Acne: An Overview
Acne is a disease that affects the skin's oil glands. The tiny holes in your skin (pores) connect to oil glands under the skin through a canal called a follicle. Inside the follicles, sebum (an oily substance the glands produce) carries dead skin cells to the surface of the skin. A thin hair also grows through the follicle and out to the skin. When a follicle gets clogged up with cells and sebum, a pimple develops.
Most pimples (also known as zits) are found on the:
- Face
- Neck
- Back
- Chest
- Shoulders.
The term "acne" simply refers to several pimples occuring together. Nearly 17 million people in the United States have acne, making it the most common skin disease. Although acne is not a serious health threat, severe acne can lead to disfiguring, permanent scarring. This can be upsetting to people who are affected by the disorder.
Understanding Acne and the Skin
Doctors describe acne as a disease of the pilosebaceous units (PSUs). Found over most of the body, PSUs consist of a sebaceous (oil) gland connected to a canal -- called a follicle -- that contains a fine hair. These units are most numerous on the face, upper back, and chest.
The sebaceous glands make an oily substance called sebum that normally empties onto the skin's surface through the opening of the follicle, commonly called a pore. Cells called keratinocytes line the follicle.
The hair, sebum, and keratinocytes that fill the narrow follicle may produce a plug, which is an early sign of acne. The plug prevents sebum from reaching the surface of the skin through a pore.
The mixture of oil and cells allows bacteria that normally live on the skin to grow inside the plugged follicles. These bacteria, known as Propionibacterium acnes (P. acnes), produce chemicals and enzymes and attract white blood cells that cause inflammation. (Inflammation is a characteristic reaction of tissues to disease or injury and is marked by four signs: swelling, redness, heat, and pain.) When the wall of the plugged follicle breaks down, it spills everything into the nearby skin -- sebum, shed skin cells, and bacteria -- leading to lesions or pimples.
- Whiteheads. These are pimples that stay under the surface of the skin.
- Blackheads. These pimples rise to the skin's surface and look black. The black color is not from dirt.
- Papules. These are small pink bumps that can be tender.
- Pustules. These pimples are red at the bottom and have pus on top.
- Nodules. These are large, painful, solid pimples that are deep in the skin.
- Cysts. These deep, painful, pus-filled pimples can cause scars.
Acne is the most common skin disease, affecting nearly 17 million people in the United States. People of all races and ages get acne, but it is most common in teenagers and young adults. Nearly 85% of people between the ages of 12 and 24 get acne. For most people, acne goes away by age 30. But some people in their 40s and 50s still get acne.
Factors Contributing to Acne
The exact cause of acne is unknown, but doctors think certain factors might contribute to this condition. These potential factors include:
- The increase in hormones during the teenage years (this can cause the oil glands to plug up more often)
- Hormone changes during pregnancy
- Starting or stopping birth control pills
- Heredity (if your parents had acne, you might get it too)
- Some types of medicine
- Greasy makeup.
(Click Causes of Acne for more information about possible acne causes.)
Doctors who specialize in treating skin problems (dermatologists) can help you overcome acne. The different approaches to
acne treatment attempt to:
- Heal pimples
- Stop new pimples from forming
- Prevent scarring
- Help reduce the embarrassment of having acne.
Early treatment for acne is the best way to prevent scars. Your doctor may suggest over-the-counter (OTC) or prescription drugs. Some forms of
acne medication are put right on the skin. Other medicines are pills that you swallow. The doctor may tell you to use more than one acne medicine.
Here are some ways to care for skin if you have acne:
- Clean your skin gently. Use a mild cleanser in the morning, evening, and after heavy workouts.
- Scrubbing the skin does not stop acne. It can even make the problem worse.
- Try not to touch your skin. People who squeeze, pinch, or pick their pimples can get scars or dark spots on their skin.
- Shave carefully. If you shave, you can try both electric and safety razors. With safety razors, use a sharp blade. Also, it helps to soften your beard with soap and water before putting on shaving cream. Shave lightly and only when you have to.
- Stay out of the sun. Many acne drugs can make people more likely to sunburn. Being in the sun a lot can also make your skin wrinkle and raise the risk of skin cancer.
- Choose makeup carefully. All makeup should be oil-free. Look for the word "noncomedogenic" on the label. This means that the makeup will not clog up your pores. But some people still get acne even if they use these products.
(Click Acne Skin Care for more information about good skin care for those with acne.)
Things That Make Acne Worse
Some things can make acne worse, such as:
- Changing hormone levels in teenage girls and adult women 2 to 7 days before their period starts
- Leaning on or rubbing the skin
- Pressure from bike helmets, backpacks, or tight collars
- Pollution and high humidity
- Squeezing or picking at pimples
- Hard scrubbing of the skin.
There are many myths about what causes acne. Dirty skin and stress do not cause acne. Also, chocolate and greasy foods do not cause acne in most people.
(Click Acne Myths for more information on myths about acne.)
Most young women and men will have at least a few pimples over the course of their lives. But acne seems to affect men and women in different ways. Young men are more likely to have a more serious form of acne. Acne in young women tends to be more random and linked to hormonal changes, such as the menstrual cycle.
As women get older, acne often gets better. But some women have acne for many years. Some women even get acne for the first time at age 30 or 40.
For many women, acne can be an upsetting illness. Women may have feelings of
depression, poor body image, or low self-esteem. But you don't have to wait to outgrow acne or to let it run its course. Today, almost every case of acne can be resolved. Acne can also, in some cases, be prevented. Talk with your doctor or dermatologist about how you can help prevent acne and whether treatment would be beneficial for you.
Acne research scientists are looking at new ways to treat acne. These researchers are:
- Working on new drugs to treat acne
- Looking at ways to prevent plugs
- Looking at ways to stop the hormone testosterone from causing acne.
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