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Diseases and Conditions
Acne
From MayoClinic.com
Special to CNN.com

Introduction

Acne is a common skin disorder characterized by clogged pores and pimples.

More than four out of five people between the ages of 12 and 24 develop acne at least once. While the disorder is often associated with teenagers, it can affect people of all ages. It's not uncommon for acne to occur in people in their 20s and 30s. And, some people continue to have acne in their 40s and 50s. Some adult women experience mild to moderate acne due to hormonal changes associated with pregnancy, their menstrual cycles, or starting or stopping birth control pills.

Acne is rarely a serious medical condition, but it often causes emotional distress and can lead to scarring of the skin. With the right treatment, you can often keep acne under control. Measures also can be taken to reduce scars left by acne.

Signs and symptoms

Acne typically appears on your face, neck, chest, back and shoulders, which are the areas of your skin with the largest number of functional oil glands. Acne can take the following forms:

  • Whiteheads. These are created when the openings of hair follicles become clogged and blocked with oil secretions and dead skin.
  • Blackheads. These are similar to whiteheads, but are open to the skin surface and darken.
  • Pimples. These are raised, reddish spots that signal inflammation or infection in the hair follicles.
  • Cysts. These are thick lumps beneath the surface of the skin, which are formed by the buildup of secretions deep within hair follicles.

Causes

Three factors contribute to the formation of acne:

  • Overproduction of oil (sebum)
  • Irregular shedding of dead skin cells resulting in irritation of the hair follicles of your skin
  • Buildup of bacteria

Acne occurs when the hair follicles become plugged with oil and dead skin cells. Each follicle is connected to sebaceous glands. These glands secrete an oily substance known as sebum to lubricate your hair and skin. Sebum normally travels up along the hair shafts and then out through the opening of the hair follicle onto the surface of your skin. When your body produces an excess amount of sebum and dead skin cells, the two can accumulate in the hair follicle and solidify as a soft plug.

This plug may cause the follicle wall to bulge and produce a whitehead. Or, the plug may be open to the surface and may darken, causing a blackhead. Pimples are raised red spots with a white center that develop when blocked hair follicles become inflamed or infected. Blockages and inflammation that develop deep inside hair follicles produce lumps beneath the surface of your skin called cysts. Other pores in your skin, which are the openings of the sweat glands onto your skin, aren't normally involved in acne.

It's not known what causes the increased production of sebum that leads to acne. But a number of factors — including hormones, bacteria, certain medications and heredity — play a role.

Contrary to what some people think, foods have little effect on acne. Acne also isn't caused by dirt. In fact, scrubbing the skin too hard or cleansing with harsh soaps or chemicals can cause irritation, which may make acne worse.

Risk factors

Hormonal changes in your body can provoke or aggravate acne. Such changes are common in:

  • Teenagers, both boys and girls
  • Women and girls, two to seven days before their periods
  • Pregnant women
  • People using certain medications, including cortisone

Other risk factors include:

  • Exposing your skin directly to greasy or oily substances, or to certain cosmetics.
  • Having a family history of acne. If your parents had acne, you may be likely to develop it too.
  • Friction or pressure on your skin caused by items such as telephones or cell phones, helmets, tight collars and backpacks.

When to seek medical advice

Acne is rarely a serious medical condition. But you may want to seek medical treatment from a dermatologist for persistent pimples or inflamed cysts to avoid scarring or other damage to your skin. If acne or the scars it may have left are affecting your social relationships or self-esteem, you may also want to ask a dermatologist if your acne can be controlled or if your scars can be diminished.

Treatment

Acne treatments work by reducing oil production, speeding up skin cell turnover, fighting bacterial infection or doing all three. With most prescription acne treatments, you may not see results for four to eight weeks, and your skin may get worse before it gets better. Oral prescription medications for acne should not be used during pregnancy, especially during the first trimester.

