The medical term — acne vulgaris — captures the condition pretty well: an ugly, vulgar scourge that ravages the faces of many unfortunate adolescents. Acne can leave lifelong scars, both physical and emotional. However, it’s something that most guys assume is behind them once they hit their twenties.
But for some, that’s not the case. For some men, acne is like a bad credit rating — no matter what they do, it won’t go away, and it keeps on humiliating them. And like that of a bad credit rating, the cause of acne may not be apparent. Stress, diet, too little sleep — all have been implicated. But dermatologists usually can’t identify the cause for each patient.
The result, however — the inflamed spots on the face and maybe the back too — are plain for all to see. At least our credit ratings aren’t stamped on our faces.
Adult acne may not be as severe as that experienced by adolescents, but it can be bad enough to give men high school flashbacks and send them scrambling for treatment. Fortunately, acne treatment is better than ever for teens and adults. Why allow your self-worth to suffer when you can fight back?
The gross anatomy of a zit
No matter how smooth the skin on your face may look to the naked eye, it actually consists of millions of follicles, each containing a tiny, almost invisible hair. These follicles exude…stuff. For example, a fatty substance called sebum empties into the follicles. Water from sweat glands climbs out of them too. So does the skin’s natural oil.
As long as this stuff flows all the way out of the follicles, your skin will look smooth and clear. Sometimes, however, the stuff gets stuck. If it gets stuck below the surface of the skin, the back-up produces a whitehead. If the stuff breaks through the top layer of skin and comes into contact with air, oxygen will turn it black, transforming it into a blackhead. (Shaving too close can produce an infection of the hair follicle known as folliculitis, which is not typical acne even though it can be just as unsightly.)
When the trapped stuff gets backed up, pressure grows, stretching the walls of the follicle. This may give bacteria a chance to multiply in the clogged follicle, known as a comedo or sometimes incorrectly as a comedone. If the follicle wall ruptures, your immune system will respond by sending cells to attack the bacteria and other foreign matter in the comedo. In the ensuing battle, the surrounding skin becomes red and inflamed. You might even see a little pus full of dead bacteria and immune cells.
While acne in men may not be dangerous, it certainly can be distressing — and it’s surprisingly common too. 17 million adults in the U.S. have acne, with 25% of them being men. Acne is also affecting more people after adolescence. One 1999 study published in the Journal of the American Academy of Dermatology found thatthe median age of people with acne has risen by almost 23%, from 20.5 years to about 26.5 years.
What causes acne in men?
The cause of acne can be traced to the sebaceous glands, which start releasing generous quantities of sebum during adolescence and continue to do so throughout life. But why does sebum continue to cause acne in men who are well beyond the hormone surges of adolescence?
“I don’t know if we have an answer to that,” says Christopher B. Harmon, MD, of Total Skin and Beauty Dermatology Center in Birmingham, Alabama. “Genetic predisposition is a major factor — more than diet or environment. The kind of skin someone is genetically programmed to have will determine who gets acne and who doesn’t.”
Basic acne treatment involves keeping follicles open by using a variety of skin cleansers that exfoliate, or remove dead skin cells.
“Over the counter products tend to contain peroxide or glycolic acids, which help prevent plug formation,” Harmon says. “And exfoliating the skin helps peel away those dead scales.”
Harmon tells WebMD that many non-prescription gels, creams, lotions, pads, and other acne products that help exfoliate and cleanse the skin include two familiar ingredients:
If these products don’t help, a dermatologist can prescribe several other treatments:
- Antibiotics taken orally or rubbed into the skin help control bacteria.
- Vitamin A derivatives, known as retinoids, help unclog pores and keep them unclogged.
- Anti-inflammatory medications known as corticosteroids can be injected directly into an inflamed cyst or pustule by a doctor to subdue severe eruptions.
One word of caution: Some supplements designed to quell acne can actually cause other problems. “If you take too much zinc to treat acne, it can cause anemia,” says Dr. David Rahimi, a privately practicing dermatologist in Los Angeles. “It can bring your white cell count down and lead to severe infection. Too much vitamin A in the form of Accutane can cause a host of problems from liver toxicity to hair loss — all sorts of problems.” Rahimi says these products should be used moderately, if at all, and preferably under a doctor’s supervision.
Adult acne and anabolic steroids
Anabolic steroids, used by athletes and bodybuilders to build muscle mass, are one well-known cause of acne in men. Studies indicate that about one-third of men who use steroids get acne, and about 50% of the men who get it develop a severe form known as cystic acne.
“With some patients, I can tell from the kind of acne they have that they are using anabolic steroids,” says Jeffrey Dover, MD, a dermatologist at Skin Care Physicians of Chestnut Hill in Massachusetts. “The acne usually is on the back and on the chest, but it can be anywhere. Treating them involves getting them to acknowledge that they’re taking these performance-enhancing drugs. It is very difficult to treat because it’s intensely resistant to typical treatments.”
Such acne usually goes away gradually if the man stops taking the steroids.
Men also can develop an acne-like disorder known as folliculitis, Rahimi tells WebMD. Frequently, this comes from the tiny nicks caused by shaving too closely. Bacteria enter the follicles and cause infection.
“One way to distinguish a follicular pimple from acne is that with a follicular pimple you often can see the hair shaft at the center of the lesion,” Rahimi says. “The pimples sometimes contain pus, and they may crust over or become surrounded by an area that’s red and inflamed. The infection may itch or be somewhat tender, but it usually isn’t painful.” Deep folliculitis, however, which affects the entire hair follicle, can cause large, painful, pus-filled bumps that may leave scars, he adds.
Folliculitis is more common among Hispanics and African-Americans, Rahimi says, because their hair tends to curl up under the skin and cause a pocket of infection. The best treatment is to switch to an electric shaver.
“The electric shaver doesn’t give as close a shave as a blade, but it causes fewer problems with irritation and inflammation around the hair follicle,” Rahimi says. “Also, I have [men with folliculitis] use salicylic acid or glycolic acid to unclog the pores, and then retin A once a week. The key is to use different medicines from different families to control bacteria, clear the pores, and bring inflammation down.”
Another type of facial inflammation known as rosacea is sometimes confused with acne because it produces small pimples and redness across the nose and cheeks. “Acne rosacea,” as it’s known, involves the follicles, but is not caused by sebum or oil. Although the cause is not known, some dermatologists believe the condition is caused or aggravated by common mites known as Demodex folliculorum, which inhabit follicles and are found in far greater numbers in people with rosacea. Treatment for rosacea differs from treatment for typical acne vulgaris.
Treatments for acne, as well as for rosacea, have improved in recent decades, and they continue to get better, dermatologists say. Harmon predicts an even clearer future for men’s faces: “In 10 years we’ll have new topicals and new oral agents, and more innovations involving the use of oral vitamin A derivatives,” he says.