Acne is a skin problem that occurs when the hair follicles of your skin are blocked by a mix of dead skin cells and sebum (oil). When this happens, bacteria can grow in the plugged hair follicles and cause more skin irritation.
Acne can occur anywhere on skin, but is most common on the face, neck, chest, and back. It usually starts in the early teen years, when the oil glands in the body start making more sebum, but can last into or begin in adulthood, too.
Acne occurs when a mix of dead skin cells and sebum block the hair follicles of your skin. There are a few different types of acne:
- When the hair follicle becomes plugged with oil and skin cells, a “whitehead” forms in the hair follicle.
- If the follicle is plugged near the surface of the skin and air touches the plug, it turns black and is called a "blackhead." A blackhead isn't caused by dirt.
- If the wall of a plugged hair follicle breaks, the area swells and turns into a red bump. If the hair follicle wall breaks near the skin surface, the bump usually becomes a pimple.
- If the follicle wall breaks deep in the skin, acne nodules or cysts can form. This is called "cystic acne."
Both boys and girls get acne. But it may be worse in boys because they have more skin oils. For many people, acne symptoms fade by the age of 25, but they can continue well into the adult years.
Family history also plays a role. If your mother and father had bad acne, you may have it, too.
Your immune system plays a role too. Some people are extra sensitive to the bacteria that get trapped in their hair follicles.
- Hormonal changes, especially during puberty, before your monthly period (in women), or during pregnancy
- Certain medications
- Certain cosmetics, such as oil-based makeup, suntan oil, and hair products
- Squeezing or picking at skin blemishes
- Hard scrubbing of the skin
- Chocolate or greasy foods
- Sexual activity or masturbation
Many treatments are available for acne, including over-the-counter and prescription medicines.
Benzoyl peroxide and salicylic acid are the most common and most effective over-the-counter medicines for acne. These medicines kill bacteria, dry up skin oil, and make your skin peel off. They are available in many forms, such as gels, lotions, creams, soaps, or pads. Keep in mind that it can take up to 8 weeks before you notice an improvement in the appearance of your skin. If an over-the-counter acne product doesn't seem to help after 2 months, talk to your doctor.
In some people, over-the-counter acne medications may cause side effects such as skin irritation, burning, or redness. Tell your doctor if you have side effects that are severe or that don't go away over time.
If over-the-counter medicines are not effective, your doctor may prescribe one or more of the following medicines:
- A retinoid cream or gel: Retinoids, such as tretinoin and adapalene, are usually applied to the skin once a day. Be sure not to get them near your eyes, mouth, and the area under your nose. If you use a retinoid, you must avoid the sun or use a strong sunscreen because this medicine increases your risk of sunburn. Women who are pregnant or may become pregnant should not use a retinoid called tazarotene because it can cause birth defects.
- Antibiotics: If your acne is severe, your doctor may prescribe an antibiotic to treat it. Antibiotics such as minocycline, doxycycline, and tetracycline reduce bacteria and inflammation, and can be used in combination with other treatments for acne, such as benzoyl peroxide. Antibiotics can be taken by mouth or used on the skin as a lotion, cream, or gel. Erythromycin and clindamycin are 2 antibiotics used in topical lotions and gels for acne.
- Isotretinoin: Isotretinoin is a strong medicine used to treat very bad acne. This medicine can cause serious side effects. You will need to carefully follow your doctor’s instructions for taking the medicine, and your doctor will monitor you closely.
- Birth control pills: Birth control pills can help treat acne in women. Talk to your doctor about the pros and cons of taking birth control pills for acne.
In addition to or in combination with medicines, cosmetic procedures such as peels, skin abrasion (dermabrasion or microderm abrasion), and laser or light treatments may help treat acne. These treatments may also help reduce acne scars. Individual large acne cysts often respond dramatically to small injections of steroid medication by your family doctor or a dermatologist.
Lifestyle changes such as healthy diet and regular exercise may also help treat or prevent acne.
Acne, especially cystic acne, can cause scars in some people. You can help reduce scarring by not squeezing or picking at blemishes. Also, avoid scrubbing your skin. If you do get scars, treatments to help reduce scarring are available.