Acne

If you have acne, also called acne vulgaris, you’re not alone. It is the most common skin condition in the United States. Approximately 40 to 50 million Americans have acne. Most are teens and young adults but it can occur at any age.Newborns get acne. Children get acne. Even menopausal women get acne.

At any age, virtually everyone with acne can have clearer skin. In recent years, medical advances have been made including new acne treatments and using well-known treatments differently to get better results.

WHAT IS ACNE?

Many people think that acne is just "pimples." If you have acne, you can have any of these blemishes:

• Blackheads (called open comedones)
• Whiteheads (called closed comedones)
• Papules (red bumps)
• Pustules (red bumps with white centers, what many people call “pimples”)
• Cysts
• Nodules

Acne can appear on the face, back, chest, neck, shoulders, and upper arms.

Acne

WHAT CAUSES ACNE?

Acne first appears when a pore in the skin clogs. This clog begins with dead skin cells.

Normally dead skin cells are shed from the surface of the skin every day. Normal skin also produces sebum, which is an important oil that keeps our skin from drying out. When sebum production is increased during certain phases of life, the excess oil can cause the dead skin cells to stick together inside the pore. Instead of being shed, the cells become trapped inside the pore.

One type of bacteria that lives on everyone’s skin is called P. acnes. Inside the pores, the bacteria have a perfect environment for multiplying very quickly, especially if there is a lot of oil in the pores. When hormones change at puberty, oil production increases in the skin. The combination of bacteria and oil in the pores is very irritating to the surrounding skin so the pore becomes inflamed (red and swollen). Sometimes the inflammation can damage the lining of the pore and then the inflammation goes deep into the skin, causing an acne cyst or nodule to appear.

WHAT ARE THE BENEFITS OF ACNE TREATMENT?

Treatment has many benefits. If you have severe acne, which consists of deep and often painful lumps called cysts and nodules, effective acne treatment may prevent acne scars. Clearing acne usually improves a person’s self-esteem. Some patients say they feel happier and more confident.

If you want to treat acne, it is important to have realistic expectations. Misinformation about acne treatment is widespread. Here are five important facts about acne treatment that you should know:

• It takes time to see results (at least 4 to 8 weeks).
• "Overnight results" or an “immediate cure” is not possible.
• Treatment may help to clear existing acne faster, but works best to prevent new breakouts.
• To continue seeing results, you must continue treating acne even after your skin has cleared.
• When red acne bumps go away, they often leave red or brown flat marks which will gradually go away over several months. These are not necessarily permanent scars.

Acne papules and pustules

HOW IS ACNE TREATED?

Dermatologists customize acne treatment for each patient. Before creating a treatment plan for you, a dermatologist must know some important information about you. Be sure your dermatologist knows if you are:

• Pregnant
• Breastfeeding
• Trying to become pregnant
• Allergic to any previous treatments you may have tried for acne

To get your acne under control, you may need to use more than one acne treatment. This approach is called combination therapy and can produce the best results. These are some treatments that may be included in your plan:

Treatment applied to the skin

Your dermatologist may refer to this as “topical treatment.” Medicines that are applied to the skin help treat mild to moderate acne. These treatments work best to prevent new blemishes, so it is important to apply them to the entire area affected by acne, not just the acne spots. Some treatments unclog pores and prevent whiteheads and blackheads. Others reduce the amount of acne-causing bacteria on your skin. Some reduce the redness of your spots.

Some of the active ingredients in these topical acne treatments can include retinoids, salicylic acid, benzoyl peroxide, or azelaic acid, and antibiotics such as dapsone, clindamycin or sodium sulfacetamide. You may receive a prescription for a topical acne medicine. Some effective topical medicines do not require a prescription. Your dermatologist will know what will be most effective for you.

Medicine that works throughout the body

Also called “systemic treatment,” this medicine helps to treat moderate to severe acne. You may receive a prescription for an antibiotic like minocycline, doxycycline, tetracycline or another medicine. These antibiotics can treat acne that covers a large area of the body.

Some women who have acne see their skin clear when they take hormonal therapy (birth-control pills with estrogen or spironolactone). Your dermatologist can help you decide whether this is a good treatment option for you.

Most acne treatments have little effect on deep and often painful cysts and nodules. When other treatments do not work, isotretinoin may be an option. It is the only medicine approved by the U.S. Food and Drug Administration (FDA) to treat severe acne. Acne will improve in about 85% of patients after one course (4-6 months) of treatment with isotretinoin.

Isotretinoin is not for everyone. The medicine cannot be prescribed to a female patient who is pregnant. The risk of a baby developing severe birth defects is high, even if taking this medicine for a short time. Women who can become pregnant must follow strict rules to prevent pregnancy. Future pregnancies are not affected by isotretinoin.

Cystic acne

Because of the high risk of birth defects, both male and female patients must enroll in a program called iPLEDGE, before they can start taking isotretinoin. This program collects anonymous medical information about patients who are using isotretinoin. This information is used to determine if education to prevent birth defects is effective. If you decide to take isotretinoin, your dermatologist will monitor you closely. You should immediately report any possible side effect to your dermatologist.

Procedures

It is rare for a procedure to clear acne. Dermatologists include procedures in their acne treatment plans because a procedure may improve the overall results you get from other acne treatments.

Acne papules and pustules

HOW SHOULD I CARE FOR MY SKIN?

Acne is not caused by dirt and cannot be washed away. Your dermatologist can create a skin care plan that helps prevent breakouts. Follow these dermatologist tips on how to care for your skin:

• Be gentle with your skin. Avoid skin care products that feel rough on your skin.
• Wash twice a day and after sweating. Excessive washing and scrubbing will not prevent or treat acne. Too much scrubbing can irritate your skin and make acne worse.
• Keep your hands off your face. Do not pop, squeeze or pick at your acne.
• Look for the words "non-comedogenic" on cosmetic or sunscreen labels. These products should not cause blackheads, whiteheads or red pimples. You also may see the term “non-acnegenic” or the phrases "won't cause acne" or "won't clog pores."
• Do not seek a tan to “treat” your acne. Tanning does not “dry out” acne. In fact, it damages your skin. In addition, some acne medications make the skin very sensitive to ultraviolet (UV) light which can make your acne worsen.

DOES MY DIET AFFECT MY ACNE?

There may or may not be a link between diet and acne. Researchers are studying certain foods and beverages, like milk, to find out whether they worsen or trigger acne. Foods that cause high blood sugars, such as white bread and sugary snacks may worsen acne. Studies have shown that smoking also makes acne worse.

Tip: Avoid getting oil from very greasy foods on your face. Working in a greasy environment, such as a fast food kitchen, may worsen acne. When some vegetable oils touch the skin, acne can worsen.

HOW CAN ACNE SCARS BE TREATED?

Once your acne is under control, your dermatologist can treat your acne scars. Dermatologists use lasers, chemical peels, microdermabrasion, fillers, and other procedures to diminish the appearance of acne scars. Like treatment for active acne, a successful outcome often comes from a customized treatment plan.

A board-certified dermatologist is a medical doctor who specializes in diagnosing and treating the medical, surgical, and cosmetic conditions of the skin, hair and nails. To learn more about acne or to find a board-certified dermatologist in your area, visit aad.org or call toll free (888) 462-DERM (3376).

All content solely developed by the American Academy of Dermatology.
Copyright © by the American Academy of Dermatology and the American Academy of Dermatology Association.

Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides

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