Condition Basics

What is acne?

Acne, or acne vulgaris, is a skin problem that starts when oil and dead skin cells clog up your pores. Some people call it blackheads, blemishes, whiteheads, pimples, or zits. When you have just a few red spots, or pimples, you have a mild form of acne. Severe acne can mean hundreds of pimples that can cover the face, neck, chest, and back. Or it can be bigger, solid, red lumps that are painful (cysts).

Acne is very common among teens. It usually gets better after the teen years. Some women who never had acne growing up will have it as an adult, often right before their menstrual periods.

What causes it?

Acne starts when oil and dead skin cells clog the skin's pores. This traps bacteria inside the pores causing swelling, redness, and pus. For most people, acne starts during the teen years. This is because hormone changes make the skin oilier after puberty starts.

What are the symptoms?

Symptoms of acne include whiteheads, blackheads, and pimples and cystic lesions. These can occur on the face, neck, shoulders, back, or chest. Mild acne usually causes only whiteheads and blackheads. Severe acne can produce hundreds of pimples that cover large areas of skin.

How is it diagnosed?

When you see a doctor about acne, you'll have a physical exam. Your doctor will ask you questions about your past and current health. Women may be asked questions about their menstrual cycles. Most often, you won't have any special tests to diagnose acne.

How is acne treated?

To help control acne, keep your skin clean. Avoid skin products that clog your pores. Look for products that say "noncomedogenic" on the label. Wash your skin once or twice a day with a gentle soap or acne wash. Try not to scrub or pick at your pimples. This can make them worse and can cause scars.

If you have mild acne, you can get an acne cream without a prescription. Look for one that has adapalene, benzoyl peroxide, or salicylic acid. These work best when they're used just the way the label says.

It can take time to get acne under control. But if nonprescription products haven't helped after 3 months, see your doctor. You may need different medicines or prescription medicines. The medicines may be creams or pills, and may include antibiotics or medicines derived from vitamins. If you are a woman, taking certain birth control pills may help control acne.

Cause

Acne starts when skin glands start making more oil. The oil and dead skin cells can clog the pores of the skin. This traps bacteria inside the pores causing swelling, redness, and pus.

For most people, acne starts during the teen years. This is because hormone changes make the skin oilier after puberty starts.

Acne can run in families. If one of your parents had severe acne, you are more likely to have it. Certain medicines, such as corticosteroids or lithium, can also cause acne to form.

Sometimes newborns have acne because their mothers pass hormones to them just before they are born. Acne can also appear when the stress of birth causes the baby's body to release hormones on its own. Young children and older adults also may get acne.

A few conditions, such as polycystic ovary syndrome and Cushing's syndrome, can lead to outbreaks of acne.

What Increases Your Risk

The tendency to develop acne runs in families.

The risk of getting acne is highest during the teen and young adult years. These are the years when hormones such as testosterone are increasing. Many women have acne flare-ups in the days just before their menstrual periods.

Acne can be made worse if you:

• Use skin and hair care products that have irritating substances.
• Wash your face too often or too hard, or use harsh soaps or very hot water.
• Have a lot of stress.
• Touch your face a lot.
• Sweat a lot.

Symptoms

Symptoms of acne include whiteheads, blackheads, and pimples. These can occur on the face, neck, shoulders, back, or chest.

Mild acne usually causes only whiteheads and blackheads. At times, these may develop into an infection in the skin pore (pimple).

Severe acne can produce hundreds of pimples that cover large areas of skin. Cystic lesions are pimples that are large and deep. These lesions are often painful and can leave scars on your skin.

Acne can last for a few months or many years. Or it may come and go your entire life.

What Happens

Acne develops most often in the teen and young adult years. During this time, both males and females usually produce more testosterone than at any other time in life. This hormone causes oil glands to produce more oil (sebum). The extra oil and dead skin cells can clog pores. This traps bacteria inside the pores causing swelling, redness, and pus (pimples).

Acne usually gets better in the adult years when your body produces less testosterone. Still, some women have premenstrual acne flare-ups well into adulthood.

When to Call

Call a doctor if:

• You have symptoms of infection, such as:
  • Increased pain, swelling, warmth, or redness.
  • Red streaks leading from the area.
  • Pus draining from the area.
  • A fever.
• Your acne gets worse or does not improve after 3 months with home treatment.
• You start to have other physical symptoms, such as facial hair growth in women.

You may want to see a doctor sooner if you have a strong family history of acne, are emotionally affected by acne, or got acne at an early age.

Watchful waiting

Watchful waiting is a wait-and-see approach. If you get better on your own, you won't need treatment. If you get worse, you and your doctor will decide what to do next.

Mild acne, with a few pimples that clear up on their own, may not need any treatment. But if you are worried about how much you're breaking out, see your doctor. Getting medical treatment early may prevent acne from getting worse or from causing scars.

Exams and Tests

When you see a doctor about acne, you'll have a physical exam. Your doctor will ask you questions about your past and current health. Women may be asked questions about their menstrual cycles. This information can help a doctor find out if hormones are playing a role in a woman's acne.

Most often, you won't have any special tests to diagnose acne.

