Topic Overview
	Causes
	Symptoms
	What Happens
	What Increases Your Risk
	When to Call a Doctor
	Exams and Tests
	Treatment Overview
	Prevention
	Home treatment
	Medications
	Surgery
	Other treatment

Clogging of pores leads to pimples, whiteheads, or blackheads, which usually occur on the face, neck, shoulders, back, or chest. Pimples that are large and deep are called cystic lesions. Cystic lesions can cause painful infections and lead to scarring.

It is not clear what causes a person's body to produce too much oil or not properly shed dead skin cells. Outbreaks of acne may be linked to hormones, genetics, or bacteria. Acne is not caused by eating too much chocolate or oily foods.

Acne can range from mild to severe. A person may have only occasional bouts with acne or it may be constant. Treatment for acne is based on the severity of the outbreak and how much it affects a person's appearance.

The goal of treatment is to reduce or eliminate outbreaks and to prevent scarring. Home care of acne and use of nonprescription medications can be effective. Prescribed oral medications (such as isotretinoin) and topical medications (such as benzoyl peroxide) are also available to treat acne. Usually, a combination of medications is most helpful.

Certain light therapies (such as blue or red light therapies prescribed by a doctor) can be helpful in treating mild to moderate acne that has not responded to other treatments. While mild sun exposure can lessen the redness of acne, ultraviolet rays from sunlight or a sunlamp can damage a person's skin.

Moderate to severe acne can cause embarrassment and self-esteem problems, and sometimes depression. Only one-third of teenagers with acne seek treatment, although most report that acne causes them to have a poor self-image.

Causes
Acne develops when the sebaceous glands in a person's skin make extra oil (sebum). This oil combines with cells that line the walls of these glands and clogs the person's skin pores. Although it is known that acne is linked to the body's overproduction of sebum, it is not clear why the body begins to produce too much sebum. The overproduction of sebum leading to outbreaks of acne may be linked to several causes, including genetics, hormones, or bacteria. Acne is not caused by foods.

A person's clogged skin pores can develop into whiteheads and blackheads or pimples.

Although whiteheads and blackheads do not contain bacteria, pimples always contain bacteria. The bacteria in pimples (Propionibacterium acnes, or P. acnes) is commonly found on a person's skin. However, people with extra sebum in their skin pores usually have more bacteria on their skin than people with less oil.

Certain hormones, mainly testosterone, stimulate particular glands in a person's skin pores to make extra oil. It is not known why testosterone stimulates these glands.

Sometimes acne develops when a person takes certain medications. This type of acne usually clears up when the medication is stopped.

Newborns may develop acne because certain hormones are passed to them by their mothers just before delivery or because the stress of birth causes the baby's body to release hormones on its own. Young children and older adults also may get acne. Their acne may be caused by rare conditions of the endocrine system.

Symptoms
Acne can range from mild to severe. Acne can last for a few months, many years, or a person's entire life. Acne develops most often on a person's face, neck, chest, shoulders, or back.

People with mild acne have only whiteheads and blackheads. Occasionally, they may develop an infected skin pore, or pimple. Acne may cause permanent scars, especially if it goes untreated.

People with severe acne have many pimples. Pimples that are large and deep under a person's skin are called cystic lesions. Cystic lesions can cause painful infections, leading to scars.

Acne can cause a person to feel ashamed of his or her appearance, leading to problems with low self-esteem and sometimes depression. These feelings should be acknowledged and treated along with the acne.

What Happens
Acne develops most often in teens and young adults. During this time, both males and females usually produce more testosterone than at any other time in life. Testosterone stimulates oil glands to make extra oil (sebum). This extra oil can lead to acne. Acne usually gets better in the adult years as a person's body produces less testosterone, although women often will get premenstrual flares well into their adult years.

Acne develops in 4 stages:

1. Plugging of hair follicle
   Cells in the walls of the sebaceous glands and cells from the hair follicle itself sometimes do not leave the body once they die. The hair follicles (canals) become clogged with these dead cells and block the flow of oil, or sebum, from the canals.
2. Overactivity of sebaceous glands
   The sebum produced in the sebaceous glands is stimulated by hormones, such as testosterone. Since hormone production increases during adolescence, sebum production increases then as well. Boys generally will experience more severe acne during their teenage years because of increased testosterone production. The overproduction of sebum alone does not cause acne. Acne may be caused when the increased sebum occurs along with clogged hair follicles.
3. Increased bacteria (P. acnes)
   The bacteria P. acnes are more abundant in people with acne. These bacteria, combined with the sebum and dead cells, cause inflammation of the hair follicles.
4. Inflammation of hair follicles
   Once the bacteria has invaded the hair follicles, sebum, and dead cells, the hair follicle wall becomes inflamed. This inflammation causes pimples, papules, or pustules to appear on the skin. If the inflammation is severe and continues, the formation of cystic lesions and scarring may occur.

