Definition
Acne is a skin disorder resulting from the blockage of hair follicles in the
skin. Excess cells produced in the follicle combine with sebum, an oily
substance secreted by glands connected to the follicle. When a plug forms
in the follicle and is infected with bacteria, a pimple erupts.
DescriptionAcne is a skin problem commonly associated with teenagers, but it can
also occur in children, adults in their thirties or forties, and women
around the time of menopause. It is most likely to appear on the parts
of the body with the largest number of hair follicles
upper back, and (in some people) upper arms. Some forms of acne arerelatively mild. The less severe form consists
of comedones, which are hair follicles
blocked by plugs of sebum. If the comedo
is open to the air on the skin surface, the
sebum grows darker, giving the comedo a
blackish appearance. This type of comedo is
called a blackhead; its dark color is not
caused by dirt. If the comedo is not
open, the sebum inside produces a whitish
bump called a whitehead. Both whiteheads
and blackheads can remain in the skin for
weeks. Bacteria that normally live on the skin can grow inside the
plugged follicles. The bacteria then secrete various chemicals that
prompt an inflammatory response from the person
The plugged follicle may eventually burst, allowing the bacteria, the
sebum, dead skin cells, and dead white blood cells to leak into nearby
skin, causing reddened papules (small pink bumps), pus-filled pimples,
or cysts (deep pus-filled lesions that are sore to the touch and can cause
scarring).
’s immune system. Demographics
According to the National Institute of Arthritis and Musculoskeletal and
Skin Diseases (NIAMS), about 80 percent of people in the United States
develop acne at some point between the ages of eleven and thirty. Boys
are more likely than girls to develop acne during adolescence; however,
among adults, women are more likely than men to suffer from acne.
Twelve percent of women and 5 percent of American men at age
twenty-five have acne; at age forty-five, 5 percent of both men and
women still have acne. Some older women are troubled by acne again
during menopause. Acne is equally common among people of all races
and ethnic groups in the United States.
Causes and Symptoms
Acne is thought to result from the interaction of four factors that are
most common in adolescents but can occur in adults as well. The first
is the rise in production of hormones known as androgens, which
are hormones produced by the adrenal glands (located on top of the
kidneys) and are present in women as well as in men. The hormonalincrease triggers the rapid multiplication of the
cells lining the hair follicles on the face, chest,
upper back, and shoulders. When these cells are
produced faster than the follicle can shed them,
they form a plug that blocks the follicle and
keeps the sebum produced by the glands connected
to the follicle from reaching the surface
of the skin. The mixture of oily sebum and dead
skin cells in the plug allows bacteria known as
Propionibacterium acnes
on the skin, to grow inside the follicle. The chemicals
produced by the bacteria then trigger an inflammatory response
from the body
around the plugged follicle to fight the bacteria. If the plugged follicle
bursts, the inflammation may spread, leading to the pus-filled pimples andcysts of severe acne. Some people are more likely than others to develop
acne.
Risk factors include:
, which normally live’s immune system. White blood cells are drawn to the area •
develop acne at a relatively early age and to have more severe
breakouts.
Heredity. People with a family history of acne are more likely to •
in the week preceding the menstrual period, women in early menopause,
and teenagers of either sex are more likely to develop acne.
People who use steroids for bodybuilding, medications containing
cortisone, antiepileptic medications, or lithium are also more likely
to have acne.
Changes in the body’s hormonal levels. Pregnant women, women 
•
cooking equipment, lubricating oils and grease guns, oil-based
paints) at home or in the workplace.
Exposure to greasy or oily substances (deep-fat fryers or similar •
headsets, etc.) that puts pressure on skin or rubs against it.
Clothing or athletic equipment (backpacks, shoulder straps, helmets, •
levels of air pollution are more likely to develop acne.
Mild acne is not painful; the pustules and cysts of severe acne, however,
may be sore to the touch. In addition, the psychological effects of
acne can be very painful for many patients, particularly adolescents.Diagnosis
In most cases the doctor diagnoses acne on the
basis of the appearance of the skin. Primary care
doctors can usually treat milder cases of acne.
People with more severe cases are usually referred
to a dermatologist, who is a doctor who specializes
in diagnosing and treating skin disorders.
In a very few cases, women whose skin problems
may be related to abnormally high levels of
androgens may be given a hormone test.
