Acne

Overview

Acne is a common skin disorder characterized by whiteheads, blackheads, and inflamed red pimples or "zits." Acne usually subsides after adolescence but may last into middle age. It is not a serious health threat but severe cases can cause disfigurement and permanent scarring. If not treated some people - especially teenagers -- can become significantly depressed.

Causes

There are many myths about what causes acne. Chocolate and greasy foods are often blamed but foods seem to have little 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. Finally stress does not cause acne. The truth is nobody knows the exact cause of acne although researchers believe it results from several related factors.

Acne is a disorder of the skin's oil glands which produce a substance called sebum. Sebrum normally rises to the skin's surface through hair follicles. During adolescence, changing hormone levels are thought to increase the number of oil glands and the amount of sebum they produce. When there is an excess amount of sebum the follicles become blocked , leading to the formation of small cysts called comedones. These cysts are filled with pus. If they do not rupture they can progressto open comedones (whiteheads) or closed comedones (blackheads).(However, when comedones rupture there is usually an inflammatory reaction which may spread into the surrounding tissue. Papules, pustules, cysts, and nodules are all forms of inflammatory lesions.

Researchers believe 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 and form a plug.

Factors that can cause acne to flare up include:

  • Changing hormone levels in adolescent girls and adult women two tosevendays before their menstrual period starts
  • Friction caused by leaning on or rubbing the skin
  • Pressure from bike helmets backpacks or tight collars
  • Environmental irritants such as pollution and high humidity
  • Squeezing or picking at blemishes
  • Hard scrubbing of the skin.

Symptoms

Acne occurs on the face as well as the neck, chest , back, shoulders, and upper arms and may appear as:

  • whiteheads
  • blackheads
  • pustules
  • cysts
  • redness around the skin eruptions
  • inflammation around the skin eruptions
  • crusting of skin eruptions
  • scarring of the skin

Treatment

Mild cases of acne can be self-treated with over-the-counter topical (applied to the skin) creams, typically containing benzoyl peroxide. Thereis also a variety of other medications that your family physician might prescribe which come as creams, ointments , and pills. It is wise to start by applying the cream or ointment at night to see how you react and then if necessary you can go to twice a day. You may have to see a dermatologist for severe cases. Some of the stronger medications for acne are not to be used if you are pregnant so make sure you tell your doctor if this is a possibility. Most acne medications work by reducing the next "crop" of acne so don't get discouraged if the treatment does not work right away.

In all cases the goals of treatment are to heal existing lesions, stop new lesions from forming, prevent scarring, and minimize the psychological stress caused by acne. Drug treatment is aimed at reducing abnormal clumping of cells in the follicles increased oil production bacteria and inflammation. Depending on the extent of the person's acne the doctor will recommend one of several over-the-counter medicines or prescription medicines that are topical or systemic (taken by mouth). The doctor may suggest using more than one topical medicine or combining oral and topical medicines.

Most doctors recommend that people with acne gently wash their skin with a mild cleanser once in the morning and once in the evening and after heavy exercise. Some people with acne may try to stop outbreaks and oil production by scrubbing their skin and using strong detergent soaps and rough scrub pads. However , scrubbing will not improve acne; in fact it can make the problem worse. You should ask your doctor or another health professional for advice on the best type of cleanser to use. Wash your face from under the jaw to the hairline. It is important that you thoroughly rinse your skin after washing it. Astringents are not recommended unless the skin is very oily and then they should be used only on oily spots. Doctors also recommend that patients regularly shampoo their hair. If you have oily hair you may want to shampoo it every day.

Other tips:

  • Avoid touching pimples and zits. Squeezing pinching or picking at them may cause scarring.
  • Be careful when shaving
  • Take precautions when in the sun. Many of the medicines used to treat acne can make a person more prone to sunburn. A sunburn that reddens the skin or suntan that darkens the skin may make blemishes less visible and make the skin feel drier. However these benefits are only temporary. There are known risks of excessive sun exposure, such as more rapid skin aging and an increased risk of developing skin cancer.
  • Choose cosmetics carefully. All cosmetics should be oil free.

Reviewed by Dr. Mike Evans, M.D.
Updated February 28, 2008