What Is Acne?
There's a reason it's called "common acne" - nearly everyone suffers from outbreaks of pimples at some point in life.

It starts when greasy secretions from the skin's sebaceous glands plug the tiny openings for hair follicles up. If the openings are large, the clogs take the form of blackheads: small, flat spots with centers darkened by exposure to air. If the openings stay small, the clogs take the form of whiteheads: small, closed, flesh-colored bumps. Both types of pimple can develop into swollen, tender inflammations. Cysts associated with severe cases of acne, are firm swellings below the skin's surface that become inflamed and sometimes infected.

Although acne remains largely a curse of adolescence, about 20% of all cases occur in adults. Acne commonly starts during puberty and tends to be worse in people with oily skin. It occurs in both sexes, although teenage boys tend to have the most severe cases. Women are more likely than men to have mild to moderate forms into their thirties and beyond. Women are also somewhat more susceptible to rosacea, an acne-like disorder characterized by abnormally flushed cheeks and nose.

Acne lesions are most common on the face, but they can also occur on the neck, chest, back, shoulders, scalp, and upper arms and legs.

Acne isn't caused by a harmful diet, poor hygiene, or an uncontrolled sex drive. The simple truth is that heredity and hormones are behind most forms of acne. Swearing off chocolate or scrubbing your face 10 times a day won't change your predisposition to this unsightly, sometimes painful, and often embarrassing skin problem.

What Causes It?
The cause of acne is not fully understood. While poor hygiene, poor diet, and stress can aggravate acne, they clearly do not cause it.

Hormones.
Common acne in teenagers starts with an increase in hormone production. During puberty, both boys and girls produce high levels of androgens, the male sex hormones that include testosterone. Androgens signal the body to make more sebum, a waxy substance helps the skin retain moisture. Androgens also boost production of keratin, a substance used by the body to make hair and nails.

Bacteria.
Excess sebum and keratin clogs the openings to hair follicles -- especially those on the face, neck, chest, and back. Bacteria grow in these clogged follicles. This makes blackheads or whiteheads form on the skin's surface -- a condition called non-inflammatory acne. Sometimes the follicle wall breaks under the pressure of this buildup. When this happens, sebum leaks into nearby tissues and forms a pustule - this is called inflammatory acne. If pustules become infected, matters get even more complicated. This infection can go and create cysts. Ruptured cysts leave temporary or permanent scars.

Some people are more prone to develop acne than others. This involves things such as a family history of acne, stress, and use of contraceptives or corticosteroids. Depending on the type of pill, oral contraceptives may trigger acne in some women but suppress it in others. Steroids taken by some bodybuilders and other athletes can also lead to severe outbreaks.

Acne has many subtypes. Some forms -- acne neonatorum and acne infantum -- occasionally affect newborns and infants, usually boys. A pimply rash appears on the face but usually clears within weeks with no lasting effect. People who escaped their teen years almost pimple free may develop persistent adult-onset acne as they get older. In some cases the outbreaks are allergic reactions to cosmetics or foods, while others are linked to menstruation. Both premenstrual and postmenopausal acne tend to be relatively milder than cosmetic-related flare-ups.

Despite the normal increase in androgen levels during puberty, some doctors believe that flare-ups of acne have less to do with androgen levels than with how a person's skin responds to an increase in sebum production. The bacteria Propionibacterium acnes and Staphylococcus epidermidis occur naturally in healthy hair follicles. If too many of them accumulate in plugged follicles, they may secrete enzymes that break down sebum and cause inflammation. Some people are simply more sensitive than others to this reaction. Sebum levels that might cause a pimple or two in one person may result in widespread outbreaks - or even acute cystic acne -- in another person.

What Are the Symptoms?

• Persistent, recurrent red spots or swellings on the skin, generally known as pimples. These swellings may become inflamed and fill with pus. They typically appear on the face, chest, shoulders, neck, or upper portion of the back.
• Dark spots with open pores at the center are blackheads.
• Spots that bulge under the skin and have no opening are whiteheads.
• Red swellings or lumps, sometimes visibly filled with pus, are pustules, which develop from blackheads or whiteheads.
• Cysts are inflamed, fluid-filled lumps under the skin. These nodules may become as large as an inch across.

Call Your Doctor If:

• If your acne doesn't respond in two to three months to over-the-counter remedies you may need medical treatment.
• Your acne makes you unhappy or uncomfortable
• Your acne is producing scars in addition to the acne lesions
• Acne is causing dark patches to appear in a dark skinned individual
• You have severe acne, which may produce cysts under the skin and persistent pimples that may become infected. A dermatologist may recommend prescription drugs to control the condition and prevent permanent scars.

What Are the Treatments?
The occasional pimple needs no treatment. Over-the-counter cover-up creams and cosmetics, if used at all, should be water based and hypoallergenic. Even if outbreaks of acne cannot be eliminated, conventional treatment can provide relief.

The best treatments inhibit sebum and keratin production, limit bacterial growth, or encourage shedding of skin cells to unclog pores. Because many therapies can have important side effects, any patient with a skin problem should proceed with caution when trying a new treatment. People with severe, persistent cases need the care of a dermatologist.