What Increases Your Risk
The tendency to develop acne runs in families (genetic tendency). The severity of a person's acne may be related to whether their parent's acne was mild or severe.

The risk of developing acne is highest during adolescent and young adult years, when the production of hormones such as testosterone is increased. Women who are at the age of menstruation are also more likely to develop acne.

Acne can be irritated or made worse by:

• Wearing straps or other tight-fitting items that rub against the skin (such as a football player wearing shoulder pads) or using equipment that rubs against the body (such as a violin held between the cheek and shoulder). Helmets, bra straps, headbands, and turtleneck sweaters also may cause acne to get worse.
• Using skin and hair care products that contain certain irritating substances.
• Washing the face too often or scrubbing the face too hard. Using harsh soaps or very hot water can also cause acne to get worse.
• Experiencing a lot of stress.
• Sweating a lot.
• Having hair hanging in the face, which can cause the skin to be oilier.
• Taking certain medications.
• Working with oils and harsh chemicals on a regular basis.

When to Call a Doctor
Call a health professional if:

• You are concerned about your own or your child's or teen's acne.
• Your acne gets worse or does not improve with home care.
• You have tried home care for 6 to 8 weeks, and your acne has not improved.
• You develop scars or marks after your acne pimples heal.
• Your pimples become large and hard or filled with fluid.
• You start to have other physical symptoms, such as hair growth on your chin (women only) or bone and muscle pain.
• Your acne began when you started a new medication prescribed by a health professional.
• You have been exposed to chemicals, oils, or other substances that cause your skin to break out.

Watchful Waiting
Acne does not necessarily have to be treated if a person is not bothered by the presence of whiteheads, blackheads, and/or pimples.

Most mild acne can be treated successfully by using products you can buy without a prescription.

If you have severe acne, if your acne does not clear up with home treatment, or if you develop acne scars, call your doctor.

Who to See
The following health professionals can diagnose and treat acne:

• Pediatrician
• Family physician or internist
• Pediatric nurse practitioner or family nurse practitioner
• Physician's assistant
• Dermatologist (a specialist in the care of skin)

Exams and Tests
Acne is diagnosed by a physical exam and medical history. No special tests are needed to diagnose acne.

If a health professional suspects that acne is a symptom of another medical problem (for example, higher-than-normal amounts of testosterone in a woman), other tests may be ordered.

Treatment Overview
There is no known cure for acne. Treatment focuses on limiting the number of pimples, whiteheads, and blackheads, and controlling the progression of inflammation and cyst formation. Treatment includes prescription and nonprescription oral medications and topical creams or lotions.

If acne is mild to moderate, home care with nonprescription products such as lotions, cleansing soaps, or washes may be enough to control the condition.

If acne is severe or has not improved after 6 to 8 weeks of home care, treatment by a doctor may be necessary. A person may want to seek medical assistance sooner if there is a strong family history of acne, or if the person developed acne at an early age. If a person has mild acne but is emotionally affected it, treatment may be needed.

Acne treatment usually needs to be continued over a long period of time (often years). Medications used to treat acne can decrease the number of pimples or cystic lesions and prevent or stop infections.

Sometimes surgery to remove whiteheads and blackheads or to drain pimples may be necessary. Plastic surgery is occasionally recommended for people who have disfiguring scars due to severe acne.

Prevention
While all forms of acne cannot be prevented, you can do a lot at home to keep your acne from getting worse.

• Gently wash and care for your skin every day. Avoid scrubbing too hard or washing too often. See the Home Treatment section.
• Eat a balanced diet, although diet does not cause acne.
• Reduce stress in your life.
• Avoid excessive sweating if you think it causes your acne to get worse. Wash soon after participating in activities that cause you to sweat.
• Wash your hair often. Try to keep your hair off of your face.
• Avoid hair care products such as gels, mousses, cream rinses, and pomades or hair greases that contain a lot of oil, which can make your acne worse.
• Wear soft, cotton clothing or moleskin under sports equipment (if possible). Parts of equipment such as chin straps can rub your skin, making your acne worse.
• Avoid exposure to oils and harsh chemicals, such as petroleum.
• Avoid long periods of time in sunlight. Use sunscreens when you are out in the sun.

