Acne

Acne is a disorder resulting from the action of hormones and other substances on the skin's oil glands (sebaceous glands) and hair follicles. These factors lead to plugged pores and outbreaks of lesions commonly called pimples or zits. Acne lesions usually occur on the face, neck, back, chest, and shoulders. Although acne is usually not a serious health threat, it can be a source of significant emotional distress. Severe acne can lead to permanent scarring.

It is common during puberty, as testosterone levels rise in both sexes. Hormonal changes related to pregnancy, birth control, and stress can also cause it in women, as can any medication that increases testosterone or estrogen. Greasy and oily cosmetics and hair products can also contribute.

The exact cause of acne is unknown, but doctors believe it results from several related factors. One important factor is an increase in hormones called androgens (male sex hormones). These increase in both boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy or starting or stopping birth control pills can also cause acne.

Another factor 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. Certain drugs, including androgens and lithium, are known to cause acne. Greasy cosmetics may alter the cells of the follicles and make them stick together, producing a plug.

Factors That Can Make Acne Worse

Factors that can cause an acne flare include:

• Changing hormone levels in adolescent girls and adult women 2 to 7 days before their menstrual period starts 
• Oil from skin products (lubricants or cosmetics) or grease encountered in the work environment (for example, a kitchen with fry vats) 
• Pressure from sports helmets or equipment, backpacks, tight collars, or tight sports uniforms 
• Environmental irritants, such as pollution and high humidity 
• Squeezing or picking at blemishes 
• Hard scrubbing of the skin 
• Stress
• Myths About the Causes of Acne

There are many myths about what causes acne. Chocolate and greasy foods are often blamed, but there is little evidence that foods have much effect on the development and course of acne in most people. Another common myth is that dirty skin causes acne; however, blackheads and other acne lesions are not caused by dirt. Stress doesn't cause acne, but research suggests that for people who have acne, stress can make it worse.

Diagnosis is made by physical exam, and treatment is primarily preventive (careful face washing, not popping zits, avoiding cosmetics). Many over the counter products contain benzoyl peroxide, sulfur, resorcinol, or salicylic acid which will kill bacteria and dry the skin, leading to clearing of the face.

To diagnose acne, a dermatologist will first examine your skin to make sure you have acne. Other skin conditions can look like acne. If you have acne, the dermatologist will:

• Grade the acne. Grade 1 is mild acne. Grade 4 is severe acne.
• Note what type, or types, of acne appear on your skin.

Questions to Discuss with Your Doctor:

• At what age did your problem with acne begin?
• Do you have blackheads, whiteheads, pustules, or cysts?
• If so, what areas are involved: your face, chest, back?
• What is your skin-care routine?
• What products do you use? Do any of them help?
• What medications have you tried (e.g., benzoyl peroxide, Retin-A, antibiotics, Accutane)?
• If you are female, does your acne get worse around the time of your menstrual period and do you have regular menstrual periods?
• What medicines do you take, including over-the-counter medicines and birth-control pills?
• Have you been developing extra body or facial hair?

Self-help strategies

Suggestions to manage acne include:

• Cleansing – cleansers specifically developed for acne-prone skin can help. Try washing the affected areas twice per day. Don’t overdo it. Too much cleansing can cause other skin problems, such as dryness or skin irritations. Try to keep hair clean and off the face and neck, as oil from the hair can make acne worse.
• Make-up – choose water-based, oil-free products where possible to avoid worsening acne by clogging the pores with oils or powder. Make-up should be thoroughly removed before going to bed.
• Don’t squeeze – picking and squeezing pimples can make it worse and lead to scarring.
• Stress – this can trigger an outbreak of pimples as it causes the release of hormones that can make oil glands release more oil onto the skin. This is why pimples seem to magically appear on stressful days, such as at the time of an exam or special date. While stress may be difficult to control, at least you know that the outbreak is due to stress, not a sign that the treatments do not work.
• Diet – there is now more evidence that a low-GI diet may help some people with acne. Many people think that lollies or chocolate cause pimples. Research has not shown any strong link with these foods, but if you notice that eating certain foods causes pimples for you, try avoiding them.

Acne is often treated by dermatologists (doctors who specialize in skin problems). These doctors treat all kinds of acne, particularly severe cases. Doctors who are general or family practitioners, pediatricians, or internists may treat patients with milder cases of acne.

The goals of treatment are to heal existing lesions, stop new lesions from forming, prevent scarring, and minimize the psychological stress and embarrassment caused by this disease. Drug treatment is aimed at reducing several problems that play a part in causing acne:

• abnormal clumping of cells in the follicles 
• increased oil production 
• bacteria 
• inflammation

All medicines can have side effects. Some medicines and side effects are mentioned in this booklet. Some side effects may be more severe than others. You should review the package insert that comes with your medicine and ask your health care provider or pharmacist if you have any questions about the possible side effects. Depending on the extent of the problem, the doctor may recommend one of several over-the-counter (OTC) medicines and/or prescription medicines. Some of these medicines may be topical (applied to the skin), and others may be oral (taken by mouth). The doctor may suggest using more than one topical medicine or combining oral and topical medicines.

Prescription medications are available for severe cases, usually oral or topical antibiotics, topical retioic acid (Retin-A) and prescrition strength benzoyl peroxide. Severe cystic acne can be treated with isotretinoin (Accutane) but severe side effects have been reported for some populations.

When to Contact a Doctor

Call your doctor or a dermatologist if:

• Self-care measures and over-the-counter medicine have not helped after several months
• Your acne is severe (for example, you have a lot of redness around the pimples or you have cysts)
• Your acne is getting worse
• You develop scars as your acne clears up
• Call your baby's health care provider if your baby has acne that does not clear up on its own within 3 months.