Acne is a chronic, inflammatory skin condition that causes spots and pimples, especially on the face, shoulders, back, neck, chest, and upper arms.

Effective acne treatments are available, but acne can be persistent. The pimples and bumps heal slowly, and when one begins to go away, others seem to crop up.

Depending on its severity, acne can cause emotional distress and scar the skin. The earlier you start treatment, the lower your risk of such problems.

Causes

How acne develops Open pop-up dialog box?

Four main factors cause acne:

• Excess oil (sebum) production
• Hair follicles clogged by oil and dead skin cells
• Bacteria
• Inflammation

Acne typically appears on your face, forehead, chest, upper back and shoulders because these areas of skin have the most oil (sebaceous) glands. Hair follicles are connected to oil glands.

The follicle wall may bulge and produce a whitehead. Or the plug may be open to the surface and darken, causing a blackhead. A blackhead may look like dirt stuck in pores. But actually the pore is congested with bacteria and oil, which turns brown when it’s exposed to the air.

Pimples are raised red spots with a white center that develop when blocked hair follicles become inflamed or infected with bacteria. Blockages and inflammation deep inside hair follicles produce cystlike lumps beneath the surface of your skin. Other pores in your skin, which are the openings of the sweat glands, aren’t usually involved in acne.

Certain things may trigger or worsen acne:

• Hormonal changes. Androgens are hormones that increase in boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormone changes during midlife, particularly in women, can lead to breakouts too.
• Certain medications. Examples include drugs containing corticosteroids, testosterone or lithium.
• Diet. Studies indicate that consuming certain foods — including carbohydrate-rich foods, such as bread, bagels and chips — may worsen acne. Further study is needed to examine whether people with acne would benefit from following specific dietary restrictions.
• Stress. Stress doesn’t cause acne, but if you have acne already, stress may make it worse.

Acne myths

These factors have little effect on acne:

• Chocolate and greasy foods. Eating chocolate or greasy food has little to no effect on acne.
• Hygiene. Acne isn’t caused by dirty skin. In fact, scrubbing the skin too hard or cleansing with harsh soaps or chemicals irritates the skin and can make acne worse.
• Cosmetics. Cosmetics don’t necessarily worsen acne, especially if you use oil-free makeup that doesn’t clog pores (noncomedogenics) and remove makeup regularly. Nonoily cosmetics don’t interfere with the effectiveness of acne drugs.

Complications

People with darker skin types are more likely than are people with lighter skin to experience these acne complications:

• Scars. Pitted skin (acne scars) and thick scars (keloids) can remain long-term after acne has healed.
• Skin changes. After acne has cleared, the affected skin may be darker (hyperpigmented) or lighter (hypopigmented) than before the condition occurred.

Risk factors

Risk factors for acne include:

• Age. People of all ages can get acne, but it’s most common in teenagers.
• Hormonal changes. Such changes are common during puberty or pregnancy.
• Family history. Genetics plays a role in acne. If both of your parents had acne, you’re likely to develop it too.
• Greasy or oily substances. You may develop acne where your skin comes into contact with oil or oily lotions and creams.
• Friction or pressure on your skin. This can be caused by items such as telephones, cellphones, helmets, tight collars and backpacks.

TREATMENT

Treatment depends on how severe and persistent the acne is.

Mild acne

Mild acne can be treated with over-the-counter (OTC) medications, such as gels, soaps, pads, creams, and lotions, that are applied to the skin.

Creams and lotions are best for sensitive skin. Alcohol-based gels dry the skin and are better for oily skin.

OTC acne remedies may contain the following active ingredients:

• Resorcinol: helps break down blackheads and whiteheads
• Benzoyl peroxide: kills bacteria, accelerates the replacement of skin, and slows the production of sebum
• Salicylic acid: assists the breakdown of blackheads and whiteheads and helps reduce inflammation and swelling
• Sulfur: exactly how this works is unknown
• Retin-A: helps unblock pores through cell turnover
• Azelaic acid: strengthens cells that line the follicles, stops sebum eruptions, and reduces bacterial growth. There is cream for acne, but other forms are used for rosacea.

It is advisable to start with the lowest strengths, as some preparations can cause skin irritation, redness, or burning on first use.

These side effects normally subside after continued use. If not, see a doctor.

Treating moderate to severe acne

A skin specialist, or dermatologist, can treat more severe cases.

They may prescribe a gel or cream similar to OTC medications but stronger, or an oral or topical antibiotic.

Corticosteroid injection

If an acne cyst becomes severely inflamed, it may rupture. This can lead to scarring.

A specialist may treat an inflamed cyst by injecting a diluted corticosteroid.

This can help prevent scarring, reduce inflammation, and speed up healing. The cyst will break down within a few days.

Oral antibiotics

Oral antibiotics may be prescribed for up to 6 months for patients with moderate to severe acne.

These aim to lower the population of P. Acnes. The dosage will start high and reduce as the acne clears.

P. acnes can become resistant to the antibiotic in time, and another antibiotic is needed. Acne is more likely to become resistant to topical rather than oral antibiotics.

Antibiotics can combat the growth of bacteria and reduce inflammation.

Erythromycin and tetracycline are commonly prescribed for acne.

Oral contraceptives

Oral contraceptives can help control acne in women by suppressing the overactive gland. They are commonly used as long-term acne treatments.

These may not be suitable for women who:

• have a blood-clotting disorder
• smoke
• have a history of migraines
• are over 35 years old

It is important to check with a gynecologist first.

Topical antimicrobials

Topical antimicrobials also aim to reduce P. acnes in patients with moderate to severe acne. Examples are clindamycin and sodium sulfacetamide.

The dermatologist may prescribe a topical retinoid.

Topical retinoids are a derivative of vitamin A. They unclog the pores and prevent whiteheads and blackheads from developing.

Examples of topical retinoids prescribed in the U.S. are adapalene, tazarotene, and tretinoin.

Isotretinoin

This is a strong, oral retinoid, used for the treatment of severe cystic acne and severe acne that has not responded to other medications and treatments.

It is a strictly controlled medication with potentially serious side effects. The patient must sign a consent form to say that they understand the risks.

Adverse effects include dry skin, dry lips, nosebleeds, fetal abnormalities if used during pregnancy, and mood swings.

Patients who take isotretinoin must avoid vitamin A supplements, as these could lead to vitamin A toxicity.

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