Acne Introduction

Nearly all individuals during their teen years are affected to some extent by acne. Acne even affects some people well into adulthood, making it the most common type of skin condition. Acne affects both men and women and most commonly occurs on the face, neck, back, chest and upper arms. Although it is generally not considered a serious health condition, it may cause embarrassment and even scarring of the skin in severe cases. Even if you are affected by severe acne, there is good news! There are a variety of different treatment options available to treat acne that will help restore a smooth, healthy glow to your skin.

Skin Anatomy

Before you learn how best to treat your acne, it is important that you understand the basics of your skin’s anatomy and how acne occurs. Your skin is composed of two layers known as the epidermis and the dermis. The epidermis is the skin’s primary defense against the environment. The dermis is primarily composed of collagen and elastin fibers, which provide the skin with structure, support, and elasticity. Blood vessels and nerves run throughout the dermis. The blood vessels transport blood, which supplies important nutrients to your skin and the nerves allow you to perceive sensations like pain, temperature, and touch. Your skin has many pores, which are actually small openings in the skin from sweat glands, hair follicles, and sebaceous glands deep within the dermis.

Where Does Acne Occur?

Acne results from clogged pores. What you may not know is acne generally occurs in sebaceous glands that are attached to hair follicles—not sweat glands. The greatest number of sebaceous glands is found on the face, neck, and back, which is why acne commonly occurs in these regions. Sebaceous glands are special glands attached to the hair follicle. Together, the hair follicle and sebaceous gland are often referred to as the pilosebaceous follicle. Sebaceous glands produce an oily substance known as sebum, which helps make your skin waterproof and prevents it from drying out.

What Causes Acne?

You have probably heard that things like chocolate, soda, and greasy foods like pizza can cause acne. While this may be true for very select individuals, physicians do not generally believe this to be the case. Acne is usually caused by a combination of factors including a build up of dead skin cells, excessive sebum production, and bacterial overgrowth. As these factors become more severe, so too does the acne. What starts out as mild acne may progress into moderate or severe acne, depending on the conditions in your skin. Let’s take a look at how these different stages of acne develop.

Whiteheads and Blackheads

Dead skin cells are continuously shed from the walls of hair follicles during a process known as keratinization. Under normal circumstances, the skin cells do not build up and the sebum is secreted onto the skin’s surface. However special conditions can promote an increase in keratinization. If too many skin cells build up in the follicle, they may actually block the secretion of sebum, which causes a plug to form. This plug is what is commonly known as a blackhead or a whitehead, which are mild forms of acne. Blackheads generally appear as small, black holes on the skin’s surface. When the follicle is not completely blocked, it opens slightly and the top of the plug turns black, which is what you see as a blackhead. In contrast, whiteheads generally appear as small, skin-colored bumps beneath the skin’s surface. The follicle opening is completely blocked with sebum and dead skin cells, which is what you see as a whitehead.


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Acne formation gets even more complex. In response to hormones known as androgens, like progesterone and testosterone, the sebaceous glands produce more sebum. This is why acne usually starts to occur during puberty and why women may experience more acne at the onset of menstruation.

When excess sebum is produced in already blocked pores the follicle becomes inflamed. Further inflammation can be caused by bacterial overgrowth as well. Together, this causes a papule to form, which is a red, raised bump on the skin.


Continual sebum production and bacterial overgrowth increase the inflammation around the follicle even further. Like a dam that cannot hold any more water, the follicle may eventually rupture, spilling its contents into the skin layers below. When this happens, pustules form. This is because your body sends white blood cells to the area as an immune response. These white blood cells along with other debris create pus, which is what gives pimples their white or yellowish center.

Nodules and Cysts

In cases in which inflammation becomes even more severe, nodules and cysts may develop. Nodules are large, round bumps that originate deep beneath the skin’s surface. They are typically caused by severe inflammation and infection within the dermis. Although similar to nodules, cysts are usually filled with pus. Both of these types of acne may be long lasting and painful. In addition, nodules and cysts may lead to acne scarring and generally only respond to intense forms of treatment.

Acne Treatment: Benzoyl Peroxide

Often, prescription medications are necessary to resolve acne. A common treatment for mild to moderate acne, benzyol peroxide is available over-the-counter or by prescription in a variety of strengths and formulas. Like other antimicrobial products, benzoyl peroxide works by limiting the bacteria that contributes to acne. Dermatologists often use benzoyl peroxide in combination with antibiotic treatments because it not only increases the effectiveness of antibiotic treatment but also decreases the chance that the acne-causing bacteria will develop resistance to antibiotic treatment. Other antimicrobial products similar to benzoyl peroxide may be available. You should discuss these different options with your dermatologist to find the treatment that is right for you.

Acne Treatment: Antibiotics

Antibiotic treatment has been a standard approach in treating acne for many years. Available in both topical and oral formulas, antibiotics such as erythromycin and tetracycline are often used to treat moderate to severe acne. Antibiotic treatment works by reducing acne-causing bacteria, sometimes by as much as ninety percent. However, unlike benzoyl peroxide, antibiotics work to reduce inflammation as well. This is why dermatologists often combine topical antibiotics with benzoyl peroxide for better results. Your dermatologist may start you off with a high dosage and gradually decrease it as your acne improves over the course of several months. It is important to realize that if you use the same antibiotic treatment for a long period of time the bacteria may eventually develop resistance, which means that the treatment will stop working. However, under these circumstances, different antibiotics can usually be used.

Acne Treatment: Oral Contraceptives

Certain oral contraceptives, or “the pill,” have been found to be effective in treating acne in women. As you learned earlier, sebaceous glands produce more sebum in response to androgens, which promotes acne formation. Oral contraceptives work by reducing androgens. As a result, sebum production decreases, which reduces acne. Oral contraceptives can be used over a long period of time to treat your acne, although it may take a few months for you to notice an improvement in your complexion. It is important to realize that if you stop taking the pill, your acne may return. Although there are many different forms of the pill, not all of them can be used to treat acne. You should discuss the different options with your physician to find the treatment that is right for you.

Acne Treatment: Retinoids

Retinoids are Vitamin A derivatives and are available in topical and oral formulas. Commonly used to treat mild to moderate acne, topical retinoids work by unclogging your pores and also preventing new whiteheads and blackheads from forming. Like other acne treatments, topical retinoids can increase the effectiveness of benzoyl peroxide and antibiotics when used together. In contrast to topical retinoids, oral retinoids are only appropriate for the most severe cases of nodulocystic acne. They work by reducing sebum production, limiting the build up of dead skin cells, inhibiting the growth of acne-causing bacteria, and even reducing redness and inflammation. While oral retinoids can produce significant results, they also come with serious side effects such as increased cholesterol, compromised digestive and liver function, and even birth defects. Therefore, you should discuss your health history as well as the possible side effects with your dermatologist to determine if the treatment is right for you.