Acne is a common skin condition that affects about 85 percent of teenagers. It occurs when oil glands (called sebaceous glands) and hair follicles become clogged.
People with acne often have spots that look red. Some of these blemishes can be painful. Many feel self-conscious about their appearance. Some find that their acne makes them a target of taunting or bullying.
Acne is caused when tiny holes in your skin, called hair follicles, become clogged with oil and dead skin cells. The sebaceous glands (which make oil) normally lubricate the hair and skin to keep them from drying out, but when they over-produce, it can cause a plug in the pore that leads to inflammation, red bumps and other symptoms of acne.
The basic acne lesion is a pimple, which can be any size or color. Blackheads (open comedones) have a small opening at the top that is usually flesh-colored, but they look black because of oxygen in the air discoloring the sebum. Whiteheads, on the other hand, remain closed and are not affected by oxygen. Papules are tender, red and often have pus at the tip, which indicates an infection. Larger, harder lumps beneath the skin are cysts, which can also be infected and painful.
Hormonal changes during puberty, pregnancy or the use of birth control pills can cause outbreaks. Greasy foods and certain medications can also trigger acne. People of all races and ages can get acne, but it is more common in teenagers and young adults. Some people continue to have acne into their 30s, 40s and even 50s — this is called adult acne or hormonal acne.
In some cases, stress can also cause acne to flare up. Other factors that can contribute to acne include diet, family history, and underlying health conditions such as polycystic ovary syndrome or congenital adrenal hyperplasia, which can raise androgen levels and increase your risk of acne.
The main symptoms of acne are red bumps that may be inflamed and filled with pus. They usually appear on the face, neck, chest and shoulders because these areas have many hair follicles connected to oil glands. Acne may also affect other parts of the body. The condition usually starts during the teen years, when hormone changes cause the skin to become oilier. It can last for 3 to 5 years, although it sometimes continues into adulthood.
The most common types of pimples are whiteheads, blackheads and papules. These are plugged pores that either don’t reach the surface of the skin (whiteheads) or open up at the surface of the skin (blackheads). Oxygen from the air (not dirt) gives them their dark appearance. Papules are small, red bumps that have a pus-filled top from your immune system’s response to bacteria in the inflamed pore.
When a clogged pore ruptures, it creates a hard lesion called a cyst. Cysts are large, inflamed and painful. They can form under the skin or on top of it and they can leave scars. When a cyst becomes too inflamed, it can burst and drain pus. This causes more inflammation and can lead to permanent scarring. A health care provider may prescribe medicines to help control acne and prevent permanent scarring. They can include gels, creams or oral antibiotics.
The treatment of acne varies depending on the age and type of skin affected, but the main aim is to prevent new pimples forming and to reduce inflammation. There are several treatments available from a pharmacist or dermatologist that can help.
The first step is often to use a cleanser for acne-prone skin that contains benzoyl peroxide or azelaic acid. These treatments clean the pores and reduce the oiliness of the skin, but they can irritate it sometimes. These treatments are most effective for mild acne or when used alongside other treatments.
Antibiotic tablets are usually prescribed for more severe acne. These are usually in the form of tetracyclines, eg erythromycin, except for pregnant or breastfeeding women when a less potent form is taken, such as sulfacetamide. They work by killing the bacteria P. acnes which is involved in inflammatory acne. A course of antibiotics can last 4 to 6 months and you may need to switch to another medication if your acne is not cleared by the original one.
Hormonal therapies can also be helpful in treating acne, especially when it is aggravated by periods or associated with a hormonal condition such as polycystic ovary syndrome. These can include a combination oral contraceptive pill (although you should always use an alternative method of contraception during this time) or co-cyprindiol which works by reducing the production of sebum.
Acne can be prevented by keeping the skin clean. Washing with warm, not hot, water and a mild soap or cleanser twice a day is enough to remove impurities, excess oil and dead skin cells that may be clogging pores. Avoid scrubbing or washing too often, which can irritate the skin and make it worse. It’s also important to use a gentle, nondrying moisturizer. Over-exposure to sunlight can dehydrate the skin, and too much makeup can cause pore-clogging buildup. It’s best to use water-based products and to remove makeup before going to bed. Some medications can also cause acne, such as steroids and lithium, and women are more likely to develop it during puberty or just before their period.
Do not pick at or try to pop pimples, as this can irritate the skin and lead to infection and scarring. It’s also a good idea to avoid eating greasy foods, as these can contribute to more breakouts.
Some over-the-counter cleansers, creams and lotions that contain salicylic acid or benzoyl peroxide can help prevent breakouts or treat them when they do occur. Always follow the directions on the product label and be patient — it may take several weeks or months before you see results. Avoid trying too many different treatments at once, which can irritate the skin and cause more acne.