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Acne is not just a condition affecting teenagers. Although many people experience acne during their adolescent years, people in their twenties often report having the condition. Men are more likely than women to have long-term acne. Women are more likely to have shorter experiences of acne often caused by changes in hormones or by certain types of cosmetics. Although you may think that greasy cafeteria food or late-night chocolate snacks might be a cause of acne outbreaks, this is untrue because food is not responsible for acne outbreaks. For more info on acne, visit http://www.nlm.nih.gov/medlineplus/acne.html . [ To Top ]

What Causes Acne?

Over 17 million Americans have acne making it the most common skin condition in the United States. acne is most likely to occur on the face, neck, back, and chest. These areas are where sebaceous glands are mostly located. Sebaceous glands produce an oily substance called sebum. Normally, the sebum empties onto the skin surface through the opening of the follicle but sometimes the sebum can get trapped inside the pore, causing acne pimples to appear on the face or on other areas. Acne pimples can be non-inflammatory or inflammatory. Whiteheads are non-inflammatory pimples that form under the skin and are caused by blocked pores. Blackheads are open to the air, and are black due to a chemical reaction that occurs between the air and the debris inside. Bacteria (called P. acnes) or yeast inside the pore can cause whiteheads to become inflamed and can lead to pus-filled, swollen pimples. For examples of different types of acne pimples, visit: http://www.derm-infonet.com/acnenet/typesof.html.

The exact cause of acne is unknown, but doctors believe it results from several related factors. One important factor is rising hormone levels. These hormones, called androgens (male sex hormones), increase in both boys and girls during puberty and can cause the sebaceous glands to enlarge and make more sebum. This explains why teenagers between the ages of 11 and 14 are at greatest risk of getting acne. Also, due to hormonal changes that occur during a woman's menstrual cycle, women are more likely to suffer from outbreaks 2 to 7 days before menstruation begins. Other periods during which hormones are fluctuating, such as pregnancy or starting or ending birth control pills can also cause outbreaks.
Adapted from: http://www.nih.gov/niams/healthinfo/acne/acne.html .

Another factor that influences the appearance of acne is heredity or genetics. Researchers believe that the tendency to develop acne can be inherited from parents. For example, studies have shown that many school-age boys with acne have a family history of the disorder.

Once a pore is clogged, bacteria are more likely to enter the area of skin around the acne and cause inflammation. These inflamed pimples may become large and painful and develop into cystic acne that may eventually cause scarring. A CYST is deep, inflamed, pus-filled lesion. For more info on scaring, visit: http://www.derm-infonet.com/acnenet/scarring.html

Acne can also be caused by certain cosmetics that contain a lot of oil and are likely to block pores. Avoid these products and purchase ones that are labeled "noncomedogenic". If you use make-up to cover breakouts, make sure you use ones that are noncomedogenic. However sometimes even these may worsen the condition. Additionally, keep in mind that environmental irritants, such as pollutants and high humidity, can make acne worse.

Contrary to popular belief, acne is not caused by poor hygiene. Dirt does not cause acne, whiteheads, or blackheads. These result from internal biological processes. Washing skin vigorously to remove all dirt and oil will just make acne worse. Poor diet and stress also do not cause acne; however, stress, particularly severe or prolonged emotional tension, may aggravate the disorder. [ To Top ]

How to Prevent Acne?

Wash face gently twice a day and pat dry. Harsh cleansers and vigorous washing often aggravates the skin.
Don't touch your face too much, since bacteria from your hands can get into the pores, causing, spreading, or increasing acne pimples.
Try to use water-based cosmetics and avoid make-up that is oil-free (noncomedogenic products).
Stay healthy by eating well, exercising, and not letting stress get the best of you.
Try to avoid tight clothing, such as hats and sports equipment, which prevent the skin from breathing.

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How to Treat Acne?

It is important to follow these as well as the behaviors above if you have acne:

Don't pick or squeeze pimples, since this can increase and spread bacteria, and thus cause an infection.
If you are using over the counter (OTC) or prescribed acne medication, make sure to give it enough time to work-usually between 4-6 weeks. And if your skin begins to clear up, don't necessarily stop using the medication.
Avoid sun tanning. If you are taking medication, your skin is more sensitive to sunlight and tanning booths, which can harm your skin more, in addition to increasing your risk for skin cancer.

Although some people may feel that allowing acne to "take its course" is a natural way to remedy the condition, acne is almost always curable. If you have mild acne you might want to try over-the-counter medications first. If the acne persists, you can visit a dermatologist who can prescribe you medication.

Over-The-Counter (OTC) Medication- Many OTC products help to dry up excess oil and help to remove the dead skin cells which can clog pores. Be careful of special cleansers, since they may be harsh and aggravate the skin. Look for lotions, creams, or gels with:

benzoyl peroxide. This dries up excess oil and kills the bacteria often associated with inflamed acne. Since it doesn't affect the sebum production, it can only keep the acne at bay until it goes away on its own accord.
salicylic acid. This increases the cell turnover so that dead cells don't accumulate. Like benzoyl acid, it often times must be used continuously for at least two weeks before effects can be seen. Slicylic acid also breaks down blackheads and whiteheads.

