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Acne(Pimples; Blackheads; Whiteheads; Acne Vulgaris)

Pronounced: AK-nee

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 is common 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 and mixes with dead skin cells and bacteria. This causes clogged pores called comedones.

Pimple

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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:

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

Acne is more common in people who are Caucasian. It is also common in people who are 12-24 years old.

Factors that increase your risk of acne include:

  • Changes in hormone levels, such as during:
    • Puberty
    • Pregnancy
    • The time before a menstrual period
  • Stress
  • Certain medication such as androgens, lithium, and barbiturates
  • Certain cosmetic products
Symptoms

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

  • Excess oil in the skin
  • Blackheads
  • Whiteheads
  • Papules—small, pink bumps that may be tender to the touch
  • Pimples—inflamed, pus-filled bumps that may be red at the base
  • Nodules—large, painful, solid lumps that are lodged deep within the skin
  • Cysts—deep, inflamed, pus-filled lumps that can cause pain and scarring
Diagnosis

The areas of your skin with the most sebaceous glands will be examined. These areas include the face, neck, back, chest, and shoulders. If your acne is severe, you may be referred to a dermatologist (skin specialist).

Treatment

Acne may require a combination of treatments. 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
  • Over-the-counter topical medications such as cleansers, creams, lotions, and gels—to reduce the amount of oil and/or bacteria in the pores. These medications may contain one of the following ingredients:
    • Benzoyl peroxide
    • Salicylic acid
  • Prescription topical medications—includes cleansers, creams, lotions, and gels to reduce the amount of oil and/or bacteria in the pores. Examples include:
    • Antibiotics, such as clindamycin, erythromycin
    • Retinoids, such as tretinoin adapalene
  • Oral antibiotics—to control the amount of bacteria in pores, including:
    • Tetracycline
    • Clindamycin
  • Oral medications—to control androgen levels, including:
    • Birth control pills
    • Spironolactone
  • Oral retinoids—to reduce the size and secretions of sebaceous glands. This medication is only used for severe cases of cystic acne.
    • Isotretinoin—must not be taken by women who are pregnant or who may become pregnant due to the risk of serious birth defects.
Procedures

There are a number of procedures that can be used by your doctor or dermatologist to treat acne, examples include:

  • Corticosteroids—the injection of corticosteroid directly into the cyst; mostly used for large, cystic acne lesions
  • Acne surgery
  • Chemical peels—uses glycolic acid and other chemical agents to loosen blackheads and decrease acne papules
  • Dermabrasion —used to treat deep acne scars
  • Scar excision—used to reduce or improve the appearance of acne scars
  • Collagen fillers—used to add volume to acne scars to make them appear more smooth
  • Light and laser therapies

Some of the procedures have risks, such as scarring and infection.

Prevention

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

  • Gently wash your face with mild soap and warm water no more than twice a day to remove excess oil. Scrubbing or washing too often can make acne worse.
  • Allow your face to dry before applying any lotion.
  • Do not pick at or squeeze blemishes.
  • 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.
  • Recognize and limit emotional stress whenever possible.
  • Wear sunscreen year-round. This is especially important if you are using medication that can make your skin more sensitive to the sun.

RESOURCES:

The Acne Resource Center Online
http://www.acne-resource.org

The American Academy of Dermatology
http://www.aad.org

CANADIAN RESOURCES:

Canadian Dermatology Association
http://www.dermatology.ca

Dermatologists.ca
http://www.dermatologists.ca

References:

Acne. American Academy of Dermatology website. Available at: http://www.aad.org/skin-conditions/dermatology-a-to-z/acne. Accessed December 12, 2013.

Acne. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 18, 2013. Accessed December 12, 2013.

Questions and answers about acne. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health_Info/Acne/default.asp. Updated May 2013. Accessed December 12, 2013.

9/2/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed : Arowojolu A, Gallo M, Lopez L, Grimes D, Garner S. Combined oral contraceptive pills for treatment of acne. Cochrane Database Syst Rev. 2009;(3):CD004425.



Last reviewed December 2013 by Peter Lucas, MD

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.

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