome. HS can be disabling without treatment.
Medical researchers are working on new drugs to treat acne, particularly topical antibiotics to replace some of those in current use. As with many other types of bacterial infections, doctors are finding that, over time, the bacteria that are associated with acne are becoming resistant to treatment with certain antibiotics, though it is not clear how significant a problem this resistance represents.
Scientists are also trying to better understand the mechanisms involved in acne so that they can develop new treatments that work on those mechanisms. For example, one group of NIAMS-supported researchers is studying the mechanisms that regulate the development of the sebaceous glands. Another group is trying to understand how P. acnes activates the immune system in order to identify possible immunologic interventions. Other areas of research involve examining the effects of isotretinoin (a potent drug for acne) on the sebaceous glands. Moreover, a new drug called isoprenylcysteine is currently being evaluated for the treatment of P. acnes-induced inflammation and overproduction of sebum.
Suggestions to manage acne include:
- Cleansing – cleansers specifically developed for acne-prone skin can help. Try washing the affected areas twice per day. Don’t overdo it. Too much cleansing can cause other skin problems, such as dryness or skin irritations. Try to keep hair clean and off the face and neck, as oil from the hair can make acne worse.
- Make-up – choose water-based, oil-free products where possible to avoid worsening acne by clogging the pores with oils or powder. Make-up should be thoroughly removed before going to bed.
- Don’t squeeze – picking and squeezing pimples can make it worse and lead to scarring.
- Stress – this can trigger an outbreak of pimples as it causes the release of hormones that can make oil glands release more oil onto the skin. This is why pimples seem to magically appear on stressful days, such as at the time of an exam or special date. While stress may be difficult to control, at least you know that the outbreak is due to stress, not a sign that the treatments do not work.
- Diet – there is now more evidence that a low-GI diet may help some people with acne. Many people think that lollies or chocolate cause pimples. Research has not shown any strong link with these foods, but if you notice that eating certain foods causes pimples for you, try avoiding them.