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Acne

Acne vulgaris; Cystic acne; Pimples; Zits

 

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

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:

  • Crusting of skin bumps
  • Cysts
  • Papules (small red bumps)
  • Pustules
  • Redness around the skin eruptions
  • Scarring of the skin
  • Whiteheads
  • Blackheads

 

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.

 
  • Acne

    Acne

    Animation

  •  

    Acne - Animation

    You can call them blackheads, pimples or zits, but by any name, acne can really ruin your day. Waking up to find a giant pimple in the middle of your forehead or chin, especially if it's picture day at school, or you have a big date, can be a real bummer. So, what causes acne? All over your skin you've got tiny little holes called pores. These holes are openings to your hair follicles. Each hole also contains an oil gland. The oil helps keep your skin lubricated and removes dead skin cells. Sometimes your oil glands work overtime, producing too much of the slimy stuff. The extra oil can fill up and block your pores, causing a backup of dirt, bacteria, and cells. At the top of the blockage sits a plug. If the top of the plug is white, you've got a whitehead, the type of pimple many of us are so tempted to pop. If the top of the plug is dark, you've got a blackhead. If the plug bursts open, you'll have a swollen red bump. The most common place to find acne is on your face. But you can also get breakouts on your shoulders, arms, legs, back, and buttocks. Although acne is known as a teenage affliction, you can get pimples at any age, especially if you sweat a lot, use greasy cosmetics, or eat a high-sugar diet. Hormones can also trigger acne outbreaks. Women who are just starting their period may notice more pimples than usual. You may also discover a few pimples on the day of a big test or presentation, because stress can lead to breakouts. So, you may ask, how do you get rid of acne? First, here's something you should never do when you've got acne. Don't squeeze or pick at the bumps. In fact, try not to touch your face at all. You'll just make the acne worse, and you could even leave permanent scars. To treat acne, the first step is gently cleaning your face twice a day with a pH balanced cleanser, such as Cetaphil or Dove. Use warm (not hot) water, and pat dry. Aggressive scrubbing may make acne worse. Many people benefit from adding an over-the-counter acne medicine that contains ingredients like benzoyl peroxide. These creams dry up the extra oil in your skin and kill bacteria. They may make your skin a little red or cause it to peel at first, but they work pretty well at clearing up breakouts. If over-the-counter treatments don't work, see your doctor or a dermatologist. Prescription creams or gels are stronger and may be more effective at clearing up stubborn acne. Many will prescribe antibiotics such as tetracycline, erythromycin, or doxycycline. You can either take these by mouth, or rub them on your skin. Another option is to have a laser treatment or skin peel. Talk to your doctor about these treatments if medicines haven't cleared up your acne. Acne is a rite of passage for teenagers, but pimples can plague people well into their 30s or 40s. You don't have to live with acne, because there are several very effective treatments for it. See your doctor or a dermatologist to discuss your options. Also make an appointment if your acne is getting worse even with treatment, or you've got scarring where your acne used to be.

  • Baby acne

    Baby acne - illustration

    Baby acne is usually seen on the cheeks, chin, and forehead. It can be present at birth but usually develops around 3 to 4 weeks of age. Baby acne occurs when hormonal changes in the body stimulate oil glands in the baby's skin. The condition can look worse when the baby is crying or fussy, or any other instance that increases blood flow to the skin. Baby acne is harmless and usually resolves on its own within several weeks.

    Baby acne

    illustration

  • Acne - close-up of pustular lesions

    Acne - close-up of pustular lesions - illustration

    Acne lesions frequently contain pus. This close-up photograph shows small acne pustules with surrounding inflammation (erythema).

    Acne - close-up of pustular lesions

    illustration

  • Blackheads (comedones)

    Blackheads (comedones) - illustration

    Blackheads, or open comedones, are common in acne. Clogged hair follicles reflect light irregularly to produce this black hue.

    Blackheads (comedones)

    illustration

  • Acne, cystic on the chest

    Acne, cystic on the chest - illustration

    Cystic acne may occur across the upper chest as well as on the back.

    Acne, cystic on the chest

    illustration

  • Acne, cystic on the face

    Acne, cystic on the face - illustration

    The face is the most common location of acne. Here, there are 4 to 6 millimeter red (erythematous) pustules, some with bridging scars and fistulous tract formation (connecting passages). Severe acne may have a profound psychological impact and may cause scarring. Effective treatments are available for this type of acne.

    Acne, cystic on the face

    illustration

  • Acne, vulgaris on the back

    Acne, vulgaris on the back - illustration

    Acne frequently occurs on the back. Here, there are 2 to 6 millimeter wide erythematous (red) pustules with large open and closed comedones. Permanent scarring may follow a severe case of acne. Men are more often affected on their shoulders and back than are women.

    Acne, vulgaris on the back

    illustration

  • Acne on the back

    Acne on the back - illustration

    Acne affects the areas of the skin that contain sebaceous glands, including the face, upper chest, and back. Acne occurs most commonly during adolescence. Many new treatment regimens are available for acne, especially for the most severe types.

    Acne on the back

    illustration

  • Acne

    Acne - illustration

    Acne is a skin condition that causes whiteheads, blackheads, and inflamed red lesions to form. These growths are commonly called pimples or "zits." Three out of four teenagers have acne to some extent.