You may need other tests if your doctor suspects that acne is a symptom of another medical problem. These problems include higher-than-normal amounts of testosterone in a woman.

Treatment Overview

Acne treatment depends on whether you have a mild, moderate, or severe type of acne. Sometimes a doctor will combine treatments to get the best results and to avoid developing drug-resistant bacteria. Treatment could include lotions or gels you put on blemishes or sometimes on entire areas of skin, such as the chest or back (topical medicines). You might also take medicines by mouth (oral medicines).

Most treatments for acne take time. It often takes 6 to 8 weeks for acne to improve after you start treatment. Some treatments may cause acne to get worse before it gets better.

Certain medicines, such as low-dose birth control pills or spironolactone, may help control acne for some women.

Mild acne

If you have just a few pimples to treat, you can get an acne cream without a prescription. Look for one that has adapalene, benzoyl peroxide, or salicylic acid. These work best when they're used just the way the label says.

Treatment for mild acne (whiteheads, blackheads, or pimples) may include:

• Gentle cleansing with warm water and a mild soap.
  • Avoid skin products that clog your pores. Look for products that say "noncomedogenic" on the label.
  • Try not to scrub or pick at your pimples. This can make them worse and can cause scars.
• Using a retinoid you put on your skin, such adapalene or tretinoin.
• Applying benzoyl peroxide alone or benzoyl peroxide with a topical antibiotic.
• Applying azelaic acid or salicylic acid.

If these treatments don't work, you may want to see your doctor. You may be given a prescription for stronger lotions or creams. You may try an antibiotic lotion. Or you may try a lotion with medicine that helps to unplug your pores.

Moderate-to-severe acne

Sometimes acne needs treatment with stronger medicines or a combination of therapies. Deeper blemishes, such as nodules and cysts, are more likely to leave scars. So your doctor may give you oral antibiotics sooner to start the healing process. This kind of acne may need a combination of several therapies. Treatment for moderate-to-severe acne may include:

• Applying benzoyl peroxide.
• Draining of large pimples and cysts by a doctor.
• Applying prescription antibiotic gels, creams, or lotions.
• Applying prescription retinoids.
• Applying azelaic acid.
• Taking prescription oral antibiotics.
• Taking prescription oral retinoids (such as isotretinoin).

Photodynamic therapy (PDT) and other light and laser-based therapies are being used to treat acne. These include the use of blue light, red light, intense pulsed light (IPL), and infrared or pulsed dye lasers. Sometimes these treatments are used along with medicines. But they may also help people who can't be treated with medicines.

Acne scars

There are many procedures to remove acne scars, such as laser resurfacing, chemical peels, and dermal fillers. Some scars shrink and fade with time. But if your scars bother you, talk to your doctor. You may be referred to a dermatologist or a plastic surgeon.

Self-Care

• Gently wash your face 1 or 2 times a day with warm (not hot) water and a mild soap or cleanser. Always rinse well.
• Use an over-the-counter lotion or gel that contains benzoyl peroxide. Start with a small amount of 2.5% benzoyl peroxide and increase the strength as needed. Benzoyl peroxide works well for acne, but you may need to use it for up to 2 months before your acne starts to improve.
• Apply acne cream, lotion, or gel to all the places you get pimples, blackheads, or whiteheads, not just where you have them now. Follow the instructions carefully. If your skin gets too dry and scaly or red and sore, reduce the amount. For the best results, apply medicines as directed. Try not to miss doses.
• Do not squeeze or pick pimples and blackheads. This can cause infection and scarring.
• Use only oil-free makeup, sunscreen, and other skin care products that will not clog your pores.

Over-the-counter acne products that can help

Medicated creams, soaps, lotions, and gels can help treat your acne. Always read the label carefully to make sure you are using the product the right way.

Use over-the-counter acne medicines. Examples include:

• Benzoyl peroxide. This unplugs pores.
• Alpha hydroxy acid. This dries up blemishes and causes the top skin layer to peel. You'll find alpha hydroxy acid in some moisturizers, cleansers, eye creams, and sunscreens.
• Salicylic acid. This dries up blemishes and causes the top skin layer to peel.
• Tea tree oil. This kills bacteria. You'll find tea tree oil in some gels, creams, and oils.

Some skin care products, such as those with alpha hydroxy acid, will make your skin very sensitive to ultraviolet (UV) light. Protect your skin from the sun and other sources of UV light.

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Medicines

Medicines can help manage how severe acne outbreaks are and how often they occur.

Treatment depends on whether inflammation or bacteria are present. The best treatment often is a combination of creams or lotions (topical medicines) and pills (oral medicines).

Creams and lotions usually have fewer and less serious side effects than pills. But they may not work as well for severe acne.

Medicine choices

Medicines used to treat acne include:

• Benzoyl peroxide.
• Salicylic acid.
• Alpha hydroxy acid.
• Topical and oral antibiotics.
• Topical retinoid medicines.
• Azelaic acid.
• Isotretinoin.
• Low-dose birth control pills that contain estrogen.
• Androgen blockers, such as spironolactone.

Isotretinoin and the retinoid tazarotene can have serious side effects. Women who take one of these medicines need to use birth control to avoid having a baby with serious birth defects.

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