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 have acne at least once. But 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 it in their 40s and 50s. Many adult women experience mild to moderate acne due to hormonal changes associated with pregnancy, their menstrual cycles, or starting or stopping birth control pills.
It is rarely a serious medical condition, but it often causes emotional distress and can lead to scarring of the skin.
Acne typically appears on your face, neck, chest, back, shoulders and scalp and can take the following forms:
These are created when the openings of hair follicles become clogged and blocked with oil secretions and dead skin.
These are similar to whiteheads, but are open to the skin surface and darken.
These are raised, reddish spots that signal inflammation or infection in the hair follicles.
These are thick lumps beneath the surface of the skin, which are formed by the buildup of secretions deep within hair follicles.
Three factors contribute to the formation of acne:
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. The plug 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, heredity and stress may play a role.
Contrary to what some people think, foods have little affect. Neither chocolate nor greasy foods like french fries are likely to cause or aggravate this skin condition. 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 it worse.
Hormonal changes in your body can provoke or aggravate it. Such changes are common in:
Other risk factors include:
Acne treatments work by reducing oil production, speeding up skin cell turnover, fighting bacterial infection or doing all three. With most prescription, you may not see results for up to eight weeks, and your skin is likely to get worse before it gets better. Oral prescription medications for this condition 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:
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 (Retin-A, Renova) and adapalene (Differin) are 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.
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.
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 this skin condition. It’s very effective, but people who take it need close monitoring by a dermatologist because of the possibility of severe side effects.
Oral contraceptives, including a combination of norgestimate and ethinyl estradiol (Ortho-Cyclen, Ortho Tri-Cyclen), have been shown to improve acne in women. Oral contraceptives may cause other side effects that you’ll want to discuss with your doctor.
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 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.
You can control or prevent this condition with good basic skin care and the following self-care techniques.
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.
Look for products containing benzoyl peroxide, resorcinol or salicylic acid as the active ingredient.
You may want to avoid oily or greasy cosmetics, sunscreens, hair-styling products or concealers. Use products labeled “water-based” or “noncomedogenic.” If the sun worsens your acne, protect yourself from sunlight which is a good idea in general. If stress causes outbreaks, work on reducing your stress level.
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.
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.