Acne is a common skin condition that comes from hair follicles (also called oil glands). Usually it’s mild and goes away with age. It can show up as blackheads, whiteheads or pimples.
There are many home remedies and prescription medications for acne. Medicines treat acne by killing bacteria, decreasing sebum production and reducing inflammation.
Causes
The condition occurs when tiny holes in the skin called hair follicles become blocked. Sebaceous glands are attached to each follicle and produce an oily substance, called sebum, that helps lubricate your skin and keep it from drying out. When the follicle is blocked, it becomes inflamed. The resulting red bumps are called pimples.
Other pores in the skin, such as those that open sweat glands and help regulate body temperature, aren’t involved in acne. Hormonal changes during puberty and pregnancy can cause the sebaceous glands to enlarge and make more sebum, which may lead to more acne. Certain medications, such as androgens (hormones that increase during puberty), steroids, and lithium can also contribute to the condition.
When the wall of a pore ruptures, bacteria and dead skin cells mix with pus to create an inflamed bump called a pustule. A pustule usually has a white top from the body’s reaction to the infection. Pustules are larger than papules and appear on the face, chest, back, and shoulders.
Some people break out when their clothing, a pillowcase, or sports equipment rubs against their skin. This type of acne is called acne mechanica and it usually develops on the cheeks. It can also occur on the arms, back, and chest, depending on what irritates the skin. Acne mechanica often improves when the irritant is removed or changed.
Symptoms
Pimples (also called zits) happen when hair follicles become clogged with oil and dead skin. They most often appear on the face, neck, shoulders and chest because these areas have many oil glands. Pimples may be red, firm or painful and surrounded by discolored skin. Sometimes a pimple becomes infected with bacteria (pus), which causes it to get larger and more painful. When this happens, the skin around the pimple can be red and swollen. Eventually, the pimple will break open and clear. When a pimple breaks open, it can cause a blackhead or whitehead. These are known as comedones. They begin as a small bump under the surface of the skin. They can stay under the skin and produce a white top, which is caused by oxygen in the air, or they can reach the surface of the skin and turn dark brown to black because of the oil and dead skin that is left behind. Blackheads and whiteheads are not harmful and they will go away on their own.
Other types of acne include pus-filled bumps that are visible on the skin (papules) and painful, solid lumps under the skin that resemble boils (cysts). These are more serious than regular pimples and need to be treated by a doctor because they can lead to scarring.
Diagnosis
Acne occurs when the pores or hair follicles become clogged with oil (sebum) and dead skin cells. The resulting inflammation causes pimples. The type and severity of the acne depends on how clogged the pores are and how the immune system responds to the sebum and dead skin cells. Acne is most common during adolescence and early adulthood, but can affect people of any age. It is not life threatening, but can cause embarrassment and psychosocial problems.
To diagnose acne, doctors usually start with a physical exam and ask about your family history, skin care routine, and medications you take. They may also examine the affected area of your skin and note the type of lesions you have. They may order blood tests to measure hormone levels, especially testosterone, which is linked to acne in some people. They may also order skin biopsy to see if the condition is caused by a bacterial infection or another medical problem.
The doctor can then determine which treatment is best for you. This will depend on your skin type, the severity of the acne, and whether it is causing scarring. Topical treatments like cleansers, lotions and gels containing benzoyl peroxide or salicylic acid, and retinoids can help decrease the number of acne lesions. Antibiotics can reduce bacteria and inflammation, and help prevent scarring. If you have severe or persistent acne, a dermatologist, who specializes in conditions affecting the skin, can recommend more intensive treatments.
Treatment
Treatments vary depending on the type of acne and its severity. Generally, treatments aim to clear away bacteria and reduce oil that leads to clogged pores. Most acne medications are topical – lotions, gels or washes that you put on your skin. They can be bought over the counter or by prescription. Benzoyl peroxide (Clearasil, Stridex, PanOxyl) is available in various concentrations over-the-counter and by prescription as washes, creams or lotions that help to kill bacteria and keep the pores from clogging. Salicylic acid is another topical medication that can reduce the amount of sebum produced and help to unclog pores.
Oral antibiotics, such as tetracyclines (Doxycycline, Erythromycin) or minocycline (Minocycline) are used to treat more severe cases of acne. These drugs can also decrease oil production, clogged pores and inflammation. It can take 4-6 weeks for these medications to start working. This is why it is very important to complete a full course of treatment.
Other medications include light and heat therapy, which have been shown to destroy acne-causing bacteria and shrink glands that make oil. A newer type of light therapy uses blue light and is thought to decrease inflammation without drying the skin as much as earlier types of light therapy. Another option is pulsed light and heat therapy, which is also believed to decrease the number of acne-causing bacteria and may even shrink the glands that produce sebum.