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Acne

Definition

Acne is a skin condition that causes pimples or "zits." Whiteheads, blackheads, and red, inflamed patches of skin (such as cysts) may develop.

Alternative Names

Acne vulgaris; Cystic acne; Pimples; Zits

Causes

Acne occurs when tiny holes on the surface of the skin become clogged. These holes are called pores.

  • Each pore opens to a follicle. A follicle contains a hair and an oil gland. The oil released by the gland helps remove old skin cells and keeps your skin soft.
  • When glands produce too much oil, the pores can become blocked. Dirt, bacteria, and inflammatory cells build up. The blockage is called a plug or comedone.
  • If the top of the plug is white, it is called a whitehead.
  • If the top of the plug is dark, it is called a blackhead.
  • If the plug breaks open, swelling and red bumps occur.
  • Acne that is deep in your skin can cause hard, painful cysts. This is called nodulocystic acne.

Acne is most common in teenagers, but anyone can get acne, even babies. The problem tends to run in families.

Some things that may trigger acne include:

  • Hormonal changes that make the skin oilier. These may be related to puberty, menstrual periods, pregnancy, birth control pills, or stress.
  • Greasy or oily cosmetic and hair products.
  • Certain drugs (such as steroids, testosterone, estrogen, and phenytoin).
  • Heavy sweating and humidity.

Research does not show that chocolate, nuts, and greasy foods cause acne. However, diets high in refined sugars or dairy products may be related to acne in some people.

Symptoms

Acne commonly appears on the face and shoulders. It may also occur on the trunk, arms, legs, and buttocks. Skin changes include:

Exams and Tests

Your health care provider can diagnose acne by looking at your skin. Testing is not needed in most cases. Bacterial culture may be performed to rule out infection if large pus bumps persist.

Treatment

SELF-CARE

Steps you can take to help your acne:

  • Clean your skin gently with a mild, nondrying soap (such as Dove, Neutrogena, Cetaphil, CeraVe, or Basics).
  • Look for water-based or "noncomedogenic" formulas for cosmetics and skin creams. (Noncomedogenic products have been tested and proven not to clog pores and cause acne.)
  • Remove all dirt or make-up. Wash once or twice a day, including after exercising.
  • Avoid scrubbing or repeated skin washing.
  • Shampoo your hair daily, especially if it is oily.
  • Comb or pull your hair back to keep the hair out of your face.

What NOT to do:

  • Try not to squeeze, scratch, pick, or rub the pimples. This can lead to skin infections and scarring.
  • Avoid wearing tight headbands, baseball caps, and other hats.
  • Avoid touching your face with your hands or fingers.
  • Avoid greasy cosmetics or creams.
  • DO NOT leave make-up on overnight.

If these steps do not clear up the blemishes, try over-the-counter acne medicines that you apply to your skin.

  • These products may contain benzoyl peroxide, sulfur, resorcinol, or salicylic acid.
  • They work by killing bacteria, drying up skin oils, or causing the top layer of your skin to peel.
  • They may cause redness, drying, or peeling of the skin.

A small amount of sun exposure may improve acne slightly, but tanning mostly hides the acne. Too much exposure to sunlight or ultraviolet rays is not recommended because it increases the risk for skin cancer.

MEDICINES FROM YOUR HEALTH CARE PROVIDER

If pimples are still a problem, a provider can prescribe stronger medicines and discuss other options with you.

Antibiotics may help some people with acne:

  • Oral antibiotics (taken by mouth) such as tetracycline, doxycycline, minocycline, erythromycin, trimethoprim, and amoxicillin
  • Topical antibiotics (applied to the skin) such as clindamycin, erythromycin, or dapsone

Creams or gels applied to the skin may be prescribed:

  • Retinoic acid cream or gel (tretinoin, Retin-A)
  • Prescription formulas of benzoyl peroxide, sulfur, resorcinol, or salicylic acid
  • Topical azelaic acid

For women whose acne is caused or made worse by hormones:

  • A pill called spironolactone may help.
  • Birth control pills may help in some cases, though they may make acne worse in some women.

Minor procedures or treatments may also be helpful:

  • A laser procedure called photodynamic therapy may be used.
  • Your provider may also suggest chemical skin peeling; removal of scars by dermabrasion; or removal, drainage, or injection of cysts with cortisone.

People who have cystic acne and scarring may try a medicine called isotretinoin (Accutane). You will be watched closely when taking this medicine because of its side effects.

Pregnant women should NOT take Accutane, because it causes severe birth defects.

  • Women taking Accutane must use 2 forms of birth control before starting the drug and enroll in the iPledge program.
  • Men also need to be enrolled in the iPledge program.
  • Your provider will follow you on this drug and you will have regular blood tests.

Outlook (Prognosis)

Most of the time, acne goes away after the teenage years, but it may last into middle age. The condition often responds well to treatment after 6 to 8 weeks, but may flare up from time to time.

Scarring may occur if severe acne is not treated. Some people become very depressed if acne is not treated.

When to Contact a Medical Professional

Call your provider if:

  • Self-care steps and over-the-counter medicine do not help after several months.
  • Your acne is very bad (for example, you have a lot of redness around the pimples, or you have cysts).
  • Your acne is getting worse.
  • You develop scars as your acne clears up.
  • Acne is causing emotional stress.

If your baby has acne, call the baby's provider if acne does not clear up on its own within 3 months.

References

Habif TP. Acne, roacea, and related distorders. In: Habif TP, ed. Clinical Dermatology. 6th ed. St. Louis, MO: Elsevier Saunders; 2016:chap 7.

Zaenglein AL, Thiboutot DM. Acne vulgaris. In: Bolognia JL, Jorizzo JL, Schaffer JV, et al, eds. Dermatology. 3rd ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 36.

Review Date:7/23/2015
Reviewed By:Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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