What is acne?
Acne is a disorder of the hair follicles and oil glands (sebaceous glands). The sebaceous
glands secrete oils (sebum) to keep the skin moist. When the glands get clogged, it
can lead to pimples and cysts.
Acne is very common. People of all races and ages have acne. In fact, most people
in the U.S. between 11 and 30 years old will be affected by it. Even people in their
40s and 50s can have acne. However, acne most often begins in puberty. During puberty,
the male sex hormones (androgens) increase in both boys and girls. This causes the
sebaceous glands to make more oil.
Normally, the sebum produced travels through the hair follicles to the skin. However,
skin cells can plug the follicles. This can block the sebum. When follicles become
plugged, skin bacteria begin to grow inside the follicles. Inflammation and pimples
then develop. The most common types of pimples are:
- Whiteheads (closed comedones). These pimples are sealed over and have a small white pus filled
- Blackheads (open comedones). These pimples have a small, black opening at the top. Although
these pimples are black, the color is not from dirt. It's from the process of oxidation when
the sebum is exposed to air.
- Papules. These are tender, small pink bumps.
- Pustules. Pimples that have pus on the top and are red on the bottom of the lesion. These are
characteristics of inflammatory acne.
- Nodules. These are hard, large, painful pimples that arise deep in the skin.
- Cysts. Pus-filled, deep, painful pimples that often result in scars.
The basic acne lesion is called a comedo.
What causes acne?
Rising hormone levels during puberty may cause acne. Also, acne is often inherited.
Other causes of acne may include the following:
- Hormone level changes during a woman’s menstrual cycle
- Hormone changes during pregnancy
- Starting or stopping birth control pills
- Certain medicines (such as corticosteroids, lithium, and barbiturates)
- Oil and grease from the scalp, mineral or cooking oil, and certain cosmetics
- Diet may also play a role
Squeezing the pimples or scrubbing the skin too hard can make acne worse. Skin may
also become irritated with friction or pressure from helmets, backpacks, or tight
collars. Pollution or humidity can also irritate the skin.
What are the symptoms of acne?
Acne can appear as pimples without abscesses or pus-filled cysts that rupture and
result in larger abscesses. It can happen anywhere on the body. However, acne most
often appears in areas where there is a high concentration of sebaceous glands, including:
- Upper back
Acne may look like other skin conditions. Always talk with your healthcare provider
for a diagnosis.
How is acne diagnosed?
Your healthcare provider can usually diagnose acne by examining your skin.
How is acne treated?
Your healthcare provider will consider your age, overall health, the severity of the
acne and other factors in determining what treatment is best for you.
Treatment for acne focuses on minimizing scarring and improving appearance. Treatment
for acne may include medicines you apply to your skin or medicine you take in pill
form. Some of these medicines need to be prescribed by your healthcare provider. In
some cases, a combination of both types of medicines may be advised.
Medicines you apply to the skin are often prescribed to treat acne. These may be in
the form of a cream, gel, lotion, or solution. Examples include:
Kills the bacteria
Helps stop or slow down the growth of the bacteria and reduces inflammation. Erythromycin
and clindamycin are commonly used.
Stops the development of new acne lesions and encourages cell turnover, unplugging
pimples. These include tretinoin, adapalene, and tazarotene.
Topical tazorotene, azelaic acid, salicylic acid, and dapsone are also commonly used.
Acne medicines you take by mouth, or oral antibiotics, are often prescribed to treat
moderate to severe acne, and may include the following:
Spironolactone or birth control can be used by women to affect hormones to control
Photodynamic therapy is a laser procedure used to control moderate to severe acne.
Isotretinoin is a prescription medicine taken by mouth for severe, cystic, or inflammatory
acne. It is used when other methods can’t prevent extensive scarring. Isotretinoin
reduces the size of the sebaceous glands that make the skin oil. It also increases
skin cell shedding, and affects the hair follicles. These effects reduce the development
of acne. Isotretinoin can clear acne in the majority of people who use it. However,
the medicine has major side effects, including potential psychiatric side effects.
It is very important to discuss this medicine with your healthcare provider.
Women who are pregnant or who are able to become pregnant must not take isotretinoin.
It can cause birth defects. Isotretinoin can also cause miscarriage or premature birth.
Your healthcare provider can recommend specific steps to minimize acne scars.
Although acne often is a chronic condition, even if it lasts only during adolescence,
it can leave lifelong scars. Acne scars typically look like "ice pick" pit scars or
crater-like scars. Although proper treatment may help reduce scarring, several dermatological
procedures may help to further reduce any acne scars, including the following:
- Dermabrasion. This may be used to minimize small scars, minor skin surface irregularities, surgical
scars, and acne scars. It involves removing the top layers of skin with an electrical
machine that "abrades" the skin. As the skin heals from the procedure, the surface
appears smoother and fresher.
- Chemical peels. These are often used to reduce sun-damaged skin, irregular pigment, and superficial
scars. The top layer of skin is removed with a chemical applied to the skin. By removing
the top layer, the skin regenerates, often improving the skin's appearance.
- Dermal filler injections. These are injected beneath the skin to replace the body's natural collagen that has
been lost. Injectable dermal fillers are generally used to treat wrinkles, scars,
and facial lines.
- Laser resurfacing. This uses high-energy light to burn away damaged skin. It may be used to reduce wrinkles
and fine scars.
- Phototherapy or blue light therapy. Phototherapy using a blue light source. It has been shown to decrease the number of
acne-causing bacteria with minimal side effects, such as dry skin. Blue light therapy
does not use ultraviolet (UV) light, so it does not damage the skin as earlier types
of light therapy did.
- Pulsed light and heat energy (LHE) therapy. This type of combined light and heat therapy is believed to work by destroying acne-causing
bacteria. It also shrinks the glands in the skin that make oil. The FDA has approved
an LHE system that uses green light and heat pulses for treating mild to moderate
- Punch grafts. Punch grafts are small skin grafts used to replace scarred skin. A hole is punched
in the skin to remove the scar. This is then replaced with unscarred skin (often from
the back of the earlobe). Punch grafts can help treat deep acne scars.
- Autologous fat transfer. An autologous fat transfer uses fat taken from another site on your own body and injects
it into your skin. The fat is placed beneath the surface of the skin to push up the
depressed scars. This method is used to correct deep contour defects caused by scarring
from severe acne. Because the fat may be reabsorbed into the skin over months, you
may need to have it repeated.
What are the complications of acne?
Acne can leave lifelong physical scars. It can also cause self-esteem problems.
Can acne be prevented?
Acne is caused by normal hormonal changes that happen during puberty. This makes prevention
of acne very difficult, or even impossible.
However, avoiding substances that can cause acne may help. This includes certain medicines
(such as corticosteroids, lithium, and barbiturates), mineral or cooking oil, or certain
cosmetics. Also, daily shampooing helps prevent oil and grease on the scalp from getting
on your face or back. Early treatment of acne may prevent it from getting worse and
When should I call my healthcare provider?
Acne is a common condition. If you have acne that isn't helped with home care or is
severe or leaving scars, see your healthcare provider.
Key points about acne
- Acne is a disorder of the hair follicles and sebaceous glands that become clogged.
This leads to pimples and cysts.
- Acne is a common condition that usually begins during puberty because of hormonal
- Acne can be either superficial or deep.
- If untreated, acne can cause scaring that can last a lifetime.
- Avoiding substances that make acne worse, and early treatment of acne, can reduce
or prevent acne scars.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also
know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that
- Know how you can contact your provider if you have questions.