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Southern Cross Medical Library

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Acne - causes, symptoms, treatment


Acne is a common disease of the skin, caused by hair follicles becoming blocked with oil and dead skin cells. It is characterised by pimples (zits), blackheads or whiteheads, and sometimes scarring. Acne can be persistent, but effective treatments are available.  

General information

Most people will get acne at some time during their lives. Anyone can get acne, even babies, but it is most prevalent in teenagers. Acne vulgaris, which is the most common form of acne, affects people during their teenage years and early twenties. In some people, however, the condition may persist in adulthood.

You should consult your doctor if your baby develops acne that does not clear up on its own within three months.  Other skin conditions that may resemble acne include rosacea and keratosis pilaris

Causes

There are tiny holes on the surface of the skin, called pores. The pores open to a follicle, which contains a hair and an oil gland. The gland releases oil to lubricate and protect the skin. Acne occurs when dead sin cells are not cleared from the follicle and the follicle oil glands produce too much oil, which causes the pores to become blocked.  The presence of bacteria can trigger inflammation, which makes the acne worse. 

The blockage is called a plug. If the top of the plug is white, it is called a whitehead; if the top of the plug is black, it is called a blackhead. The plugged follicle enlarges producing a bump, which, if it ruptures, releases irritating substances and bacteria that cause inflammation. Inflammation at the surface of the skin produces red bumps (papules) and inflammation deeper in the skin causes pustules (pimples). Even deeper inflammation causes hard painful cysts.

The main underlying cause of acne is a genetic predisposition (i.e. family history - people whose parents hda acne are likely to develop it too).  However, there are also other aggravating factors.

Hormonal changes related to puberty, menstrual periods, pregnancy, birth control pills, or stress can cause excessive oil secretion that contributes to acne. Oil-based cosmetics and hair products and certain drugs (e.g. corticosteroids, lithium, anti-epileptics and androgens) can also make acne worse.  Pressure or friction on the skin from headbands, helmets, backpacks or under-wire bras can be aggravating factors.

Medical conditions such as polycystic ovarian syndrome are also associated with acne.

People with acne may be advised to minimise intake of milk and sugary foods and drinks.

Signs and symptoms

Acne typically affects the areas of the skin with the highest number of hair follicles, i.e. the face, upper part of the chest, and the back. It may also occur on the arms, legs, and buttocks. The most obvious signs and symptoms of acne include: 

  • Small red bumps (papules) 
  • Small red pus-filled, blister-like lesions (pimples and cysts)
  • White raised bumps (whiteheads) 
  • Small dark spots (blackheads) 
  • Scarring.

Diagnosis

A simple examination of your skin allows your doctor to diagnose acne. Laboratory tests are not usually required.  However, laboratory testing may be used if polycystic ovarian syndrome is suspected in females.  Laboratory tests may also be used in people whose acne does not respond to antibiotic treatment.

Treatment

Acne usually responds well to six to eight weeks of treatment, but it may flare up (return) from time to time. The earlier treatment is started, the less likely there will be scarring.  Self-care that can help your acne includes: 

  • Cleaning your skin gently with a mild cleanser twice daily
  • Using over-the-counter topical (applied to the skin) medications containing benzoyl peroxide, sulphur, or salicylic acid (which are antibacterial and mild exfoliating or peeling agents) 
  • Shampooing your hair daily and keeping your hair from touching your face 
  • Avoiding scrubbing or repeated skin washing 
  • Not popping or picking your pimples (as this can worsen the infection) 
  • Using water-based (rather than oil-based) cosmetics or creams 
  • Removing make-up at night

If self-care and use of non-prescription medication does not produce improvement in your acne you should see your doctor or a dermatologist (skin specialist). Prescription-only medications include: 

  • More potent topical formulations of benzoyl peroxide or salicylic acid 
  • topical or oral antibiotics (e.g. doxycycline, tetracycline) 
  • Topical retinoids – drugs derived from vitamin A that help to keep skin pores clear, e.g. tretinoin or adapalene 
  • Some oral contraceptives are helpful in treating acne 
  • Spironolactone – a drug that affects hormone activity can help some women with persistent acne

People with severe acne may be prescribed higher doses of oral antibiotics or a powerful oral retinoid - isotretinoin - which works by reducing the skin’s oil secretion. Because of side effects, including birth defects, isotretinoin is only used in close dialogue with your doctor or a dermatologist.

Other medical treatments and minor procedures that might help your acne include: 

  • Chemical skin peeling 
  • Dermabrasion for removal of scars
  • Removal or drainage of large cysts or injection of a corticosteroid
  • Laser or light therapy. 

References

Rao, J. (2017). Acne vulgaris (Web Page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. https://emedicine.medscape.com/article/1069804-overview [Accessed 14/02/18]
Oakley, A. (2014). Acne (Web Page). Hamilton: DermNet New Zealand. https://www.dermnetnz.org/topics/acne/ [Accessed 14/02/18]
O’Toole, M.T. (Ed.) (2013). Acne. Mosby’s Dictionary of Medicine, Nursing & Health Professions (9th ed.). St Louis, MI: Elsevier Mosby.


Reviewed: February 2018 
 
Go to our Medical Library Index Page to find information on other medical conditions.