Treatment
Treatments for acne work in one or more of four
ways:
•
lowering the skin’s production of sebum •
speeding up the removal of dead skin cells •
fighting bacterial infection •
to infection
Some medications used to treat acne are
topical (applied to the skin) while others are
taken by mouth. Some can be purchased over
the counter, but others require a prescription
from the doctor.
The specific medications or other treatments
that a doctor might recommend depend on the
severity of the acne, the extent of scarring, and
the possibility of side effects for specific patients.
Mild acne is commonly treated with topical
medications in soap, cream, or lotion form, most
of which do not require a prescription. They
include various combinations of sulfur, benzoyl
peroxide, salicylic acid, and a few other drugs to dry up excess sebum, kill
bacteria, and speed up removal of dead skin cells. These nonprescription
products may take about eight weeks to produce results. Moderately
severe acne may be treated with prescription medications, including
antibiotics to be taken by mouth along with using topical creams,lotions, or gels that also require a prescription. These products may
cause stinging, reddening, or peeling of the skin in some people; however,
patients usually start seeing improvement in about four weeks.
Patients with severe cystic acne are usually referred to a dermatologist
for specialized treatment. A drug that is often prescribed for severe acne is
Accutane, a drug derived from vitamin A that shrinks the size of the oil
glands that produce sebum. Accutane must be taken only under careful
supervision by a doctor, however, as it can cause serious side effects,
including depression and an increased risk of a disease called irritable bowel
syndrome. In addition, Accutane cannot be given to women who may
become pregnant because it can cause birth defects in children. Other treatments
for acne include phototherapy, which is the use of light waves to kill
bacteria; and laser therapy, which helps to dry up the oil glands in the skin.
People with severe scarring from acne can have their scars treated
with dermabrasion or laser therapy to make them less noticeable. Very
large scars can be removed surgically if necessary.
Prognosis
The prognosis for acne depends on its severity. Most people
up by the early adult years, and newer techniques for treating scars lead to
good results for most people. Nonetheless, some people have longstanding
psychological problems
of severe acne in adolescence.
’s skin clears—usually social isolation—as the result Prevention
Acne is difficult to prevent entirely, particularly for people who have
inherited a family tendency to develop severe acne in adolescence.
However, careful attention to proper skin care can reduce the severity
and frequency of breakouts.
The Future
Current research focuses on possible ways to prevent skin inflammation
caused by
identified the bacterium
to the development of new medications to eliminate the bacterium
from acne-troubled skin. Other research is directed toward developing
lasers that can treat acne scarring with less damage to the outer layers
of skin.For more information
BOOKS
Day, Doris J.
Bartlett, Publishers, 2005.
Fried, Richard G.
Confidence
Shannon, Joyce Brennfleck, ed.
Omnigraphics, 2007.
100 Questions and Answers about Acne. Sudbury, MA: Jones andHealing Adult Acne: Your Guide to Clear Skin and Self-. Oakland, CA: New Harbinger Publications, 2005.Adolescent Health Sourcebook. Detroit, MI: PERIODICALS
American Academy of Family Practice (AAFP).
“Patient Information: Acne.” American Family Physician, May 1, 2004. Available online at http://www.
aafp.org/afp/20040501/2135ph.html (accessed May 25, 2008).
WEB SITES
Acne Animation. Available online at http://www.healthscout.com/animation/68/
44/main.html (accessed May 25, 2008). This is an animation with voiceover
about the development of acne. It takes about a minute and a half to play.
American Academy of Dermatology (AAD).
www.aad.org/public/publications/pamphlets/common_acne.html (accessed
May 25, 2008).
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).
“Acne.” Available online at http:// “
http://www.niams.nih.gov/Health_Info/Acne/acne_rp.pdf (updated February
2006; accessed May 25, 2008).
TeensHealth.
teen/your_body/skin_stuff/acne.html (updated March 2007; accessed
May 25, 2008).
“Why Do I Get Acne?” Available online at http://www.kidshealth.org/Questions and Answers about Acne.” Available online in PDF format atPropionibacterium acnes. Scientists in Germany have recently’s genome (genetic information), which may leadreducing the skin’s inflammatory responseClimate. People who live in locations with high humidity or high—the face, chest, Acne