Acne is a condition in which pimples appear on the face, chest, and back. In teenagers, acne usually appears on the forehead, nose, and chin. It is caused by the overproduction of sebum. Sebum is an oily substance that forms in glands just under the surface of the skin called sebaceous glands. Sebum normally flows out hair follicles onto the skin to act as a natural skin moisturizer. The glands are connected to hair follicles that allow the sebum, or oil, to empty onto the skin through a pore.
If hair follicles become blocked by sebum, dead skin cells, and bacteria, acne is the result. The sebaceous gland units are most commonly found on the face, neck, and back.
During puberty, there are increased levels of the male hormone androgen. High levels of androgen cause excess sebum to form. Sometimes the sebum combines with dead, sticky skin cells and bacteria called Propioni-bacterium acnes (P. acnes) that normally live on the skin. The mixture of oil and cells allows the bacteria to grow in the plugged follicles. When this happens, a hard plug called a comedo can form. A comedo is an enlarged hair follicle. It can take the following forms:
- a blackhead, which is a comedo that reaches the skin’s surface and looks black
- a whitehead, which is a comedo that is sealed by keratin, the fibrous protein produced by the skin cells and looks like a white bump.
In addition, pimples can form on the skin. Types of pimples include:
- papules, which are small, red bumps that may be tender to the touch
- pustules, which are pus-filled lesions that are often red at the base
- nodules, which are large, painful lesions deep in the skin
- cysts, which are painful pus-filled lesions deep in the skin that can cause scarring
Pimples form when the follicle is invaded by the P. acnes bacteria. The damaged follicle weakens and bursts open, releasing sebum, bacteria, skin cells, and white blood cells into surrounding tissues. Scarring happens when new skin cells are created to replace the damaged cells. The most severe type of acne includes both nodules and cysts.
Acne affects as many as 17 million people in the United States, making it the most common skin disease. Acne usually begins at puberty and worsens during adolescence . Nearly 85 percent of people develop acne at some point between ages 12 to 25. As many as 20 million teens have the condition. Acne may appear as early as age 10, and even may be found in some newborns. Some people may continue to be affected by acne after age 30.
Causes and Symptoms
The exact cause of acne is not known. There are several risk factors that make acne more likely to occur:
- Age. Adolescents are more likely to have acne.
- Disease. Certain hormonal disorders such as polycystic ovarian syndrome make acne more likely.
- Hormonal changes. Acne can flare up before menstruation . An increase in the male hormone androgen during puberty (seen in both males and females) causes the sebaceous glands to overproduce androgen. Boys have more severe acne than girls.
- Heredity. Some individual are genetically more susceptible to acne.
- Drugs. Steroids and performance enhancing drugs, oral contraceptives, antibiotics, antidepressants, and tranquillizers such as lithium are known to cause acne.
- Cosmetics. Oily cosmetics can plug up hair follicles.
Other factors can worsen acne or cause it to flare up:
- Environmental irritants. Air pollution and high humidity can worsen acne, as can exposure to greasy environments such as working in a fast food restaurant.
- Friction. Rubbing the skin vigorously or exposure to constant friction from backpacks or tight collars can worsen acne.
- Personal hygiene. Picking at pimples or scrubbing the skin too hard can result in worsened acne.
Factors that do not cause acne include:
- chocolate and greasy foods
When to call the doctor
A healthcare provider should be contacted under the following circumstances:
- Painful nodules and cysts are present.
- Over-the-counter medications have not been effective.
- Acne lesions are causing scarring.
- Acne is causing dark skin to have darker patches when lesions heal.
- Acne is causing embarrassment or self-consciousness.
- Acne is creating emotional upset.
Acne can be diagnosed by physical examination and a medical history of acne. The physician will take a medical history, including information about skin care, diet, medications, factors that can cause flare-ups, and prior treatment. Blood tests are not usually necessary unless a hormonal disorder is suspected.
Physical examination will include the face, neck, shoulders, back, and other affected areas. Using specialized lighting, the physician will examine the affected areas to see the following:
- what type and how many lesions are present
- how deep the lesions are
- whether they are inflamed
- whether scarring or skin discoloration is present
Acne treatment consists of reducing the sebum production, removing dead skin cells, and killing bacteria with oral medication and drugs used on the skin (topical). The treatment depends on the severity of the condition.
Schedule an appointment with one of our medical providers to see which treatment is best for you.