Home Treatment
There are many steps you can take at home to help your acne, including:

• Washing your face (or other affected skin) gently once or twice a day.
• Do not squeeze pimples, which often leads to infections, worse acne, and scars.
• Using special skin care products that are water-based that gently clean your skin. Avoid products such as milky cleansers, cold creams, lipsticks, and lip gloss that contain oils.
• Using nonprescription medicated creams, soaps, lotions, and gels to treat your acne. Always read the label carefully to make sure you are using them correctly.

Examples of some nonprescription products used to treat acne include:

• Benzoyl peroxide
• Alpha-hydroxy acids
• Salicylic acid
• Melaleuca alternifolia

Other products that can be included in your skin care routine that may help your overall skin condition include skin pore-cleaning strips.

It is important that you use topical medications as directed. A product is not more effective if used more often than directed. In fact, using a product too much can make acne worse.

Family members and friends can encourage the person with acne to continue taking care of his or her acne and help the person with any problems of low self-esteem due to his or her appearance. Sometimes a person with acne becomes depressed and may need treatment for depression (such as counseling).

Medications
Medications do not cure acne, but they can help manage the severity and frequency of outbreaks. Different medications are used, depending on the type of acne (pimples, whiteheads, blackheads, or cystic lesions). The types of medications used most often to treat acne include those that:

• Help unplug skin pores and stop them from getting plugged with oil (such as tretinoin [sold as Retin-A]).
• Kill bacteria, such as antibiotics and lotions that contain sodium sulfacetamide.
• Reduce the amount of sebum made by a person's body (such as isotretinoin [sold as Accutane]).
• Reduce the effects of hormones in producing acne (such as oral contraceptive pills for women).

The best medical treatment for acne often consists of a combination of medications. Some medications are combined into one product, such as Benzamycin topical gel which contains an antibiotic (erythromycin) and benzoyl peroxide, or BenzaClin topical gel, which contains benzoyl peroxide and the antibiotic clindamycin. Other times, two different medications are needed. For example, some people use benzoyl peroxide lotion or gel in the morning and tretinoin (Retin-A) at bedtime.

Medication Choices
Treatment of acne depends on whether there is inflammation or bacteria present. Some acne consists only of red bumps on the skin with no open sores (comedonal acne). This type of acne is often treated effectively by topical creams and lotions. However, if there is bacteria or inflammation present with open sores, other types of treatment,, such as oral antibiotics, may be needed.

The most common types of medications used to treat acne include:

• Antibiotics, such as erythromycin (E-Mycin) and tetracycline.
• Tretinoin (Retin-A) and adapalene (Differin), both retinoid medications.
• Other retinoids, such as isotretinoin (Accutane) and tazarotene (Tazorac).
• Certain hormones, such as estrogen (low-dose birth control pills).
• Sodium sulfacetamide, such as Klaron lotion, Novacet lotion, and Sulfacet-R lotion.
• Azelaic acid, such as Azelex, a topical cream.

Surgery
Surgery is sometimes used to treat acne or the effects of acne. All surgery to treat acne needs to be performed by specially trained health professionals.

Surgery Choices

• Whitehead and blackhead (comedone) removal. During this surgery, a health professional uses a special instrument (comedone or blackhead extractor) to remove whiteheads and blackheads.
• Draining large and painful pimples. During this surgery, a health professional opens an acne pimple with a needle or sharp blade and removes the oil and bacteria that is trapped inside. This relieves the pressure and pain. Removing the oil and bacteria often reduces the amount of scarring that develops after the pimple heals.
• Scar removal. Sometimes surgery is used to remove deep scars that have developed from acne.

Other Treatment
Other therapies are occasionally used to treat acne. These therapies usually are used for severe acne and to prevent or treat acne scars.

Other Treatment Choices

• Collagen injections and gelatin implants, used to treat acne scars
• Cryotherapy, used to help pimples heal faster with less scarring
• Dermabrasion, to remove scars
• Chemabrasions, a chemical peel used to remove surface scars