Acne
(Pimples)
Medical Author: Alan Rockoff, MD
Medical Editor: Melissa Conrad Stoppler, MD
What is acne? What are the different types of acne?
Acne (acne vulgaris, common acne) is not just a problem for teenagers; it can affect people from ages 10 through 40. It is not unusual for women, in particular, to develop acne in their mid- to late-20s, even if they have not had breakouts in years (or ever). On the positive side, those few individuals who have acne into their 40s may well grow out of it. Acne can appear on the skin as any of the following:
- congested pores ("comedones"),
- whiteheads,
- blackheads,
- pimples ("zits"),
- pustules, or
- cysts (deep pimples, boils). The pus in pustules and cysts is sterile and does not actually contain infectious bacteria.
These blemishes occur wherever there
are many oil (sebaceous) glands, mainly on the face, chest, and back.
You can do a lot to treat your acne using products available at a drugstore
or cosmetic counter that do not require a prescription. However, for tougher cases
of acne, you should
consult a physician for treatment options.
What causes acne?
No one factor causes acne. Acne happens when oil (sebaceous) glands come to
life around puberty,
stimulated by male hormones from the adrenal glands of both boys and girls.
Sebum (oil) is a natural substance which lubricates and protects the
skin, and under certain circumstances, cells that are
close to the surface block the openings of sebaceous glands and cause a
buildup of oil underneath. This oil stimulates bacteria
(which live on
everyone's skin and generally cause no problems) to multiply and cause
surrounding tissues to become inflamed.
Inflammation near the skin's surface produces a pustule; deeper inflammation results in a papule (pimple); deeper still and it's a cyst. If the oil breaks though to the surface, the result is a "whitehead." If the oil accumulates melanin pigment or becomes oxidized, the oil changes from white to black, and the result is a "blackhead." Blackheads are therefore not dirt, and do not reflect poor hygiene.
Here are some factors that don't usually cause acne, at least by themselves:
- Heredity: With
the exception of very severe acne, most people do not have the problem
exactly as their
parents did. Almost everyone has some acne at some point in their life.
- Food: Parents often tell teens to avoid pizza, chocolate, greasy and fried foods, and junk food. While these foods may not be good for overall health, they don't cause acne or make it worse. Although some recent studies have implicated milk and dairy products in aggravating acne, these findings are far from established.
- Dirt: As
mentioned above, "blackheads" are oxidized oil, not dirt.
Sweat does not
cause acne, therefore, it is not necessary to shower instantly after exercise
for fear that sweat will clog pores. On the other hand, excessive washing can
dry and irritate the skin.
- Stress: Some people get
so upset by their pimples that they pick at them and make them last longer.
Stress, however, does not play much of a direct role in causing acne.
- Hormones: Some women
break out cyclically, but most women (and men) don't. Some oral contraceptive pills
may help relieve acne, but unless a woman has abnormal
menstrual periods and excessive hair growth, it's unlikely that hormones play
much of a role in causing acne. Pregnancy has a variable effect on acne;
some women report that they clear up completely,
and others get worse, while many others see no overall change.
- Cosmetics: Most cosmetic and skin-care products are not pore-clogging
("comedogenic"). Of the many available brands, those which are listed as
"water-based" or "oil-free" are generally a better choice.
In occasional patients, the following may be contributing factors:
- Pressure: In some
patients, pressure from helmets, chinstraps, collars, suspenders, and the like can
aggravate acne.
- Drugs: Some medications
may cause or worsen acne, such as those containing iodides, bromides, or oral
or injected steroids (either the medically prescribed prednisone or the
steroids that bodybuilders or athletes take). Other drugs that can cause or aggravate acne are anticonvulsant medications and lithium,
which is used to treat bipolar disorder. Most cases of acne, however, are not drug-related.
- Occupations: In some jobs, exposure to industrial products like cutting
oils may produce acne.
Next: What other skin conditions can mimic acne? »
- doxycycline, Vibramycin, Oracea, Adoxa, Atridox and Others - Learn more about Doxycycline, including a description, generic and brand names, drug class and mechanism, preparations, storage, reasons for prescription, dosing, drug interactions, effect on pregnancy and nursing mothers, and common side effects.
- Photodynamic Therapy - Read about photodynamic therapy (PDT). PDT uses a photosensitizing agent and light source to treat cancers (skin, lung, esophageal, Barrett's esophagus), acne and rosacea.
- Boils - Learn about boils (skin abscess), localized infections deep within the skin that begins as a reddened, sore area. Eventually, the area hardens and fills with pus. Boils may be caused by ingrown hairs, clogged sweat glands, or foreign material that becomes imbedded in the skin. Treatment typically involves heat application, draining the boil, and antibiotics to eliminate bacterial infection.
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