Acne

Overview, Causes, & Risk Factors

Acne is a common skin condition in which the hair follicles become clogged withsebum. The hair follicles are the openings around the hair shaft, and sebum isthe oil produced by the glands within the follicle. The clogged follicles causepimples and inflamed infected abscesses, or collections of pus.

What is going on in the body?

Acne tends to develop in teenagers because of an interaction among hormones,sebum, and bacteria. During puberty, the glands in the skin produce excessivesebum. In acne-prone skin, the sebum and dead skin cells clog the hairfollicles and form comedones, or clogged pores.

What are the causes and risks of the condition?

Acne is caused by 4 factors:

hormones, particularly the hormone called androgen

increased production of sebum, the oily substance within the hairfollicles

changes in the lining of the hair follicles

bacteria, including organisms that normally live on the skin surface. Whenthese bacteria are trapped within the hair follicles, they can cause infectionsand inflame the follicles.

Virtually every adolescent experiences some comedones.Generally, acne starts at about age 10 to 13, and lasts for 5 to 10 years. Aroundthe age of 14 or 15, 40% of adolescents have acne that is serious enough to require avisit to a healthcare provider. Acne occurs in both male and female adolescents,but males are more likely to have a severe form of acne. Some peopledevelop acne for the first time as an adult.

Certain forms of acne tend to run in families. If an adolescent’s parents orolder siblings have severe acne, the adolescent has a higher risk of developingsevere acne.

Risk factors for development or worsening of acne include the following:

makeup and skin care products, which can clog the hair follicles

menstrual cycles infemales. A female is more likely to have flare-ups of acne around the time ofher period, when her glands are more sensitive to the hormone androgen.

airborne grease, such as in a fast-food restaurant

routine exposure to products, such as motor oil in an automotiveshop

rubbing and friction of the skin by hair, clothing, or sportingequipment

Symptoms & Signs

What are the signs and symptoms of the condition?

Acne may occur on a person’s face, neck, chest, back, shoulders,scalp, and upper arms and legs. Comedones, or clogged pores, are the firstsigns of acne. There are 2 types of comedones:

blackheads, which are incompletely clogged pores capped with blackened dustor debris

whiteheads, which are completely clogged pores

A comedone may also break through the pore wall underneath the skin and releaseits contents. This causes a pimple or pustule. If this substance is releaseddeep into the skin it will cause a cyst, which is a small, pus-filled bumpbeneath the skin.

Diagnosis & Tests

How is the condition diagnosed?

Acne is diagnosed when blackheads, whiteheads, pimples, pustules, or cystsare seen on the skin.

Prevention & Expectations

What can be done to prevent the condition?

Measures to prevent or minimize acne include the following:

washing the face twice a day with a mild soap and patting it dry

avoiding any picking, squeezing, or popping of comedones, pimples,pustules, and cysts. This type of manipulation actually makes the acneworse.

selecting skin care products labeled as noncomedogenic, which means theydon’t clog pores. Look for the noncomedogenic label on makeup, foundation,moisturizers, and creams.

avoiding prolonged exposure to oil and grease in settings such as fast-foodrestaurants and automotive shops

avoiding unnecessary friction from hair, clothing, or sportingequipment

What are the long-term effects of the condition?

Long-term acne can lead to permanent scarring. It can alsodecrease a person’s self esteem and confidence.

What are the risks to others?

Acne is not contagious and poses no risk to others.

Treatment & Monitoring

What are the treatments for the condition?

The most important thing in treating acne is to keep the skin gently cleansedand pores unclogged. Over-the-counter products for acne include the following:

cleansers, which should be used only if recommended by the healthcareprovider. Many cleansers may aggravate the acne, especially if the personvigorously scrubs the area.

benzoyl peroxide, which can be a cream, gel, or lotion. Benzoyl peroxideworks by killing the bacteria that can inflame the hair follicle.

salicylic acid, which can be a lotion, cream, or pad. Salicylic acidhelps unclog pores and prevent abnormal shedding of skin cells.

Prescription medications used to treat acne include the following:

antibiotics, such as tetracycline and erythromycin, which can be takenorally or applied to the skin. Antibiotics kill bacteria on the skin and withinthe hair follicles.

retinoids, a class of medications that are derived from vitamin A. Retinoids are used formoderate to severe acne. They work by reducing sebum production, killingbacteria, and making skin growth and shedding normal. These medications aregenerally applied to the skin. Isotretinoin, also known as Accutane, is apowerful oral medication used for severe acne. It is currently the subject ofinvestigation by the Food and Drug Administration, or FDA, for a host of sideeffects.

oral contraceptives,which are female hormones used as birth control pills. These may be prescribedto females with acne to offset the effect of androgen on the skin.

Removal of comedones can also help to treat acne. This needs to be done with aspecial instrument to minimize skin injury. Cortisone may also be injecteddirectly into the skin lesion in certain cases for large, painful cysts.

What are the side effects of the treatments?

Excessively dry and red skin is the most common side effect of medicationsapplied to the skin for treatment of acne. Oral antibiotics may cause stomachupset, allergic reactions,and a sensitivity to sunlight. They may also decrease the effectiveness oforal contraceptives.

Isoretinoin, or Accutane, has been linked to birth defects and miscarriage when used by apregnant woman. Anadvisory committee of the Food and Drug Administration has proposed amandatory registry for women who take isotretinoin. The FDA has also receivedreports of depression andsuicide in individualstaking the medication. At the request of the FDA, the medication’s manufacturerhas also notified healthcare providers that people taking isotretinoin mustreceive a medication guide and sign an informed consent document.

What happens after treatment for the condition?

Most treatments need to be continued on an ongoing basis to be effective. Oneexception is isotretinoin, which is used for 16 to 20 weeks.

How is the condition monitored?

Any new or worsening symptoms should be reported to the healthcare provider.

Article type: xmedgeneral