Acne is a chronic, inflammatory skin condition causing spots and pimples on the face, shoulders, back, neck, chest, and upper arms in particular.
All types of acne include whiteheads, blackheads, pimples, cysts, and nodules.
It is the most common skin disorder in the United States that affects as many as 50 million Americans annually.
It usually occurs when the sebaceous glands activate during puberty, but it can occur at any age. It’s not harmful, but can leave marks on the skin.
The glands contain oil, and are stimulated in both males and females by male hormones released by the adrenal glands.
At least 85 percent of people in the U.S. experience acne from 12 to 24 years of age.
Fast facts on acne
Here are some facts about acne. More detail is in the main article.
- Acne is a skin disease involving the oil glands at the base of hair follicles.
- It affects 3 in every 4 people aged 11 to 30 years.
- It is not dangerous, but it can leave skin scars.
- Treatment depends on how severe and persistent it is.
- Risk factors include genetics, the menstrual cycle, anxiety and stress, hot and humid climates, using oil-based makeup, and squeezing pimples.
There are several suggested home remedies for acne but work supports not all of them.
Diet: What role diet plays in exacerbating acne is unclear. Scientists have found that individuals who eat a diet that includes a good supply of vitamins A and E and zinc can have a lower risk of severe acne. One analysis describes the link between acne and diet as “controversial,” but indicates that a low-glycemic diet may be of benefit.
Tea-tree oil: Findings from a study published in the Indian Journal of Dermatology, Venereology, and Leprology of 60 patients indicated that 5 percent tea-tree oil may help treat mild to moderate acne.
Tea: There is some evidence that tea polyphenols, like green tea, applied in a topical preparation can help to reduce sebum production and treat acne. In this case, however, the compounds were extracted from water, rather than directly using water.
Moisturizers: These can soothe the skin, say researchers, especially in people who use acne medication such as isotretinoin. Moisturizers that contain aloe vera may have a soothing and probably anti-inflammatory effect at a concentration of at least 10 per cent or witch hazel.
Human skin has pores under the skin which are linked to oil glands. Follicles attach pores to glands. Follicles are small sacks where liquid is formed and secreted.
The glands make an oily liquid called sebum. Sebum takes dead skin cells to the skin surface, via the follicles. A small hair grows out of the skin through the follicle.
When these follicles are blocked, the pimples develop and oil builds up under the skin.
Cells of the skin, sebum, and hair can clump together in a plug. This plug gets bacteria infected, and results in swelling. When the plug starts to break down a pimple may begin to form.
Propionibacterium acnes (P. acnes) is the name of the bacteria that reside on the skin and that contribute to the pimple infection.
Research indicates the severity and frequency of acne is dependent on the bacterial strain. Not all bacteria causing acne cause pimples. One strain helps keep the skin free from pimples.
A number of factors activate acne, but a increase in androgen levels is thought to be the principal cause.
Androgen is a type of hormone whose levels rise when adolescence begins. It is oestrogen in women.
Increasing levels of androgen cause the oil glands to expand under the skin. More sebum is developed via the enlarged gland. Excessive sebum can break down the pores of cell walls, allowing bacteria to develop.
Other possible triggers
Some studies suggest that genetic factors may increase the risk.
Other causes include:
- some medications that contain androgen and lithium
- greasy cosmetics
- hormonal changes
- emotional stress
Treatment depends on the severity and frequency of the acne.
Mild acne can be treated with over-the-counter (OTC) medications that are applied to the skin, such as gels, soaps, pads, creams, and lotions.
Ideal for sensitive skin is creams and lotions. Gels based on alcohol dry the skin, which are ideal for oily skin.
OTC acne remedies can contain active ingredients such as:
- Resorcinol: helps break down blackheads and whiteheads
- Benzoyl peroxide: kills bacteria, accelerates the replacement of skin, and slows the production of sebum
- Salicylic acid: assists the breakdown of blackheads and whiteheads and helps reduce inflammation and swelling
- Sulfur: exactly how this works is unknown
- Retin-A: helps unblock pores through cell turnover
- Azelaic acid: strengthens cells that line the follicles, stops sebum eruptions, and reduces bacterial growth. There is cream for acne, but other forms are used for rosacea.
Starting with the lowest strengths is advisable, as some preparations can cause irritation of the skin, redness or burning on first use.
