Acne vulgaris (commonly called acne) is a skin condition characterized by pimples on the face, chest, neck or back. Acne occurs when the pores on the surface of the skin become clogged with dead skin cells, sebum (oil), or bacteria.
Acne usually begins during puberty, but it is not restricted to any age group. In fact, many adults develop acne in their 20s, 30s and 40s.
Acne is one the common skin problems, affecting more than 50 million people in U.S., and nearly 85 percent of all people experience acne at some point in their lives.
Although acne is not a life-threatening condition, but it can be upsetting and severe acne can lead to permanent scarring.
Different Types of Acne and Their Symptoms
The signs and symptoms of acne depend on the severity of the condition and the type of acne. There are six different types of acne:
Blackheads, also known as open comedones, form when a pore is partially blocked, allowing some trapped sebum (oil) and dead skin cells to appear to the surface of the skin, giving them a black appearance. The black marking happens when a natural occurring pigment called melanin reacts with oxygen.
Whiteheads, or closed comedones, form when a pore is completely blocked, entrapping sebum, bacteria and dead skin cells. Since the pores are completely blocked, the air unable to reach the follicle, causing a white appearance on the surface.
Papules occur when the clogging causes a hair follicle to become inflamed, forming small pink or red bumps beneath the skin’ surface. Papules can last for 5 to 10 days, after which they often progress into pustules.
Pustules form when a plug deep inside a pore traps oil and bacteria, attracting white blood cells to fight the infection. Pus is simply a collection of dead white blood cells. Pustules have a yellow or white pus-filled center with a red base. The greater the inflammation, the redder and larger the pustule will be.
Nodules are large, inflamed lumps which can be quite painful. A nodule occurs when bacteria and debris become trapped deep within the layers of the skin, result in infection. Nodules are one of the more severe types of acne and are more likely to leave post-acne marks if left untreated.
Nodules should be treated by a dermatologist. Over-the-counter treatments may not be powerful enough to clear them up, but prescription drugs can be helpful.
Cysts are the most severe form of acne. They are large, deep, pus-filled bumps that can be painful. Cysts occur when the walls of pores affected by blackheads or whiteheads burst and the bacteria and debris spread within the skin.
Like nodules, cysts are more likely to leave long-lasting post-acne mark and should be treated by a dermatologist.
Causes and Risk Factors of Acne
The exact causes of acne are unknown however experts believe that hormonal changes, lifestyle and genetics factors play a significant role.
During puberty or pregnancy, your body undergoes hormonal changes. These changes can cause the sebaceous glands to produce more sebum, an oily substance that is produced naturally to keep the skin moisturized and supple.
Excess sebum can trap dead skin cells and dirt in the pores, leading to clogged pores. Also, too much sebum can nourish the P. acnes bacteria that lives on the skin, resulting in pimples and inflammation.
Individuals with a family history of acne have greater risk of getting acne. One study has found that if both your parents had acne, you’re more likely to get more severe acne at an early age.
Several studies have shown that stress can trigger acne as it can increase the production of cortisol and adrenaline, which exacerbate acne.
Studies indicate that certain foods, including cow’s milk and carbohydrate-rich foods such as bread and bagels, may worsen acne. Chocolate has long been suspected of making acne worse.
A small study of 14 men with acne showed that eating chocolate was related to a worsening of symptoms. Further study is needed to examine why this happens and whether people with acne would benefit from following specific dietary restrictions.
External factors, such as oil-based cosmetics may contribute to the development of acne by clogging the pores. Water-based products are less likely to cause the problems.
Certain medications, such as corticosteroids, antidepressants, or anti-epileptic drugs, can trigger the development of acne.
Diagnosis and Treatment of Acne
To diagnose acne, a dermatologist will first examine your skin to determine what kind of pimples you have and how much of your skin is affected. This exam is painless and takes about 10-15 minutes.
Your dermatologist will also ask a variety of questions about your symptoms, including how and when you have acne breakouts, what kind of pimples you have most often, and if acne runs in your family. This information helps your GP to determine what treatment is best for you.
Treatment will also depend on how severe the condition is – mild, moderate or severe. The goals of treatment are to get rid of acne breakouts and prevent scarring.
Topical medications are the first-line choice for mild to moderate acne. The most common topical medications for acne include:
Benzoyl peroxide (BP) is one of the most widely used topical agent for acne. It is capable to treat mild to moderate acne with less side effects such as redness, dryness and irritation.
Benzoyl peroxide is available without prescription as a cream, lotion, or gel at concentrations of 2.5% to 10%. It should be applied to all parts of your skin affected by acne for 20 minutes after washing with mild soap.
Avoid contact with hair, clothes, towels and pillowcases as benzoyl peroxide can bleach these materials.
In addition, benzoyl peroxide could makes your face more sensitive to sunlight, so avoid excess exposure to sunlight, or use sunscreen.
Topical retinoids are commonly used to treat acne, particularly comedonal acne such as blackheads and whiteheads.
Retinoids are derivatives of vitamin A, and are effective at unblocking pores of acne spots and preventing new blockages from developing. They can also be used as maintenance therapy to keep skin clear after successful treatment.
