The Facts

Acne is an inflammation of the skin that causes blackheads, whiteheads, and red spots usually called "pimples" or "zits." The most common type of acne is acne vulgaris (vulgaris means common). Doctors call a flare-up of acne pimples lesions. Acne appears most often on the face, but can also be a nuisance on your chest, back, and upper arms. Acne affects about 90% of adolescents as well as 20% to 30% of individuals aged 20 to 40 years. It accounts for more doctor visits than any other skin problem.

Acne isn't life threatening, but it can be upsetting and disfiguring and cause psychosocial problems. Acne can also lead to serious and permanent scarring.

Causes

Acne develops because your sebaceous glands are overactive. These glands normally produce small amounts of sebum, which is a thick mixture of oil and skin cells. When you have acne, these glands go into overproduction and the extra sebum can block your follicles and bacteria move in, particularly the species called Propionibacterium acnes.

Hormones can cause an outbreak of pimples, or increase the number you get. The hormones that are active during puberty also trigger your sebaceous glands to produce more sebum. The hormones with the greatest effect on the oil glands are the androgens, the male hormones. Both men and women have androgens, but men have more.

In women, these hormones can also cause acne during the menstrual cycle, and that's why women often find that acne continues into adulthood. Hormones found in many types of birth control pills can also cause flare-ups of acne.

Eating junk food and chocolate normally has nothing to do with acne. In a few cases, particular foods cause pimples, but this is rare. Greasy hair and skin also doesn't cause acne, but they're often a sign of overactive sebaceous glands, which can cause acne. Research suggests that stress may worsen acne.

A tendency to get acne can run in families. It's more common among Caucasians than Asians or people of African descent.

Things that irritate your skin can also cause acne. These include:

• rubbing or friction from your clothes
• contact with a dog's tongue (e.g., after a friendly lick)
• skin contact with certain sports equipment
• certain cosmetics
• skin exposure to extreme temperatures

Taking corticosteroid medications can also cause an acne-like condition.

Symptoms and Complications

Acne symptoms vary from person to person. They include:

• blackheads - black spots the size of a pinhead - are open right on the surface of your skin (superficial) and don't leave scars.
• whiteheads or pustules, the most common type of acne, are usually the first lesions people get. They don't turn black because they're not exposed to the air.
• deep pustules and cysts look irritated; they're usually red and swollen with visible pus.
• deep acne can be more severe: it's usually red, inflamed, filled with pus, and painful to touch. It often appears on the back and chest. It's often the most difficult type of acne to treat and may leave scarring. Deep acne includes pustules and cysts, both of which can appear on the skin's surface. Some, however, are deep in the layers of the skin. If they burst, the pus that's released will cause more lesions.

Deep acne can lead to scarring. Picking at or squeezing the pimples often leaves a pitted appearance that may or may not be permanent. Scarring is more common in men because deep acne affects more men than women - and because men don't seek a doctor's advice as often as women do.

Making the Diagnosis

Acne is diagnosed by its appearance. Your doctor may do a physical exam and look at your medical and personal history to rule out any other possibilities. Your doctor may ask about things like cosmetics and any medications you're taking. p>

Treatment and Prevention

Most of the cleansers you see advertised for acne aren't necessary. In fact, they may actually make your acne worse. Instead, your doctor will probably recommend some of the following:

• Creams and lotions containing benzoyl peroxide, salicylic acid, glycolic acid, or sulphur are widely available without a prescription. They are peeling and drying agents that unplug clogs and help the skin shed dead cells. They usually take about two weeks to work and have to be used continuously afterwards to remain effective.
• Sunlight is helpful for many people. It's probably why acne is less common in the summer.
• For some women, taking the birth control pill can help regulate the hormones that cause acne flare-ups.
• For more serious acne, an antibiotic lotion or retinoic acid (a derivative of vitamin A) usually works.
• For deep acne, antibiotic pills may be given.
• Prescription medications (e.g., isotretinoin*) are effective in treating deep acne. These should be used with caution by women. It's important to discuss all the risks and benefits of these medications with your doctor.
• For deep acne scarring, collagen injections and laser resurfacing may be used.

Follow these basic guidelines to prevent and help treat acne:

• Wash no more than twice daily with a mild soap or soapless cleanser.
• Don't pop, squeeze or pick at pimples.
• Wash your face twice a day using a gentle, unscented soap, and pat dry.
• Avoid scrubbing or vigorous washing with a harsh or rough (abrasive) soap.
• Don't use antibacterial soaps - they won't help prevent acne.
• Use a fresh washcloth every day.
• Use an astringent such as alcohol after washing your face.
• Use "noncomedogenic" cosmetics, which won't cause acne.
• Shampoo your hair at least twice a week.
• Use a dandruff shampoo if necessary.
• Wash off sweat and oil as soon as possible.
• Blackheads should only be removed by your doctor.

*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol^®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.