    Acne

    illustration

  • Acne

    Animation

  •  

    Acne - Animation

    You can call them blackheads, pimples or zits, but by any name, acne can really ruin your day. Waking up to find a giant pimple in the middle of your forehead or chin, especially if it's picture day at school, or you have a big date, can be a real bummer. So, what causes acne? All over your skin you've got tiny little holes called pores. These holes are openings to your hair follicles. Each hole also contains an oil gland. The oil helps keep your skin lubricated and removes dead skin cells. Sometimes your oil glands work overtime, producing too much of the slimy stuff. The extra oil can fill up and block your pores, causing a backup of dirt, bacteria, and cells. At the top of the blockage sits a plug. If the top of the plug is white, you've got a whitehead, the type of pimple many of us are so tempted to pop. If the top of the plug is dark, you've got a blackhead. If the plug bursts open, you'll have a swollen red bump. The most common place to find acne is on your face. But you can also get breakouts on your shoulders, arms, legs, back, and buttocks. Although acne is known as a teenage affliction, you can get pimples at any age, especially if you sweat a lot, use greasy cosmetics, or eat a high-sugar diet. Hormones can also trigger acne outbreaks. Women who are just starting their period may notice more pimples than usual. You may also discover a few pimples on the day of a big test or presentation, because stress can lead to breakouts. So, you may ask, how do you get rid of acne? First, here's something you should never do when you've got acne. Don't squeeze or pick at the bumps. In fact, try not to touch your face at all. You'll just make the acne worse, and you could even leave permanent scars. To treat acne, the first step is gently cleaning your face twice a day with a pH balanced cleanser, such as Cetaphil or Dove. Use warm (not hot) water, and pat dry. Aggressive scrubbing may make acne worse. Many people benefit from adding an over-the-counter acne medicine that contains ingredients like benzoyl peroxide. These creams dry up the extra oil in your skin and kill bacteria. They may make your skin a little red or cause it to peel at first, but they work pretty well at clearing up breakouts. If over-the-counter treatments don't work, see your doctor or a dermatologist. Prescription creams or gels are stronger and may be more effective at clearing up stubborn acne. Many will prescribe antibiotics such as tetracycline, erythromycin, or doxycycline. You can either take these by mouth, or rub them on your skin. Another option is to have a laser treatment or skin peel. Talk to your doctor about these treatments if medicines haven't cleared up your acne. Acne is a rite of passage for teenagers, but pimples can plague people well into their 30s or 40s. You don't have to live with acne, because there are several very effective treatments for it. See your doctor or a dermatologist to discuss your options. Also make an appointment if your acne is getting worse even with treatment, or you've got scarring where your acne used to be.

  • Baby acne

    Baby acne - illustration

    Baby acne is usually seen on the cheeks, chin, and forehead. It can be present at birth but usually develops around 3 to 4 weeks of age. Baby acne occurs when hormonal changes in the body stimulate oil glands in the baby's skin. The condition can look worse when the baby is crying or fussy, or any other instance that increases blood flow to the skin. Baby acne is harmless and usually resolves on its own within several weeks.

    Baby acne

    illustration

  • Acne - close-up of pustular lesions

    Acne - close-up of pustular lesions - illustration

    Acne lesions frequently contain pus. This close-up photograph shows small acne pustules with surrounding inflammation (erythema).

    Acne - close-up of pustular lesions

    illustration

  • Blackheads (comedones)

    Blackheads (comedones) - illustration

    Blackheads, or open comedones, are common in acne. Clogged hair follicles reflect light irregularly to produce this black hue.

    Blackheads (comedones)

    illustration

  • Acne, cystic on the chest

    Acne, cystic on the chest - illustration

    Cystic acne may occur across the upper chest as well as on the back.

    Acne, cystic on the chest

    illustration

  • Acne, cystic on the face

    Acne, cystic on the face - illustration

    The face is the most common location of acne. Here, there are 4 to 6 millimeter red (erythematous) pustules, some with bridging scars and fistulous tract formation (connecting passages). Severe acne may have a profound psychological impact and may cause scarring. Effective treatments are available for this type of acne.

    Acne, cystic on the face

    illustration

  • Acne, vulgaris on the back

    Acne, vulgaris on the back - illustration

    Acne frequently occurs on the back. Here, there are 2 to 6 millimeter wide erythematous (red) pustules with large open and closed comedones. Permanent scarring may follow a severe case of acne. Men are more often affected on their shoulders and back than are women.

    Acne, vulgaris on the back

    illustration

  • Acne on the back

    Acne on the back - illustration

    Acne affects the areas of the skin that contain sebaceous glands, including the face, upper chest, and back. Acne occurs most commonly during adolescence. Many new treatment regimens are available for acne, especially for the most severe types.

    Acne on the back

    illustration

  • Acne

    Acne - illustration

    Acne is a skin condition that causes whiteheads, blackheads, and inflamed red lesions to form. These growths are commonly called pimples or "zits." Three out of four teenagers have acne to some extent.

    Acne

    illustration

Self Care

 

Tests for Acne

 

     

    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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