Acne

What Is Acne?

Your skin has tiny holes called pores that that can become blocked by oil, bacteria, and dirt. When this occurs, you may develop a pimple or “zit.” If your skin is repeatedly affected by this condition, you may have acne. According to the American Academy of Dermatology (AAD), acne is one of the most common skin problems in the United States. At any one time, between 40 and 50 million people have this condition (AAD, 2012 ). Although acne is not a life-threatening condition, it can be painful, particularly when it is severe. It can also cause emotional distress. Acne that appears on the face can impact self-esteem and, over time, may cause permanent scarring. Fortunately, there are effective treatments for this condition that reduce both the number of pimples you get and the chance for scarring to occur.

What Causes Acne?

Acne occurs when the pores on your skin become blocked with oil, dead skin, or bacteria. Each pore on your skin is the opening to a follicle. The follicle is made up of a hair and a sebaceous (oil) gland. The oil gland releases sebum (oil), which travels up the hair, out of the pore, and onto your skin. The sebum keeps your skin lubricated and soft. If you develop acne, this may be because of one or more problems in this lubrication process. These possible causes include:

• too much oil or sebum is being produced by the follicle
• dead skin cells are accumulating in the pore
• bacteria has built up in the pore

An overabundance of oil, a pore clogged by dead skin cells, and bacteria all contribute to the development of pimples. A zit appears when the bacteria grows in the clogged pore and the oil is unable to escape.

What Are the Risk Factors for Developing Acne?

Myths about what contributes to acne are quite common. Many people believe that foods such as chocolate or French fries will contribute to the development of acne. While there is no scientific support for these claims, there are certain risk factors that may put you at risk for developing acne. These include:

• hormonal changes caused by puberty or pregnancy
• certain medications such as birth control pills or corticosteroids
• a diet high in refined sugars or carbohydrates such as bread and chips

Young people are most at risk for developing acne during puberty. During this time, the body undergoes drastic hormonal changes. These hormones can trigger oil production, leading to an increased risk of acne. Hormonal acne related to puberty usually subsides when a teenager reaches adulthood.

What Are the Symptoms of Acne?

Acne can be found anywhere on your body. It most commonly develops on the face, back, neck, chest, and shoulders. If you have acne, you will typically notice pimples that are white or black in appearance. Both blackheads and whiteheads are known as comedones. Blackheads open at the surface of the skin giving them a black appearance. Whiteheads are closed just under the surface of the skin, giving them a white appearance. While whiteheads and blackheads are the most common types of acne, other lesions can occur. Inflammatory lesions are more likely to cause scarring of the skin and include the following:

• papules—small red, raised bumps caused by infected hair follicles
• pustules—small red pimples that have pus at their tips
• nodules—solid, painful lumps that are beneath the surface of the skin
• cysts—infections found beneath the skin that contain pus and are often painful

How Is Acne Diagnosed and Treated?

If you have symptoms of acne, your doctor will be able to confirm a diagnosis by examining your skin.

At-Home Care

You can use a number of self-care activities at home to prevent pimples and to clear up your acne. Home remedies for acne may include:

• cleaning the skin daily with a mild soap to remove excess oil and dirt
• regularly shampooing your hair and keeping it out of your face
• not squeezing or picking pimples, as this spreads the bacteria and excess oil
• avoiding hats or tight headbands
• avoiding touching your face
• using makeup that is water-based or labeled as “noncomedogenic” (not pore-clogging)

Medication

If self-care activities do not help with your acne, there are a number of over-the- counter acne medications that may be helpful. Most of these medications contain ingredients that can help kill bacteria or dry the skin. These active ingredients include:

• benzoyl peroxide: present in many acne creams and gels, used for drying out existing pimples and preventing new ones
• sulfur: a natural ingredient with a distinctive smell that is found in lotions, cleansers, and masks
• resorcinol: a less common ingredient that is used to remove dead skin cells
• salicylic acid: often contained in soaps and acne washes

Sometimes, you may continue to experience symptoms. If this happens, you may want to seek medical advice. Your doctor can prescribe medications that may help reduce your symptoms and prevent scarring. Your doctor may give you oral or topical antibiotics. These kill the bacteria that cause pimples. Typically, antibiotics are only used for a short amount of time so that your body doesn’t build up a resistance. Antibiotic resistance can make you prone to infections. Topical creams like retinoic acid or prescription strength benzoyl peroxide are often stronger formulas of over-the-counter treatments. These work to dry out the skin and reduce oil production. Women with hormonal acne may be treated with birth control pills or spironolactone. These medications seek to regulate the hormone-causing acne. Isotretinoin (Accutane) is a vitamin A-based medication that is used to treat certain cases of severe nodular acne. It has serious side effects, and is only used when all other treatments have failed.

Additional Treatments

Your doctor may recommend additional procedures to treat severe acne and prevent scarring. Many of these work by removing damaged skin.

• photodynamic therapy: also known as laser treatment, uses light pulses to remove the top layer of skin
• dermabrasion: removes the top layer of skin with a rotating brush
• chemical peel: an aesthetician applies a chemical to your face which essentially burns the top layer of skin. That skin later peels off to reveal less damaged skin underneath

Your doctor may suggest using cortisone injections if your acne consists of large cysts. Cortisone is a steroid naturally produced by the body. It can reduce inflammation and speed healing.

What Is the Outlook for Someone With Acne?

Treatment for acne is often successful. Most people can expect their acne to clear up within six to eight weeks. However, flare-ups of the condition are common and may require additional treatment. Scarring that occurs as a result of acne can cause emotional distress. Prompt treatment can help prevent scarring.

How Can Acne Be Prevented?

It’s difficult to prevent acne. However, you can take some steps at home to help prevent acne following treatment. These include:

• washing your face twice a day with an oil-free cleanser
• using an over-the-counter acne cream to remove excess oil
• avoiding makeup that contains oil
• cleaning the skin thoroughly before bed, including removing makeup
• showering after exercising
• avoiding tight-fitting clothing