Your doctor or dermatologist may recommend one or more of the following treatments for acne:

  • Topical treatments. Acne lotions may dry up the oil, kill bacteria and promote sloughing of dead skin cells. Over-the-counter lotions are generally mild and contain benzoyl peroxide, sulfur, resorcinol, salicylic acid or lactic acid as their active ingredient. These products can be helpful for very mild acne. If your acne doesn't respond to these treatments, you may want to see a doctor or dermatologist to get a stronger prescription lotion. Tretinoin (Avita, Retin-A, Renova) and adapalene (Differin) are examples of topical prescription products derived from vitamin A. They work by promoting cell turnover and preventing plugging of the hair follicle. A number of topical antibiotics also are available. They work by killing excess skin bacteria. Often, a combination of such products is required to achieve optimal results.
  • Antibiotics. For moderate to severe acne, prescription oral antibiotics may be needed to reduce bacteria and fight inflammation. You may need to take these antibiotics for months, and you may need to use them in combination with topical products.
  • Isotretinoin. For deep cysts, antibiotics may not be enough. Isotretinoin (Accutane) is a powerful medication available for scarring cystic acne or acne that doesn't respond to other treatments. This medicine is reserved for the most severe forms of acne. It's very effective, but people who take it need close monitoring by a dermatologist because of the possibility of severe side effects. Isotretinoin is associated with severe birth defects, so it can't be taken by pregnant women or women who may become pregnant during the course of treatment or within several weeks of concluding treatment. In fact, the drug carries such serious potential side effects that women of reproductive age must participate in an FDA-approved monitoring program to receive a prescription for the drug. In addition, isotretinoin may increase the levels of triglycerides and cholesterol in the blood and may increase liver enzyme levels. For most people, however, these levels return to normal when the medication is stopped.
  • Oral contraceptives. Oral contraceptives, including a combination of norgestimate and ethinyl estradiol (Ortho-Cyclen, Ortho Tri-Cyclen), have been shown to improve acne in women. However, oral contraceptives may cause other side effects that you'll want to discuss with your doctor.
  • Cosmetic surgery. Doctors may be able to use cosmetic surgery to diminish scars left by acne. Procedures include peeling away damaged skin with chemicals or by freezing it, dermabrasion, intense light therapy and laser resurfacing. Peeling procedures eliminate superficial scars. Dermabrasion, which is usually reserved for more severe scarring, involves removing the top layers of skin with a rapidly rotating wire brush. Laser resurfacing involves using short pulses of intense light to remove the outer layer of your skin. If your skin tends to form scar tissue, these procedures can make your complexion worse.

Self-care

You can avoid or control most acne with good basic skin care and the following self-care techniques:

  • Wash problem areas with a gentle cleanser. Products such as facial scrubs, astringents and masks generally aren't recommended because they tend to irritate skin, which can aggravate acne. Excessive washing and scrubbing also can irritate skin. If you tend to develop acne around your hairline, shampoo your hair frequently.
  • Try over-the-counter acne lotion to dry excess oil and promote peeling. Look for products containing benzoyl peroxide, resorcinol or salicylic acid as the active ingredient.
  • Avoid irritants. You may want to avoid oily or greasy cosmetics, sunscreens, hair-styling products or acne concealers. Use products labeled "water-based" or "noncomedogenic." For some people, the sun worsens acne. Additionally, some acne medications can make you more susceptible to the sun's rays. Check with your doctor to see if your medication is one of these, and if so, stay out of the sun as much as possible and any time you have to be in the sun, use sunscreen that doesn't clog your pores.
  • Watch what touches your face. Keep your hair clean and off your face. Also avoid resting your hands or objects such as telephone receivers on your face. Tight clothing or hats also can pose a problem, especially if you'll be sweating. Sweat, dirt and oils can contribute to acne.
  • Don't pick or squeeze blemishes. Picking or squeezing can cause infection or scarring. Most acne will clear up without this kind of intervention. If you need aggressive treatment, see your doctor or dermatologist.

  • Hidradenitis suppurativa
  • Acne treatments: Promising therapies for clearer skin
  • Acne products: Find a solution for your acne flare-ups
  • September 15, 2006

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