Article updated and reviewed by Michael S. Lehrer, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania on April 18, 2005.
Technically called acne vulgaris, this skin disease affects millions of Americans annually. It can vary from quite mild to extremely severe.
Acne usually develops when the sebaceous glands and the lining of the hair follicle begin to work overtime, as they do in adolescence. Normally, the lining of the hair follicle sheds cells that are carried to the surface of the skin by the sebum. When the follicle is overworked and clogged, cells and sebum accumulate, forming a plug (comedo).
If the plug stays below the surface of the skin, it is called a "closed" comedo or whitehead. If the plug enlarges and pops out of the duct, it is called an "open" comedo or blackhead because the top is dark. This is not dirt and will not wash away. The discoloration is due to the way light is absorbed by the skin cells within the opening.
About 80 percent of all teenagers develop acne, but this disease can also begin as late as the ages 25 or 30, particularly for women. No one is certain as to what exactly causes acne or why it usually begins in adolescence, but hormones, primarily testosterone, certainly play a large role. A number of other factors, most importantly heredity, are also important. If one of your parents had acne, there's a good chance you will, too.
There are two main types of acne: non-inflammatory and inflammatory.
In non-inflammatory acne, there are usually just a few whiteheads and blackheads on the face. A relatively mild type of acne, it can often be treated effectively with nonprescription medicines. The majority of people with acne have this type of acne.
With inflammatory acne, the whiteheads become inflamed, and red pimples and pustules develop. In its most severe form, inflammatory acne can cause disfiguring cysts and deep, pitting scars of the face, neck, back, chest and groin. Prescription drugs and sometimes surgery are needed to treat inflammatory acne.
Doctors suggest the following to clear up mild acne:
• Get a nonprescription acne medicine and apply regularly. Over-the-counter drugs containing sulfur, resorcinol, salicylic acid, and benzoyl peroxide, are all effective for treating mild acne.
• Use ordinary hygiene on affected areas, washing your face once or twice daily with your usual soap or cleanser. Deodorant soaps may be used, but they are of no particular value for acne.
• Do not scrub or use a loofa. Friction makes acne worse.
• Do not pick or squeeze. This may worsen scarring.
If home treatments do not work, acne can be treated effectively by your dermatologist. Options may include:
• Topical treatments such as retinoids (tretinoin, tazarotene, or adapalene) or antibiotics (benzoyl peroxide, clindamycin)
• Oral antibiotics
• Hormonal medications like oral contraceptives
• In severe cases, an oral medication called isotretinoin (Accutane) may be prescribed. This is extremely effective, but side effects may include severe birth defects, changes in blood fats and cholesterols, and mood changes. Because of these side effects, Accutane is usually used only for patients with severe acne, or, in patients who have failed all other treatments.
As with most diseases, acne responds best if treatment is begun early in the course of the disease. Treating your acne before it becomes severe may also help to reduce permanent scarring.
What type of treatment will you be recommending?
Will you be prescribing any medications?
What are the side effects?
How long will I need to take medication?
How long should it take for the medication or treatment to start working?
Should a dermatologist be seen?
Editorial review provided by VeriMed Healthcare Network.