Skin Conditions: Acne

Most people develop acne - the most common skin condition -- to some degree, but it primarily affects teenagers undergoing hormonal changes.

Acne may be mild (few, occasional pimples), moderate (inflammatory papules), or severe (nodules and cysts). Treatment depends on the severity of the condition.

What Causes Acne?

Acne is primarily a hormonal condition driven by male hormones, which typically become active during the teenage years. Sensitivity to such hormones, combined with surface (skin) bacteria and lipids (fatty acids) within sebaceous (oil) glands, cause acne. Common sites for acne are the face, chest, shoulders, and back -- the sites of oil glands.

Acne lesions include comedones (whiteheads, blackheads), papules and pustules (small bumps), nodules and cysts.

Though acne is essentially a normal physiologic occurrence, certain conditions may aggravate the condition, including:

• Fluctuating hormone levels around the time of menses (women)
• Manipulating (picking/prodding) acne lesions
• Clothing (for example, hats and sports helmets) and headgear
• Air pollution and certain weather conditions, especially high humidity

How Is Acne Treated?

Only three medications have proven to be effective for the treatment of acne -- benzoyl peroxide, retinoids, and antibiotics. Most people require at least one or two agents, depending on the severity of their acne.

• Benzoyl peroxide, available as an over-the-counter product (for example, Clearasil, Stridex) and by prescription (for example, Benoxyl, PanOxyl, Persagel), targets surface bacteria which often aggravate acne. Irritation (dryness) is a common side effect.
• Retinoids (vitamin A derivatives), for example, Retin-A, Differin, Tazorac, treat blackheads and whiteheads, the first lesions of acne. The most common side effect is irritation.
• Antibiotics, either topically applied to the skin (clindamycin, erythromycin), or taken orally (tetracycline and its derivatives) control surface bacteria which aggravate and often foster acne. Antibiotics are more effective when combined with benzoyl peroxide or retinoids. The oral retinoid isotretinoin (Accutane) is reserved for people with severe (nodular or cystic) disease. Accutane shrinks the size of oil glands, the anatomic origin of acne. Without active, plump oil glands, acne actively diminishes. Side effects can include dry skin, elevated lipids (cholesterol) and birth defects. Women of childbearing age must practice birth control before, during and after treatment (often a year) with Accutane. The use of Accutane requires rigorous testing (lipids, pregnancy) and follow-up for the prescribed period (five months).
• Hormone therapy may be helpful for some women with acne, especially for those with signs and symptoms (irregular periods, thinning hair) of androgen (male hormone) excess. The hormone therapy consists of low-dose estrogen and progesterone (birth control pills).

How Can Acne Be Prevented?

To reduce acne and its damage to your skin, follow these tips.

• Choose a cleanser specially formulated for acne. These products often contain salicylic acid or benzoyl peroxide, which help to clear acne sores.
• Clean your face gently, as trauma to the acne breakouts may worsen the acne or cause scarring. When washing your face, use your hands, as any terrycloth or other scrubbing material may cause acne sores to rupture.
• When you sleep at night, make sure you are sleeping on a clean pillowcase and that you are the only person using your pillowcase. Pillowcases absorb traces of oil during the night, and can aggravate breakouts if not changed regularly.
• If you have longer hair, make sure to pull it back when you sleep at night. The oil in your hair can aggravate your skin as well.
• If you need to use a moisturizer, use only light, non-comedogenic moisturizers, which do not aggravate acne. There are oil-free moisturizers on the market that contain anti-bacterial agents for acne-prone skin. This type of product may be your best option.
• If you are a woman, use an oil-free foundation. Heavy makeup or other cosmetic products that block pores may cause a flare-up of acne.

Reviewed by doctors at The Cleveland Clinic Department of Dermatology.