Acne is a very common skin problem that shows up as outbreaks of bumps called pimples or zits. Acne usually appear on the face, neck, back, chest, and shoulders. Acne can be a source of emotional distress, and severe cases can lead to permanent scarring. At Skin PC, our skincare specialists will work with you to find the right acne treatment for you.
What causes acne?
Acne begins when the pores in the skin become clogged and can no longer drain sebum (an oil made by the sebaceous glands that protects and moisturizes the skin.) The sebum build-up causes the surrounding hair follicle to swell. Hair follicles swollen with sebum are called comedones. If the sebum stays beneath the skin, the comedones produce white bumps called whiteheads. If the sebum reaches the surface of the skin, the comedones produce darkened bumps called blackheads. This black discoloration is due to sebum darkening when it is exposed to air. Both whiteheads and blackheads may stay in the skin for a long time.
Bacteria called Propionibacterium acnes (P. acnes) that normally live on the top of the skin can enter the clogged pores and infect the sebum. This causes the skin to become swollen, red, and painful. Infected sebaceous glands may burst, releasing sebum and bacteria into the surrounding skin, creating additional inflammation. In severe cases, larger nodules and cysts may form in the deeper layers of the skin.
What are the different types of acne?
Acne can be categorized by its severity:
- Mild acne describes a few scattered comedones (whiteheads or blackheads) with minimal inflammation (no pustules).
- Moderate acne describes a denser collection of comedones as well as red, inflamed, pus-filled lesions (pustules).
- Severe acne, also called nodular or cystic acne, describes widespread and deep lesions that are painful, inflamed, and red. This form of acne is likely to lead to scarring if left untreated.
Who gets acne?
Anyone at any age can get acne. Acne is very common in teenagers because the surging hormone levels (androgens) associated with puberty create more active sebaceous glands. Adults are also susceptible to acne, particularly women. Acne is more likely to afflict people whose parents had acne.
What factors make acne worse?
Acne lesions can come and go. These factors can cause acne to worsen:
- Changing hormone levels in women 2 to 7 days before their menstrual period, during pregnancy, or when starting or stopping birth control pills
- Oil from skin products (moisturizers or cosmetics) or grease in the workplace (for example, a kitchen with fry vats)
- Pressure from sports helmets or equipment, backpacks, tight collars, or tight uniforms
- Environmental irritants, such as pollution and high humidity
- Squeezing or picking at blemishes
- Hard scrubbing of the skin
What acne treatments are available?
Almost all cases of acne can be effectively treated. The goal of acne treatment is to heal existing lesions, stop new lesions from forming, and prevent acne scars.
Different acne medications are available that control one or more of the underlying causes of acne. Common classes of acne medications include the following:
- Topical retinoids (Differin, Epiduo, Retin A Micro, Tazorac, or tretinoin) help unclog sebaceous glands and keep skin pores open.
- Antibiotics, such as doxycycline and minocycline (Solodyn), may be used to fight the P. acnes bacteria.
- Isotretinoin (Accutane, Amnesteem, Sotret) remain a mainstay of treatment for severe acne by reducing sebum (oil) production.
- Hormonal agents, such as birth control pills, may be used by women to reduce sebum (oil) production.
Your doctor will prescribe acne medications based on the following factors:
- Severity of your acne. Mild acne may respond well to a topical retinoid alone. Moderate acne may respond better to a combination of topical retinoid with an antibiotic or other medication. Severe acne with scarring may need treatment with isotretinoin (Amnesteem, Sotret).
- Results of previous treatments. Medications may be added in a step-wise fashion, if previous acne treatments are found to be ineffective.
- Degree of scarring. More aggressive therapies may be started earlier if there already signs of acne scars.
- Gender. Some treatments are available only for women, such as birth control pills.
Non-prescription acne medications may provide sufficient results for some people with mild acne. However, most people with moderate acne and all with severe acne will need to use prescription medications or effective treatment.
A chemical peel is a type of skin treatment which is used to treat mild to moderate acne. Whether your acne is mild or more severe, regular exfoliation will smooth and soften the skin, brighten the complexion, and lessen breakout activity.