Acne is a common skin disease characterized by pimples on the face, chest, and back. It occurs when the pores of the skin become clogged with oil, dead skin cells, and bacteria. Acne affects nearly 17 million people in the United States. While it can arise at any age, acne usually begins at puberty and worsens during adolescence. Nearly 85% of people develop acne at some time between the ages of 12-25 years.

The face, chest, and back are most affected because those areas have the mostsebaceous glands. These glands produce sebum, an oily natural moisturizer. The glands are found in hair follicles and open onto the skin through pores. At puberty, sebum production increases. Excess sebum can combine with dead skin cells and form a hard plug, or comedo, which blocks the pore. Mild noninflammatory acne consists of the two types of comedones, whiteheads and blackheads.

Moderate and severe inflammatory types of acne result if the plugged follicleis invaded by Propionibacterium acnes, bacteria that normally live onthe skin. A pimple forms when the damaged follicle releases sebum, bacteria,and skin and white blood cells into the surrounding tissues. The most severeacne consists of cysts (closed sacs) and nodules (hard swellings). Scarringoccurs when new skin cells replace damaged cells.

Due to hormonal changes, teenagers often develop acne. Usually, boys are moreseverely affected than girls. However, acne can flare up before menstruation, during pregnancy, and menopause. Individuals with a family history of acneare more likely to have acne. No foods cause acne, but certain ones may trigger flare-ups. Acne can be a side effect of drugs including tranquilizers, antidepressants, antibiotics, oral contraceptives, and anabolic steroids. Abrasive soaps, hard scrubbing, or picking at pimples will make them worse, as willoil-based makeup and hair sprays. Sweating in hot weather and exposure to oils, greases, and polluted air aggravate acne. Emotional stress may contributeto acne.

Acne patients are often treated by family doctors, but some cases are handledby a dermatologist, a skin disease specialist, or an endocrinologist, a specialist who treats diseases of the endocrine (hormones and glands) system. Acne is not difficult to diagnose. The doctor takes a complete medical history and asks about skin care, diet, flare-ups, medication use, and prior treatment. Physical examination includes the face, upper neck, chest, shoulders, back,and other affected areas. Treatment choices depend on whether the acne is mild, moderate, or severe.

Treatment for mild to moderate acne consists of topical medications (medications that go on the skin) and oral antibiotics. These drugs may be used for months to years to control flare-ups. Topical medications are cream, gel, lotion, or pad preparations that include antibiotics (agents that kill bacteria) or comedolytics (agents that loosen hard plugs and open pores). Possible sideeffects include mild redness, peeling, irritation, dryness, and an increasedsensitivity to sunlight. Oral antibiotics may also be prescribed for mild tomoderate acne. The drugs are taken daily for two to four months. Possible side effects include allergic reactions, stomach upset, vaginal yeast infections, dizziness, and tooth discoloration.

For severe acne with cysts and nodules, oral isotretinoin (Accutane) is used.It may be prescribed with topical or oral antibiotics. It reduces sebum production and cell stickiness and is taken for four to five months. Side effectsinclude temporarily worse acne, dry skin, nosebleeds, vision disorders, andelevated liver enzymes, blood fats, and cholesterol. This drug cannot be taken during pregnancy because it causes birth defects. Women who are unresponsive to other therapies may be prescribed anti-androgen drugs, certain types oforal contraceptives, or female sex hormones.

Oral corticosteroids, or anti-inflammatory drugs, are used for an extremely severe, but rare type of destructive inflammatory acne called acne fulminans,found mostly in adolescent males. Acne conglobata, a more common form of severe acne, is characterized by numerous, deep, inflammatory nodules that heal with scarring. It is treated with oral isotretinoin and corticosteroids.

Surgical or medical treatments are available to treat acne or acne scars. Incomedone extraction, the comedo is removed from the pore with a special tool.Chemical peels involve applying glycolic acid to peel off the top layer of skin to reduce scarring. Another technique in which the top layer of skin is removed is dermabrasion. In this procedure, the affected skin is frozen with achemical spray, and removed by brushing or planing. If scars are deep, a procedure called punch grafting may be an option. Deep scars are excised and thearea repaired with small skin grafts. Drug injection is another option for some people. With intralesional injection, corticosteroids are injected directly into inflamed pimples. Collagen injection elevates shallow scars.

Acne is not curable, but it can be controlled by proper treatment. Acne tendsto reappear when treatment stops, but spontaneously improves over time.

User Contributions:

Comment about this article, ask questions, or add new information about this topic:

The Content is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of Content found on the Website.