Acne

Acne is an ongoing skin disorder involving the skin’s sebaceous (oil-producing) glands and hair follicles (pores). Breakouts of acne occur where these glands are concentrated, such as the face, neck, upper arms, chest, and back. Acne is a common problem that affects up to 85 percent of men and women between the ages of 12 and 25, and can continue to cause problems for people beyond their late 20s.

Causes

The most basic cause of acne is clogged pores. Changes in the hair follicles’ lining can cause an increase in the number of dead skin cells shed by the body. This build-up of dead skin, along with the oil (sebum) the skin naturally releases, plugs the follicles.

Mild acne usually consists of comedones—more specifically whiteheads (pores plugged up with excess cells and oil that the body naturally produces) and blackheads (pores filled with materials that turn a dark color when they come in contact with oxygen).

Trapped bacteria and other factors can lead to red, inflamed spots on the face, called papules and pustules. Papules are usually red and tender and mean that the skin is inflamed or infected. Pustules are like papules, only with a white rounded center of pus at the tip. In some severe cases of acne, long-lasting cysts and painful nodules may occur.

Other factors

Many factors can worsen acne. No single cause explains acne, although some conditions and habits may increase its severity.

  • Diet does not affect acne. A well-balanced diet is encouraged for overall health, but no study has proven that certain foods worsen acne. If any food seems to cause acne, avoid having too much of that food.
  • Hormones can cause the sebaceous glands to produce more oil. This explains why acne often begins during puberty and why some women notice more acne and oiliness around their menstrual periods. Medications that increase hormonal levels, such as some forms of birth control and steroids, can also affect acne.
  • Stress, both emotional and physical, can make acne worse. Unfortunately, stress is difficult to avoid because of pressure to perform well and meet deadlines. Relationship difficulties, fatigue, poor eating habits, not enough exercise, and illness can all increase life stress.
  • Sweat, especially when combined with friction, can lead to more acne. Touching the face is a common source of bacteria. Sweating also introduces bacteria to the skin and worsens rubbing from items such as hats or sweatbands, tight helmets, backpacks, and bag straps.
  • Hot, humid, or dirty environments such as a restaurant kitchen, construction site, or gym can irritate the skin and increase bacteria. After activities in such environments, showering with an antibacterial soap is recommended to clean the body.
  • Hair or skin products often have ingredients that can clog pores. Always read the labels of any products before purchase. All products, especially those for the skin like moisturizers or sunblock, should be labeled “oil-free,” “non-comedogenic” (doesn’t clog pores), or “for acne-prone skin.”

Treatment

Acne treatments do not cure acne, but rather control acne while it subsides on its own. Treating acne, whether mild or severe, requires a commitment by both the patient and clinician. Most treatments need at least four to six weeks of regular use before any benefits appear.

Topical

Topical acne medications are treatments which are applied directly to the affected skin. Always apply any topical treatments 15 minutes after washing to avoid any irritation the medications may cause.

Over-the-counter topicals

  • benzoyl peroxide, concentrations of 10% or lower
  • salicylic acid
  • sulfur
  • alpha-hydroxy acids, such as lactic or glycolic acids

Prescription topicals

Topical antibiotics, like those used for an infection, kill acne-causing bacteria and reduce inflammation.

  • clindamycin
  • erythromycin
  • sulfacetamide, with or without sulfur
  • benzoyl peroxide, concentrations above 10%

Keratolytics, the second class of topical acne medications, are chemicals that unclog the pores and prevent them from getting plugged again.

  • adapalene (Differin)
  • tazarotene (Tazorac)
  • tretinoin (Retin-A)
  • azelaic acid (Azelex)

Oral (prescription only)

Oral acne medications are treatments taken by mouth.

  • Antibiotics
    • doxycycline
    • tetracycline
    • minocycline
    • erythromycin
  • Isotretinoin (Accutane) is a very effective and expensive drug used to treat severe cystic acne that has not responded to more standard treatments. Because isotretinoin is so powerful, close medical supervision with frequent appointments and blood tests is required. Isotretinoin is usually taken for five months.

Prevention/Self-care

  • Wash the face with a gentle cleanser such as Cetaphil or Purpose twice a day. Washing too often can irritate the skin and cause it to produce more oil.
  • Use skin and hair products labeled “oil-free,” “non-comedogenic,” or that specify that they won’t clog pores. Always ask the prescribing clinician before using a product if on prescription acne medications.
  • Wash hair frequently, limit the use of hair products, and keep hair off the face as much as possible.
  • Avoid touching the face and never “pop” or pick at acne. Touching the face can spread bacteria or add more oil to the skin. Picking or squeezing at acne only worsens the irritation and can even lead to permanent scarring.
  • Shower after working out or being in a hot, humid environment. Stronger, harsher soaps than those made for the face can be used on the back and chest, since the skin there is less fragile.
  • Maintain a healthy, active lifestyle. Although diet has not been shown to affect acne, eating a balanced diet can only help.
  • Talk to a clinician about quitting smoking. Not only is smoking harmful to the entire body, but it can damage the skin’s sensitive tissues.

When to contact a clinician

Most acne can be effectively managed by self-care. In other cases, when acne is more severe or complicated by other conditions, it may be necessary to consult a dermatologist. Contact a clinician if:

  • deep, painful, or very large acne bumps appear
  • scarring, especially if deep or widespread, occurs
  • self-care measures, as listed above, are not sufficient to control and eliminate acne
  • acne is so severe that it affects self-esteem, confidence, or quality of life