Acne

Acne (AK-nee) is a condition in which there are pimples, blackheads, whiteheads, and sometimes deeper lumps on the skin.

Before he turned 13, Jay's skin was clear. Soon after the start of eighth grade, Jay noticed a few pimples on his face. Before long, the problem had gotten much worse. Jay's face was always broken out, and the pimples had spread to his neck, back, and chest.

Jay was willing to try almost anything to get rid of his acne. He had heard that it is caused by dirt or by eating certain foods, so he washed his face several times a day and gave up chocolate, nuts, and French fries. He also tried several acne medicines sold without a prescription. Nothing worked. Finally, Jay went to see the doctor, who prescribed a medicine. Within a few weeks, the acne started to go away. Although Jay had to keep using medicine and seeing the doctor for a while, he felt that his improved appearance was well worth the trouble.

Acne is the name for pimples or comedones * : blackheads, whiteheads, and sometimes deeper lumps that occur on the skin, especially on the face, neck, chest, back, shoulders, and upper arms and legs. Almost all teenagers have at least a little acne, and some adults have the problem as well. Although acne is not a serious health threat, it affects appearance, which in turn can affect how individuals feel about themselves. Severe acne can leave permanent scars on the skin.

Acne occurs when hair follicles (FOL-li-culs) become plugged. The follicle is a tiny shaft in the skin through which a single strand of hair grows. Follicles are connected to sebaceous (se-BAY-shus) glands, which are small structures in the skin that make an oily substance called sebum (SEE-bum). This oil helps keep the skin and hair healthy. To reach the surface of the skin, the oil drains from the glands into the follicles, then leaves the follicles through tiny openings in the top of the shaft. As it leaves the follicles, the oil carries away dead skin cells shed by the follicle linings.

Sometimes the cells inside the follicles shed too fast and stick together, forming a thick white plug at the surface of the skin. If the opening to the surface stays partly open, the top of the plug may darken, causing a blackhead. If the opening to the surface closes, the follicle may fill up and its wall may start to bulge, causing a whitehead. The mixture of oil and cells inside the follicle also aids the overgrowth of bacteria. If the follicle wall bursts, the oil, cells, and bacteria spill into the skin. The result is redness, swelling, and pus * ; in other words, a pimple. Ordinary acne is made up of blackheads, whiteheads, and pimples.

At times, large, pus-filled lumps called cysts (SISTS) form deeper in the skin. In this more severe form of acne, the lumps may be painful; and if they are not treated by a doctor, they may lead to permanent scars.

Nearly all teenagers have at least an occasional pimple. The problem usually starts between the ages of 10 and 13, and it typically lasts for 5 to 10 years.

Acne usually goes away on its own when people reach their early 20s. However, it can last into the 20s, 30s, and beyond. A few people get acne for the first time as adults. Acne strikes boys and girls about equally. However, boys are more likely than girls to have more severe, longer lasting forms of acne.

During the teen years, both boys and girls go through changes in their hormones * . One group of hormones called androgens (AN-dro-jens) seems to play a role in acne. Among other factors, androgens make the sebaceous glands work harder. The more oil the glands make, the greater the chance that the follicles will become clogged. Teenage boys make 10 times as much androgen as teenage girls do, so it is not surprising that boys are more likely to get more severe cases of acne.

Certain oily kinds of makeups and face creams can clog the openings of the skin and cause mild acne. That may mean that people who try to cover their pimples with makeup actually make the problem worse by causing new pimples. Oil-free products are labeled noncomedogenic (non-kom-ee-do-JEN-ik), meaning they should not cause blackheads or whiteheads, or nonacnegenic (non-ak-nee-JEN-ik), meaning they should not cause acne.

Several other factors can cause acne or make it worse. These include certain medicines. People who work in fast-food restaurants or garages may find that their acne is made worse by the constant contact with grease, motor oil, or chemical irritants. Many girls also find that their pimples get worse around the time of their menstrual periods.

Acne is typically found where the sebaceous glands are most numerous: on the face, neck, chest, back, and shoulders. Blackheads are small round dark spots, whereas whiteheads are spots with a white center. Pimples look like small red bumps. Some of them have a white center with a ring of redness around it. When pimples occur with no blackheads or whiteheads, they may be a sign of another skin disease or a skin reaction to medication. Cysts are large red bumps that are often painful. They may leave deep pits and scars after healing.

It is usually easy for a doctor to recognize acne by sight. It is wise to see a doctor whenever the following is the case:

Acne treatments work by stopping new pimples from forming. They do this by cutting back on the amount of oil the sebaceous glands make; the number of bacteria present in the skin; or the rate at which dead skin cells are shed.

It is important to give an acne treatment enough time to do its job. It may take weeks for the skin to clear up, even if a treatment is working.

Milder cases of acne are often helped by lotions, creams, pads, and gels sold without a prescription. Many of these can dry out the skin if used too frequently, so it is important to follow label instructions carefully.

A doctor may prescribe stronger medications than those sold over the counter. These come in cream, gel, liquid form (tretinoin), or pill form (isotretinoin). These medications have serious side effects: skin dryness and peeling with tretinoin; and with isotretinoin, chapped lips, itchy skin, nosebleeds, irritation of the eyelids, joint and muscle pain, temporary hair loss, and rash. The doctor can offer advice on how to deal with these side effects.

Women who are pregnant or who may become pregnant during treatment should refrain from using isotretinoin as it may harm the developing fetus * .

Doctors may prescribe topical or oral antibiotics * to help fight the overgrowth of bacteria on the skin.

The doctor may open pimples or remove blackheads and whiteheads in the office. A doctor is the best one to do this procedure. People who try to do it themselves may wind up making the acne worse and increasing the risk of scarring.

Acne is not caused by being dirty. The black core in a blackhead is dried oil and dead skin cells, not dirt. Washing too often may actually irritate the skin and make the acne worse. In general, the following guidelines may help to prevent acne or to reduce its symptoms:

Acne is not caused by the foods a person eats. Studies have shown that a strict diet alone will not clear the skin. However, some people are still convinced that certain foods such as chocolate or French fries make their acne worse. It certainly cannot hurt to cut back on junk food. A more healthful diet is always a plus regardless of its effect on acne.

See also Cyst • Skin Conditions: Overview

* comedones (KOM-e-dones) are acne pimples. Blackheads are open comedones. Whiteheads are closed comedones. Cosmetics that are labeled noncomedogenic (non-kom-e-do-JEN-ik) are less likely to cause pimples.

* pus is a thick creamy fluid, usually yellow or ivory in color, that forms at the site of an infection. Pus contains infection-fighting white cells and other substances.

* hormones are chemical substances that are produced by various glands and sent into the bloodstream carrying messages that have specific effects on other parts of the body.

* fetus (FEE-tus) is the term for an unborn human after it is an embryo, from nine weeks after fertilization until childbirth.

* antibiotics (an-tie-by-AH-tiks) are drugs that kill or slow the growth of bacteria.