How to use topical retinoids
- Before applying a retinoid, wash your face and allow it to completely dry (approximately 10-15 minutes). Retinoids that are applied to wet or damp skin are more likely to cause irritation.
- Apply a pea-sized amount to all affected areas once or twice daily for 20 minutes or longer.
- If irritation occurs, apply an oil-free moisturizer before applying your retinoid. This may be helpful to reduce the irritation.
It’s important to wear sunscreen or avoid excessive exposure to sunlight, as it makes your skin more sensitive to the sun.
Retinoids should not be used if you are pregnant or breastfeeding because they might cause birth defects. Side effects may include dryness, redness, and itching.
Azelaic acid is a naturally occurring acid found in grains such as wheat and barley. It has antimicrobial and anti-inflammatory properties, which make it effective in the treatment of acne. The acid can get rid of dead skin cells and kill bacteria that causes acne.
Azelaic acid is available as a cream or gel and is usually applied once or twice a day. You may need to use azelaic acid for a month before you feel a significant improvement in your symptoms.
The medicine does not make your skin sensitive to sunlight, so you do not have to avoid exposure to the sun.
If topical medications do not work, your dermatologist or doctor may prescribe medication that is taken by mouth.
These medications work by either killing bacteria that cause acne or by decreasing inflammation. If you do take an oral medication for acne, your doctor will likely advise you to continue using topical treatments as well so you’re treating the problem from inside and out.
Oral antibiotic is commonly used drug for the treatment of moderate to severe acne such as papules and pustules. It works by killing and reducing the P. acnes bacteria.
You will need to visit your dermatologist for a prescription in order to obtain this acne medication.
Usually, the first-line oral medication prescribed for acne is tetracycline. Pregnant or breastfeeding women are usually advised to take an antibiotic called erythromycin, which is known to be safer to use during pregnancy and breastfeeding.
Oral antibiotics are best used with benzoyl peroxide and topical retinoids, as studies have found that using oral antibiotics along with the topical drugs may reduce the risk of developing antibiotic resistance.
Antibiotics may cause side effects, such as an upset stomach and dizziness. These drugs also increase your skin’s sun sensitivity.
It will usually take about six weeks to experience a significant improvement in your conditions. Treatment is usually stopped after six months to reduce the risk of antibiotic resistance.
Isotretinoin is a vitamin-A-based medication that is used to treat certain cases of severe acne. It reduces the production of sebum, slows down the growth of skin cells that can clog pores, and kills the bacteria that can cause acne.
This drug is very effective but because of its potential side effects, it often the last resort treatment for people whose severe acne doesn’t respond to other treatments.
Some of the potential side effects of oral isotretinoin include dry mouth, chapped lips, nosebleeds, bone or joint pain. Pregnant women should not take isotretinoin because it can cause birth defects.
Wile taking isotretinoin, your skin will be more sensitive to the sun, so be sure to use sunscreen.
This treatment can often benefit women with acne, especially if the acne is associated with hormonal conditions such as polycystic ovary syndrome (PCOS).
Your doctor may recommend oral contraceptive pills or spironolactone to regulate hormones that can cause acne through a decrease in oil production.
It may take two to three months before the full benefits are seen. So, it’s important to be patient and persistent, even if there’s no immediate effect.
The common side effects of these drugs include nausea, weight gain, breast tenderness, and increased risk of blood clots.
Laser therapy is one of the most effective ways to treat acne scars and improve the overall appearance of the skin. It can clear up skin spots and acne scars, but their effectiveness is still mostly limited to mild or moderate cases.
In cases of severe acne, some dermatologists might recommend laser therapy in combination with other treatments, such as retinoids, antibiotics, oral medications, or hormonal treatments.
There are some risks and side effects of using lasers to treat your acne scars. These side effects will vary according to what kind of laser is used, your skin type, and how many treatments you need. Potential side effects may include redness, swelling, and pain at the site of treatment.
Pain from laser treatment is usually gone after an hour or two. Redness may take up to 10 days to subside.
A chemical peel is a treatment used to improve the appearance of the skin. It can effectively reduce or eliminate skin problems including acne, acne scars, wrinkles, fine lines, dark circles, large pores, and dry scaly skin.
In this procedure, a chemical solution, such as salicylic acid or retinoic acid, is applied to the skin by a dermatologist and is allowed to soak for a few minutes before workup.
Depending on the type of chemical peel you receive – light, medium or deep, the outer layer of the skin peels off within a day to up to 2 weeks. The effect of the chemical on the skin prompts the formation of new, smoother skin to take the place of the old skin.
With the growth of new skin cells and the enhanced production of collagen that follows a chemical peel, your skin will be noticeably more youthful, brighter and smoother.
Chemical peels are often performed on the face, hands, and neck, but can be done in virtually any part of the body.
The side effects of a chemical peel depend on the depth of the peel. Superficial or light peel may cause skin redness, followed by scaling that lasts from three to seven days. Medium and deep peels may cause redness, swelling, and scaling that lasts about one to two weeks. In certain types of skin, a temporary or permanent skin discoloration may occur.