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What is Acne?

Acne is a disorder resulting from the action of hormones on the skin’s
oil glands (sebaceous glands), which leads to plugged pores and outbreaks
of lesions commonly called pimples or zits. Acne lesions usually occur
on the face, neck, back, chest, and shoulders.

What Causes Acne?

The exact cause of acne is unknown, but doctors believe it results from
several related factors. One important factor is an increase in hormones
called androgens (male sex hormones). These increase in both boys and girls
during puberty and cause the sebaceous glands to enlarge and make more
sebum. Hormonal changes related to pregnancy or starting or stopping birth
control pills can also cause acne.

Another factor is heredity or genetics. Researchers believe that the tendency
to develop acne can be inherited from parents. For example, studies have
shown that many school-age boys with acne have a family history of the
disorder. Certain drugs, including androgens and lithium, are known to
cause acne. Greasy cosmetics may alter the cells of the follicles and make
them stick together, producing a plug.

Factors That Can Make Acne Worse

• Friction caused by leaning on or rubbing the skin
• Pressure from bike helmets, backpacks, or tight collars
• Environmental irritants, such as pollution and high humidity
• Squeezing or picking at blemishes
• Hard scrubbing of the skin.

Myths About the Causes of Acne

There are many myths about what causes acne. Chocolate and greasy foods
are often blamed, but foods seem to have little effect on the development
and course of acne in most people. Another common myth is that dirty skin
causes acne; however, blackheads and other acne lesions are not caused
by dirt. Finally, stress does not cause acne.

How Is Acne Treated?

Acne is often treated by dermatologists. These doctors treat all kinds
of acne, particularly severe cases. Doctors who are general or family practitioners,
pediatricians, or internists may treat patients with milder cases of acne.

The goals of treatment are to heal existing lesions, stop new lesions
from forming, prevent scarring, and minimize the psychological stress and
embarrassment caused by this disease. Drug treatment is aimed at reducing
several problems that play a part in causing acne: abnormal clumping of
cells in the follicles, increased oil production, bacteria, and inflammation.
Depending on the extent of the person’s acne, the doctor will recommend
one of several over-the-counter (OTC) medicines or prescription medicines
that are topical (applied to the skin) or systemic (taken by mouth).

Benzoyl peroxide, resorcinol, salicylic acid, and sulfur are the most
common topical OTC medicines used to treat acne. Each works a little differently.
Benzoyl peroxide is best at killing P. acnes and may reduce oil
production. Resorcinol, salicylic acid, and sulfur help break down blackheads
and whiteheads. Salicylic acid also helps cut down the shedding of cells
lining the follicles of the oil glands. Topical OTC medications are available
in many forms, such as gel, lotion, cream, soap, or pad.

How Should People With Acne Care for Their Skin?

Clean Skin Gently

Most doctors recommend that people with acne gently wash their skin with
a mild cleanser, once in the morning and once in the evening and after
heavy exercise. Some people with acne may try to stop outbreaks and oil
production by scrubbing their skin and using strong detergent soaps and
rough scrub pads. However, scrubbing will not improve acne; in fact, it
can make the problem worse. Patients should ask their doctor or another
health professional for advice on the best type of cleanser to use. Patients
should wash their face from under the jaw to the hairline. It is important
that patients thoroughly rinse their skin after washing it. Astringents
are not recommended unless the skin is very oily, and then they should
be used only on oily spots. Doctors also recommend that patients regularly
shampoo their hair. Those with oily hair may want to shampoo it every day.

Avoid Frequent Handling of the Skin

People who squeeze, pinch, or pick their blemishes risk developing scars
or dark blotches. People should avoid rubbing and touching their skin lesions.

Shave Carefully

Men who shave and who have acne can test both electric and safety razors
to see which is more comfortable. Men who use a safety razor should use
a sharp blade and soften their beard thoroughly with soap and water before
applying shaving cream. Nicking blemishes can be avoided by shaving lightly
and only when necessary.

Avoid a Sunburn or Suntan

Many of the medicines used to treat acne can make a person more prone
to sunburn. A sunburn that reddens the skin or suntan that darkens the
skin may make blemishes less visible and make the skin feel drier. However,
these benefits are only temporary, and there are known risks of excessive
sun exposure, such as more rapid skin aging and a risk of developing skin
cancer.

Choose Cosmetics Carefully

People being treated for acne often need to change some of the cosmetics
they use. All cosmetics, such as foundation, blush, eye shadow, and moisturizers,
should be oil free. Patients may find it difficult to apply foundation evenly
during the first few weeks of treatment because the skin may be red or scaly,
particularly with the use of topical tretinoin or benzoyl peroxide. Oily
hair products may eventually spread over the forehead, causing closed comedones.
Products that are labeled as noncomedogenic (do not promote the formation
of closed pores) should be used; in some people, however, even these products
may cause acne.