Acne commonly starts in the early teen years, when the oil glands in the body start making more sebum (oil). Some people also have too many “sticky” skin cells. In people who have acne, these cells mix with the oil and plug up the hair follicles in the skin.
A “whitehead” results when the hair follicle is plugged with oil and skin cells. If this plug reaches the surface of the skin and the air touches it, it turns black and is called a “blackhead.” A blackhead isn’t caused by dirt.
If the wall of a plugged follicle breaks, the area swells and turns into a red bump. If the follicle wall breaks near the skin surface, the bump usually becomes a pimple. If the wall breaks deep in the skin, acne nodules or cysts can form. This is called “cystic acne.”
Things that often make acne worse:
- Oil-based makeup, suntan oil, hair gels and sprays
- In girls: menstruation
- Squeezing or picking at blemishes
- Hard scrubbing of the skin
- Too much exposure to the sun
Things that don’t cause acne:
- Foods such as chocolate or French fries
- Sexual activity
Who gets acne?
Both boys and girls get acne. But it may be worse in boys because they have more skin oils.
Heredity also plays a role. If your mother and father had bad acne, you may too.
Your immune system plays a role too. Some people are extra sensitive to the bacteria that get trapped in their hair follicles.
How can acne be treated?
Acne can be treated in different ways. Talk with your doctor about the options.
Can an over-the-counter acne product help?
Yes. Benzoyl peroxide, resorcinol, salicylic acid and sulphur are the most common over-the-counter medications used to treat acne. Each works a little differently. These medications are available in many forms, such as gels, lotions, creams, soaps or pads. (Many have side effects!)
In some people, over-the-counter acne medications may cause side effects such as skin irritation, burning or redness. Tell your doctor if you have side effects that are severe or that don’t go away over time.
Keep in mind that it can take between 4 and 8 weeks before you notice an improvement in your skin. If an over-the-counter acne product doesn’t seem to help after 2 months, get advice from your doctor.
What can my doctor prescribe?
Your doctor may recommend antibiotics, which can be very effective for treating acne. They can be taken by mouth, or used on the skin in a lotion, cream or gel.
Retinoid, such as tretinoin (brand names: Retin-A, Avita, Altinac cream) and adapalene (brand name: Differin), are other medicines for treating acne. They are usually rubbed onto the skin once a day. Be sure not to get them near your eyes, mouth and the area under your nose.
If you use a retinoid, you must avoid the sun or use a strong sunscreen because this medicine increases your risk of getting a very bad sunburn. Girls who are pregnant or may become pregnant should not use a retinoid called tazarotene (brand name: Tazorac) because it can cause birth defects.
How is severe cystic acne treated?
Isotretinoin (brand name: Accutane) may be used to treat severe cystic acne that doesn’t get better with other treatments. It’s a pill that is taken once a day by mouth for 15 to 20 weeks.
In girls, isotretinoin can cause very serious side effects such as birth defects and miscarriages. It should never be taken during pregnancy or even 1 month before pregnancy. Girls must use 2 types of birth control or not have sex while they take isotretinoin, as well as 1 month before they start and 1 month after they stop taking it.
There is a possibility that other side effects may occur, so people taking isotretinoin should be closely monitored by their doctor.
Does acne cause scars?
Acne, especially cystic acne, can cause scars in some people. You can help reduce scarring by not squeezing or picking at blemishes. Also, avoid scrubbing your skin. If you do get scars, acne scar treatments are available.