If you've got acne, you're in good company

Nearly all teens suffer from it at some point and 3% of the adult population continue to have persistent acne breakouts. For most people acne is no longer a problem once they reach their mid 20s, but for teens it can be a major physical and emotional hurdle. Fortunately, there are a number of treatment options that can help control it.

Acne is an inflammatory disorder of sebaceous, or oil-producing, glands and the hair follicles they are connected to, that results in open comedones (blackheads), closed comedones (whiteheads), inflamed papules (pimples), pustules (a more severe form of acne that results in scarring), cysts, and nodules.

Detailed Description

Despite its dramatic name, acne vulgaris is actually the common acne that troubles nearly all adolescents or adults at some point. Acne generally begins at puberty when the body increases its production of sex hormones, namely androgens. These hormones trigger overactivity in the sebaceous or oil-producing glands. The glands enlarge and begin to produce excessive amounts of sebum, the oily substance that normally lubricates the skin.

At the same time keratin, a fibrous protein that is found in the lining of the pore, can begin to clump together. A build up of dead skin cells and sebum clogs the pores and forms a plug. This plug prevents the outflow of excess sebum to the skin surface. The bacteria then multiplies and produce an enzyme called lipase which irritates the hair follicle and causes it to rupture. The result: the red bumps we recognize as acne. A black plug, or blackhead, is caused when the plug of oxidized oil and dead skin cells is pushed to the surface. A white head results when the pore opening is very tightly closed and the plug cannot surface. Papules are formed from inflammation around the comedones.

The main features of acne are blackheads (open comedones), whiteheads (closed comedones), and pimples (inflamed papules). In severe acne (cystic acne), deep pustules and cysts will form.

How Common Is Acne?

Acne affects nearly the entire population at some point in their lives. It is most common in adolescents and young adults, but acne may persist into the eighth or ninth decade of life. Acne is slightly more common in women, though men may have more severe cases.

What You Can Expect

Acne inflammations can range from mild to severe throughout the course of the disorder, even with appropriate medical care. Women may experience increased outbreaks during menstruation as well as during pregnancy. However it's not unusual for acne to subside during pregnancy.

Most acne sufferers have no scarring or lasting effects if the acne isn't picked at, but deep, cystic acne may leave pitted or "ice pick" scarring.

Conventional Treatment

Goals of Treatment

While there is no cure for acne, new outbreaks can be controlled and your skin's appearance can be improved. Both over-the-counter and prescription medical treatments are beneficial in most cases to improve the look of the skin and prevent further outbreaks.

Mild to moderate acne eruptions can be treated with a simple cleansing routine (twice-daily cleansing and the use of topical ointments or preparations such as over-the-counter products containing benzoyl peroxide or salicylic acid). More difficult cases may require topical prescription antibiotic preparations, oral prescription antibiotics such as tetracycline, oral contraceptives, the powerful prescription drugs Retin-A (tretinoin) or Accutane (isotretinoin), and in some cases surgical comedone extraction, dermabrasion, or cryotherapy.

Medical attention from a family physician, internists, dermatologists, or plastic or reconstructive surgeon can prevent or repair scarring in severe cases.

Drug Therapy

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Activity and Diet Recommendations

Aerobic exercise and full physical activity are beneficial if you have acne.

No special diet has been shown to decrease acne but a healthy diet can contribute to overall skin health. Contrary to popular belief, chocolate and fatty foods do not cause acne eruptions.

Possible Complications

The following are some possible complications of acne:

  • Acne conglobata: a more severe form of acne that can affect other body parts as well
  • Permanent scarring of the face, neck, or upper trunk
  • Emotional "scarring"

Quality of Life

Appearance is important to most people. Teens especially can be sensitive about their acne. Prompt medical care for acne combined with emotional rapport can help ease this transition. The sufferer is not to blame for the condition. Parents need to know that acne is not the result of a defect in being clean. In fact, overwashing can make it worse. In more extreme cases, vigorous treatment may help reduce the possibility of scarring.

Considerations for Women

  • Should you choose to prevent pregnancy with oral contraceptives, your doctor may recommend one lowest in male hormones, such as desogestrel and ethinyl estradiol (such as Desogen or Ortho-Cept) or norgestimate with ethinyl estradiol (such as Ortho-Cyclen or Ortho Tri-Cyclen).
  • If your acne is being treated with oral antibiotics such as tetracycline, minocycline, or erythromycin, you may develop a vaginal yeast infection, which can be treated with vaginal creams.
  • Although controversial, some experts believe that oral antibiotics taken in conjunction with oral contraceptives may reduce the oral contraceptives' effectiveness in preventing pregnancy.