Nonprescription Treatment
Cleansers. There are many cleansers and soaps advertised for treating acne. However, most of them are unnecessary if the acne is being properly treated and can in fact aggravate acne.

Benzoyl peroxide. For mild acne, you may try, or your doctor may recommend treatment with a nonprescription medicine that contains benzoyl peroxide. This compound works by destroying the bacteria associated with acne. It usually takes about 2 weeks to work and it must be used continuously to keep acne at bay until you outgrow getting acne. This is because it does not affect sebum production or the way the skin follicle cells are shed, and when you stop using it, the acne comes back. It is available in a wide range of vehicles: creams, lotions, gels. Before applying the medication, wash the affected area with a mild soap that is free of oils or scents.

Salicylic acid. On the skin, salicylic acid helps to correct the abnormal shedding of cells. For milder acne, salicylic acid helps unclog pores to resolve and prevent lesions. It does not have any effect on sebum production or kill bacteria. It must be used continuously, just like benzoyl peroxide, since its effects stop when you stop using it -- pores clog up again and the acne returns. Salicylic acid is available in many acne products, including lotions, creams and pads.

Note: When pus-filled pimples are ready to break, apply a hot towel for a few minutes to encourage the natural bursting process. Infected pimples should be opened only by a nurse or doctor using surgical instruments and following antiseptic practices. Squeezing pimples yourself may lead to further infection - and maybe to permanent scars.

Prescription Treatments
Antibiotics. Antibiotics may be used on top of the skin (topical) or taken orally (systemic). Antibiotics work by clearing the skin of acne-causing bacteria. There are several topical products available in creams, gels, pads and lotions. Topical antibiotics are limited in their ability to penetrate the skin and clear more deep-seated P. acnes, whereas systemic antibiotics circulate throughout the body and into sebaceous glands. Systemic antibiotics, therefore, often cause more side effects than topicals, but they can be used for more severe kinds of acne.

Antibiotics do not address the other causative factors in acne and may take several weeks or months to clear up acne. Antibiotics are often used in combination with other drugs that "unclog" follicles. Orally taken antibiotics for acne should not be used during pregnancy, and some may reduce the effectiveness of oral contraception pills, risking a pregnancy during treatment.

Retinoids or Vitamin A derivatives. For chronically inflamed cysts, a doctor may prescribe the drug Accutane (also known as isotretinoin). This pill is the only medication that intervenes in all of the causes of acne. It can often clear severe acne even if it hasn't responded to other treatment. However, the product can have very severe side effects and must NEVER be taken by a women who is pregnant or who is not using contraception. Its use has also been associated with an increased risk of severe depression and suicide. A doctor must carefully monitor a person taking this drug.

There are also topical retinoids that clear up moderate-to-severe acne by normalizing the way the skin grows and sheds. They can be used in combination with other acne products, such as benzoyl peroxide, and oral antibiotics.

Oral Contraceptives. Oral contraceptives are female hormones, that work by counteracting the effect of male hormones (androgens) on acne. Their use is limited to female patients. Oral contraceptives contain combinations of hormones, and some combinations are more effective than others in clearing acne. The maximum benefit of oral contraceptives on acne occurs in 3 to 4 months.

Other. A less common treatment option is to inject triamcinolone, a type of corticosteroid, directly into the cysts. This treatment may leave some patients' skin temporarily darkened around the lesion. A dermatologist (skin doctor) may also recommend controlled exposure to ultraviolet light to keep outbreaks in check.

A dermatologist may also recommend the use use a variety of procedures that can be performed in the office to remove severe lesions and to express (push out the contents of) comedones.

Some adults carry scars or pitted skin from cysts or deep pimples that were scratched or severely infected. Two relatively aggressive surgical procedures can improve the skin's appearance: dermabrasion, in which a dermatologist essentially sandpapers frozen skin, and chemical peeling. Both procedures remove the scarred surface and expose unblemished skin layers. Before considering such treatment it is important to discuss the procedures, necessary precautions, and likely results with at least two dermatologists.

Warning!
Patients taking anti-acne drugs should be alert to possible side effects and interactions with other medicines and herbal remedies. The drugs tretinoin and benzoyl peroxide can leave skin reddened, dry, and sensitive to sunlight. Benzoyl peroxide may inhibit the healing effects of tretinoin, so never apply them at the same time. Taking antibiotics for more than a few weeks may leave women susceptible to yeast infections.

How Can I Prevent It?
Because of acne's association with fluctuating hormone levels and possible genetic influences, many doctors believe there is no way to prevent it. The accepted wisdom is that neither good hygiene nor diet can prevent outbreaks. That being said, sensible skin care is important, especially during adolescence. The basics include a daily bath or shower, and washing the face and hands with unscented or mildly antibacterial soap. Teenage girls are better off not using cosmetics regularly. And despite advertising claims, few if any commercial skin medications help prevent or treat acne.

What Is Acne?
Acne is a disorder of the skin's oil glands (sebaceous glands) that results in plugged pores and outbreaks of lesions commonly called pimples or zits. Acne lesions usually occur on the face, neck, back, chest, and shoulders. Nearly 17 million people in the United States have acne, making it the most common skin disease. Although acne is not a serious health threat, severe acne can lead to disfiguring, permanent scarring, which can be upsetting for people who suffer from the disorder.