Acne is the most frequent skin condition in the United States. Approximately 80% of adolescents have some level of acne as well as at least 5% of adults. Acne can range from a few red bumps or pustules to large nodular lesion that produce significant scarring.

Acne is characterized by 2 major types of lesions:

  • Whitehead and blackheads, also known as closed (whiteheads) or open (blackheads) comedones, are non-inflammatory.
  • Inflammtory lesions including pustules, papules and nodules (or cysts) are inflamed lesions that are pus-filled bumps (pustules), small red/pink bumps (papules) or larger red/pink bumps (nodules).

Causes

In normal skin, oil glands under the skin, known as sebaceous glands, produce an oily substance called sebum. The sebum normally exits the skin through pores and moisturizes the skin or hair. Before, during and after puberty, the pores get plugged because the skin that is supposed to shed from them gets "sticky" and creates a plug. It is similar to having a clog in a pipe. The result is a build-up of oil under the skin which creates an acne lesion. Depending on the amount of blockage, the size, the location, physical manipulation and amount of bacteria in the lesion, whiteheads, blackheads or inflammatory acne lesions can result. Open plugged pores create blackheads whereas closed plugged pores make whiteheads. Lesions that fill with pus make inflammatory lesions.

It is important to note that acne is not a result of a lack of hygiene. It is due to hereditary factors and hormonal changes during puberty. In rare cases, topical products such as make-up, sweating under a helmet or uniform and hair styles may play a role.

It is important not to pick, squeeze or pop lesions or acne. More inflammation, larger lesions, infections and scarring can result from this behavior.

Treatment of acnes is important to improve appearance and self-image and reduce the chance of life-long scarring.

Treatment

Treatment of acne is a slow process with several weeks or a few months of treatment often required to see results. Common treatment agents include:

  • Benzoyl peroxide — This is available in over the counter and prescription formulations. This agent kill bacteria, reduces inflammation and may allow pores to open up.
  • Salicylic acid- This helps to open up the blocked pores and is available over the counter in pads and washes.
  • Oral and topical antibiotics — Prescription antibiotics reduce inflammation and kill bacteria.
  • Hormonal treatments — In rare cases, may be used for adult women with hormonally-induced acne.
  • Retinoids — These prescription agents include tretinoin and adapalene, are derivatives of vitamin A and they help to unblock the pores, reduce inflammation and cause the skin to grow healthier. These agents are among the most important treatments for acne.
  • Extraction or acne surgery — Removal of whiteheads and blackheads using a small metal instrument that is centered on the comedone and pushed down, extruding the blocked pore.
  • Isotretinoin --- This prescription medication is the most powerful of the options and is reserved for moderate to severe cases of acne and/or when other treatments have failed. It is most difficult to take, but very effective.