Acne may be mild (few, occasional pimples), moderate (inflammatory papules), or severe (nodules and cysts). Treatment depends on how bad the condition is.
What Causes Acne?
No one factor causes acne. Acne happens when oil (sebaceous) glands become active at puberty, stimulated by male hormones from the adrenal glands in both boys and girls. Oil is a natural substance that lubricates and protects the skin. Under certain circumstances, cells that are close to the surface block the openings of sebaceous glands and cause a buildup of oil underneath. This oil stimulates bacteria, which live in everyone's skin. The bacteria generally cause no problems, but when stimulated, they multiply. That causes surrounding tissues to become inflamed.
If the inflammation is near the surface, you get a pustule; if it's deeper, a papule (pimple); deeper still, and it's a cyst. If the oil breaks through to the surface, the result is a "whitehead." If the oil becomes oxidized (that is, acted on by oxygen in the air), the oil changes from white to black, and the result is a "blackhead." Common sites for acne are the face, chest, shoulders, neck, and back -- where oil glands are.
Other things that may -- or may not -- cause acne include:
- Heredity: With the exception of very severe acne, most people do not have the problem exactly as their parents did. Almost everyone has some acne at some point in life.
- Food: All over the world, parents tell teens to avoid pizza, chocolate, greasy and fried foods, and junk food. While these foods may not be good for overall health, they don't cause acne or make it worse. Studies show dairy products and high glycemic foods, however, can trigger acne.
- Dirt: Some individuals have more oily skin than others (as mentioned above, blackheads are oxidized oil, not dirt). Sweat does not cause acne. There is, though, an increased buildup of bacteria after exercise, so it is advisable to shower. On the other hand, excessive washing can dry and irritate the skin.
- Hormones: Most women break out cyclically. Some oral contraceptive pills help relieve acne, but some may make acne worse. Ask your doctor which is best for you.
- Cosmetics: Most cosmetic and skin care products are not pore-clogging (comedogenic.) Those listed as “water-based” or “oil-free” (noncomedogenic) are better choices.
Sometimes, contributing factors may be:
- Pressure: In some people, pressure from helmets, cell phones, chinstraps, collars, and the like can aggravate acne.
- Drugs: Some medications may cause or worsen acne, such as those containing iodides, bromides, or oral or injected steroids (either the medically prescribed prednisone or the steroids bodybuilders or athletes take). Most cases of acne, however, are not drug-related.
- Occupations: In some jobs, exposure to industrial products like cutting oils (which is used with industrial cutting and drilling equipment) may produce acne.
How Is Acne Treated?
Four types of drugs have proven to be effective for the treatment of acne: antibiotics, benzoyl peroxide, retinoids, and some hormones. Most people need at least one or two, depending on how bad their acne is.
- Benzoyl peroxide -- available as an over-the-counter product (for example, Clearasil, Stridex) and by prescription (for example, Benoxyl, PanOxyl, Persa gel) -- targets surface bacteria, which often aggravate acne. Irritation (dryness) is a common side effect.
- Retinoids (vitamin A derivatives), like Differin, Retin-A, and Tazorac, treat blackheads and whiteheads, the first lesions of acne, as well as inflammatory papules and pustules. Trifarotene (Aklief) can be used to treat severe acne called acne vulgaris. With all retinoids, the most common side effects are dryness, irritation, and an increased risk of sunburn. While most are prescription only, there is an over-the-counter version of Differin now available.
- Antibiotics, either topically applied to the skin (clindamycin, erythromycin), or taken orally (tetracycline and its derivatives, trimethoprim-sulfamethoxazole) control surface bacteria and reduce inflammation in the skin. Antibiotics are more effective when combined with benzoyl peroxide or retinoids. The oral retinoid isotretinoin (Absorica, Amnesteem, Claravis, Myorisan, and Zenatane) is reserved for people with severe (nodular or cystic) or widespread acne. Isotretinoin shrinks the size of oil glands, the origin of acne. Without active, plump oil glands, acne actively diminishes. Side effects can include dry skin, elevated cholesterol and triglycerides, and birth defects. Women of childbearing age must practice birth control before, during, and after treatment (about one month) with isotretinoin. The use of isotretinoin requires rigorous testing (cholesterol, pregnancy, triglyceride, cholesterol, liver function and bone marrow function) and follow-up for the prescribed period (5 or more months). It is reserved for the most severe or widespread types of acne that do not respond to other treatments.
- 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) or antiandrogen medications such as aldactone (Spironolactone) -- oral, or clascoterone (Winlevi) -- topical. Winlevi can be used in both males and females as it is a local skin androgen blocker.
Can Acne Be Prevented?
To prevent acne and reduce damage to your skin, follow these tips:
- Choose a cleanser specially formulated for acne. These products often have salicylic acid or benzoyl peroxide, which help to clear acne sores.
- Clean your face gently. Vigorous rubbing and scrubbing can cause trauma to the breakout area. That may worsen the acne or cause scarring. When washing your face, use your hands or cotton pads. Terry cloth or stiff sponge material (like a loofah) may cause acne sores to rupture.
- If you need to use a moisturizer, use only light, noncomedogenic moisturizers, which don’t aggravate acne.
- If you use makeup, make sure it’s an oil-free foundation. Heavy makeup or other cosmetic products that block pores may cause an acne flare-up.