Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Acne

(Pimples; Blackheads; Whiteheads; Acne Vulgaris)
Pronounced: AK-nee
by Jennifer Hellwig, MS, RD
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 tends to occur 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, mixing with dead skin cells and bacteria. This causes clogged pores called comedones.

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:

  • Bacteria
  • Changes in levels of male hormones called androgens
  • Changes inside the hair follicle
  • Increased sebum production
Risk Factors

A risk factor is something that increases your chances of getting a disease or condition.

  • Certain medicines (eg, androgens, lithium , and barbiturates)
  • Changes in hormone levels, such as during:
    • Before a menstrual period
    • Pregnancy
    • Puberty
  • Age: between 12-24 years old
  • Certain cosmetic products
  • Race: Caucasian
  • Stress
Symptoms

Acne symptoms vary from person to person and can range from mild to severe. They include:

  • Blackheads
  • Cysts—deep, inflamed, pus-filled lumps that can cause pain and scarring
  • Excess oil in the skin
  • Nodules—large, painful, solid lumps that are lodged deep within the skin
  • 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)
  • Whiteheads
Diagnosis

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

Treatment

Acne may require a combination of treatments. But, 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
  • Oral antibiotics—aimed at controlling the amount of bacteria in pores, including:
    • Amoxicillin
    • Cephalosporins
    • Clindamycin
    • Doxycycline
    • Erythromycin
    • Minocycline
    • Sulfamethoxazole and trimethoprim
    • Tetracycline
  • Oral medicines—aimed at controlling 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—aimed at reducing the size and secretions of sebaceous glands. Only for severe cases of cystic acne.
    • Isotretinoin (Accutane)—must not be taken by women who are pregnant or who may become pregnant because of the risks of serious birth defects
  • Over-the-counter topical medicines (eg, cleansers, creams, lotions, and gels)—to reduce the amount of oil and/or bacteria in the pores; may contain one or more of the following ingredients:
    • Benzoyl peroxide
    • Resorcinol
    • Salicylic acid
    • Sulfur
  • Prescription topical medicine—includes cleansers, creams, lotions, and gels to reduce the amount of oil and/or bacteria in the pores, for example:
    • Antibiotics, such as clindamycin (Cleocin T), erythromycin
    • Adapalene (Differin)
    • Azelaic acid (Azelex)
    • Dapsone (Aczone)
    • Tazarotene (Tazorac)
    • Tretinoin (Retin-A, Avita)
Procedures

There are a number of procedures that can be used to treat acne, examples include:

  • 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
    • Collagen fillers—fill the pits of scars with a collagen substance
    • Dermabrasion —"sandpapers" the skin to smooth it out
    • Laser resurfacing—removes scars and tightens underlying skin
    • Scar excision—uses a tiny punch tool or a scalpel to remove scars
  • Acne surgery—specialized extractors are used to open, drain, and remove contents of acne lesions
  • Corticosteroids—the injection of corticosteroid directly into the cyst; mostly used for large, cystic acne lesions
  • 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, like scarring and infection.

Prevention

It can be difficult to prevent acne from occurring. This is because it can be difficult to control the factors that cause it. But, there are some things you can do to keep your acne from getting worse:

  • When washing your face:
    • Allow your face to dry before applying any lotion.
    • Use mild soap.
    • Use your hands rather than a washcloth.
  • Do not pick at or squeeze blemishes.
  • 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.
  • Recognize and limit emotional stress.
  • 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.
  • Wear sunscreen year-round. This is especially important if you are using medicine that can make your skin more sensitive to the sun.

Last reviewed: September 2011 by Ross Zeltser, MD, FAAD.

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