After continued use such side effects usually subside. If not, see a Physician.
Treating moderate to severe acne
A skin specialist, or dermatologist, may be able to handle more serious cases.
They can prescribe an OTC-like gel or cream but stronger, even or an oral or topical antibiotic.
If an acne cyst gets excessively inflamed, it can rupture. That can result in scarring.
A specialist can treat an inflamed cyst with a diluted corticosteroid injection.
This can help avoid scarring, decrease inflammation and improve healing. Within a few days the cyst breaks down.
For patients with moderate to severe acne oral antibiotics can be recommended for up to 6 months.
Those are aimed at raising P. population. Acnes. Acnes. The dosage starts high, and decreases as the acne clears.
In time, P. acnes can become antibiotic resistant, and a further antibiotic is needed. Acne has a better risk of being immune to topical antibiotics rather than oral.
Antibiotics can inhibit bacterial growth and decrease inflammation.
Acne is commonly treated for erythromycin, and tetracycline.
Oral contraceptives may aid in female regulation of acne by suppressing the overactive gland. They’re widely used as remedies for long-term acne.
These may not be suitable for women who:
- have a blood-clotting disorder
- have a history of migraines
- are over 35 years old
It is important to check with a gynecologist first.
The purpose of topical antimicrobials is also to reduce P. acnes in moderate to serious acne patients. Examples include clindamycin and sulfacetamide to sodium.
A topical retinoid can be recommended by the dermatologist
The topical retinoids are vitamin A derivatives. They open the pores, and prevent the development of whiteheads and blackheads.
Adapalene, tazarotene, and tretinoin are examples of the topical retinoids recommended in the US.
This is a strong, oral retinoid that has been used to treat serious cystic acne and moderate acne that has not reacted to other drugs and treatments.
It is a strictly regulated drug, probably having significant side effects. The patient is asked to sign a consent form saying they understand the risks.
Adverse effects include dry eyes, dry hair, nosebleeds if used during pregnancy, fetal abnormalities and mood swings.
Patients taking isotretinoin must avoid supplements with vitamin A, as these may result in toxicity to vitamin A.
Acne pimples vary in size, color, and level of pain.
The following types are possible:
- Whiteheads: These remain under the skin and are small
- Blackheads: Clearly visible, they are black and appear on the surface of the skin
- Papules: Small, usually pink bumps, these are visible on the surface of the skin
- Pustules: Clearly visible on the surface of the skin. They are red at their base and have pus at the top
- Nodules: Clearly visible on the surface of the skin. They are large, solid, painful pimples that are embedded deep in the skin
- Cysts: Clearly visible on the surface of the skin. They are painful and filled with pus. Cysts can cause scars.
Prevention and management tips
Here are some tips for looking after skin that has acne or is prone to it.
- Wash your face no more than twice each day with warm water and mild soap made especially for acne.
- Do not scrub the skin or burst the pimples, as this may push the infection further down, causing more blocking, swelling, and redness.
- Avoid popping pimples, as this makes scarring likelier.
- A specialist can treat a pimple that requires rapid removal for cosmetic reasons.
- Refrain from touching the face.
- Hold the telephone away from the face when talking, as it is likely to contain sebum and skin residue.
- Wash hands frequently, especially before applying lotions, creams, or makeup.
- Clean spectacles regularly as they collect sebum and skin residue.
- If acne is on the back, shoulders, or chest, try wearing loose clothing to let the skin breathe. Avoid tight garments, such as headbands, caps, and scarves, or wash them regularly if used.
- Choose makeup for sensitive skin and avoid oil-based products. Remove makeup before sleeping.
- Use an electric shaver or sharp safety razors when shaving. Soften the skin and beard with warm soapy water before applying shaving cream.
- Keep hair clean, as it collects sebum and skin residue. Avoid greasy hair products, such as those containing cocoa butter.
- Avoid excessive sun exposure, as it can cause the skin to produce more sebum. Several acne medications increase the risk of sunburn.
- Avoid anxiety and stress, as it can increase production of cortisol and adrenaline, which exacerbate acne.
- Try to keep cool and dry in hot and humid climates, to prevent sweating.
Acne is one common problem. It can cause serious embarrassment but there is treatment available, and in many cases it is effective.