  • Acutane (isotretinoin), prescribed for severe, persistent acne, can cause severe malformations in a developing fetus. If you take it you must also take strict precautions to avoid pregnancy at least one month before beginning treatment during treatment and one month following treatment.
  • No drug is absolutely guaranteed to be safe during pregnancy. Oral or topical erythromycin is generally thought to be safe. Topical benzoyl peroxide is probably safe.
  • Pregnancy may cause acne to flare. It may also cause a remission.
  • Tetracyclines may cause staining of growing teeth and precludes their use in pregnant women and children under 10.

Last updated 23 May 2012


Acne vulgaris

NOTE: Rosacea (also called acne rosacea), while it may look like acne, is a different condition and requires a different treatment approach. Using the methods employed to treat acne in treating rosacea can actually worsen the condition.




Established Causes

Acne is due to the overactivity of the skin's oil-producing glands, abnormal excess production of keratin within the pore, bacterial colonization, and an inflammatory reaction. Pores become plugged with a mixture of excess oil, keratin, dead skin cells, and bacteria, causing acne eruptions. With inflammatory acne, the body's immune response to a bacteria, Propionibacterium acnes, is involved, as well as its response to the inflammation from follicular rupture.

Theoretical Causes

Acne is regarded by most as a condition caused by multiple factors. A combination of abnormal keratin formation, hormonal action, colonization of hair follicles by P. acnes, and a hypersensitive immune response all contribute.

Risk Factors

There are certain risk factors for acne. They include:

  • Adolescence
  • Hormonal disorders with increased androgens
  • Hot, humid climate
  • Family history of acne
  • Androgenic steroid abuse
  • The use of some birth control pills
  • The use of oily cosmetics
  • The rubbing or occluding of the skin surface by things such as sports equipment, helmets, or even the phone or your hands when placed against your face
  • The use of systemic corticosteroids
  • Exposure to industrial oils and tars
  • Psychological stress

Risk factors are traits or behaviors that may make you statistically more likely than others in the general population to have a certain condition. They are not necessarily "causes" of the condition.

Symptoms & Diagnosis

Symptoms of Condition

Visible signs of acne include whiteheads, blackheads, pimples, pustules, and, in more serious cases, cysts and nodules.

Conditions That May Be Mistaken for Acne

It is usually easy to distinguish acne vulgaris. Somewhat similar appearing conditions can include:

  • Acne rosacea
  • Folliculitis
  • Perioral dermatitis

How Acne Is Diagnosed

Acne is diagnosed by its appearance. In addition to a physical exam, your doctor may also look at your medical and personal history to determine if you have any potentially provoking factors, such as androgenic steroid abuse, use of some birth control pills, use of oily cosmetics, rubbing or occluding of the skin surface by things such as sports equipment, helmets, or even the phone or your hands when placed against your face, use of systemic corticosteroids, and exposure to industrial oils and tars.

Should you develop acne as an adult after having been previously unaffected, your doctor may order tests to measure your levels of testosterone and other hormones.

Alternative care


Zinc may be helpful. In one study, three months of zinc supplementation significantly reduced the pimple population in a group of test subjects. Most experts recommend taking from 20 mg to 50 mg of zinc per day, but bear in mind that this treatment is considered controversial.


Tea tree oil, extracted from an Australian tree (no relative of the bush whose leaves give us Lipton), is a potent antiseptic. Australian researchers gave 124 people with acne either an over-the-counter acne product (containing 5% benzoyl peroxide) or tea tree oil. In the study, both treatments were equally effective. Use a cotton ball to dab 100% tea tree oil on trouble spots. If the oil proves irritating to your skin, discontinue use. There is increasing incidence of allergies contact dermatitis to topical tea tree oil.

Self care & Prevention

Preventing Acne Outbreaks

  • To control oiliness, wash gently no more than twice a day with a mild, unscented, nonabrasive soap or soap-free cleanser. More frequent washing can irritate skin and increase sebum production.
  • Try to use less makeup — it can clog your pores.
  • Minimize stress. Stress causes hormonal changes that can exacerbate acne.
  • Keep your hair clean with gentle, regular cleansing and shampooing. Keep hair off your face. This also helps reduce skin oiliness.
  • Use noncomedogenic (non-pore-clogging) skin-care products.


In general, chocolate and other foods do not increase the risk of acne. But there are some exceptions. If you suspect a certain food, avoid eating it for a month and see if that helps.

Self-Care Measures

Do not squeeze pimples. This can cause inflammation and further infection. Instead, try using a blackhead (comedone) extractor to gently clean out clogged pores. Wipe your skin with alcohol before and after to prevent infection.