Other active ingredients that you might want to look out for include sulfur, resorcinol, and alpha-hydroxy, which help break down blackheads and whiteheads. Some common side effects associated with these medications include skin irritation, dryness, and redness.

Prescription Medication- If OTC medications do not help your acne, you may want to visit a dermatologist who can prescribe a variety of different types of medicines. To find a dermatologist from the American Academy of Dermatology near you, visit: http://www.aad.org/findaderm_intro.html. A dermatologist can prescribe topical or oral antibiotics, other prescription lotions, birth-control pills, or other treatments. Depending upon your skin type and condition, you might have to take a combination of medications.

Topical Antibiotics-these are available in the form of creams, gels, or lotions. They help clear the skin of P. acnes, the bacteria that causes inflamed acne pimples. Some side effects may include: stinging, burning, redness, peeling, scaling, or discoloration of the skin.
Oral Antibiotics-For moderate to severe acne. These stop the growth of P. acnes and prevent inflammation. Some common oral antibiotics include tetracycline, minocycline, doxycycline, and erythromycin. Some people have side effects when taking these antibiotics, such as photosensitivity (higher risk of sunburn), upset stomach, dizziness or lightheadedness, and skin discoloration. You shouldn't take tetracycline if you are pregnant because it can cause birth defects. Tetracycline and monocycline also decrease the effectiveness of birth control pills, so a backup or alternative form of birth control must be used. Patients usually take oral antibiotics for 4 to 6 months to effectively treat acne.
Other Prescription Lotions-the most common types of lotions contain vitamin A derivatives (retinoids), such as Retin-A, Tretinoin, or adapalene gel. These medications help to unclog pores in order to allow the skin to grow and shed in a normal way. These treatments are often used in combination with other medications.
Birth-Control Pills-since hormones play a major role in causing acne, birth control pills may help some women. Certain kinds of birth-control pills have been approved as treatment for moderate acne, such as Ortho Tri-Cyclen. For more information on how Ortho Tri-Cyclen treats acne, visit: http://www.acne-site.com/drugs.htm#ortho.
Accutane-This is a retinoid taken in pill form that is used to treat severe acne that has not responded to other types of treatments. Accutane reduces the size of oil glands causing decreased growth of the acne-causing bacteria. Additionally, this medication also reduces cell shedding and the stickiness of cells in the follicles, which helps prevent the development of pore-clogging agents. However, this medication has very serious side effects. If you are pregnant or are planning to become pregnant, it is important not to take Accutane because it can cause very serious birth defects. Possible side effects include inflammation of the lip and mucous membrane of the eye; dry mouth, nose, or skin; itching; nosebleeds; muscle aches; photosensitivity; and, rarely, decreased night vision. Other more serious side effects include increased blood cholesterol, lipid, and triglyceride levels and abnormal liver enzymes. For more information on the side effects of Accutane, visit http://www.acne-site.com/drugs.htm#accutane.
Other medications-this includes corticosteroids that are directly injected into the acne lesions to help heal the lesions and stop inflammation.

The severity of acne varies greatly from one person to person and can have different effects on each woman's life. For many women acne is an inconvenience; but for others the condition is a source of great embarrassment and discomfort. Most of us go through periods of breakouts, during adolescence or just before our menstrual cycle. But for more serious conditions that persist despite proper cleansing and over-the-counter medications, treatment with prescription drugs by a dermatologist can almost always help. [ To Top ]

Resources

For more information about acne, including its causes and treatments, check out the following websites:

Questions and Answers about Acne--NIAMS
http://www.nih.gov/niams/healthinfo/acne/acne.htm#acne_i
A fact sheet by the National ARTHRITIS and Musculoskeletal and Skin Diseases about common questions concerning acne.

AcneNet
http://www.skincarephysicians.com/acnenet/index.html
A web site offered through Roche Laboratories, Inc. and the American Academy of Dermatology. Includes comprehensive information on acne and also helps to locate a dermatologist near you.

Acne-Site
http://www.acne-site.com/
This site offers helpful info on acne, as well as detailed information on specific prescription drug treatments, such as Accutane, Retin-A, and Ortho Tri-Cyclen. It also has message boards and personal experiences.

American Academy of Dermatology
P.O. Box 4014
Schaumburg, IL 60168 4014
(847) 330-0230
Fax: (847) 330-0050
http://www.aad.org/
This national organization for dermatologists publishes a brochure on acne. The brochure can be obtained by calling or writing to the academy; it is also available on the organization's Web site. The academy can also provide referrals to dermatologists. [ To Top ]