Acne is a common skin disease characterized by pimples on the face, chest, and back. It occurs when the pores of the skin become clogged with oil, dead skin cells, and bacteria.
Acne vulgaris, the medical term for common acne, is the most common skin disease. It affects nearly 17 million people in the United States. While acne can arise at any age, it usually begins at puberty and worsens during adolescence. Nearly 85% of people develop acne at some time between the ages of 12-25 years. Up to 20% of women develop mild acne. It is also found in some newborns.
The sebaceous glands lie just beneath the skin’s surface. They produce an oil called sebum, the skin’s natural moisturizer. These glands and the hair follicles within which they are found are called sebaceous follicles. These follicles open onto the skin through pores. At puberty, increased levels of androgens (male hormones) cause the glands to produce too much sebum. When excess sebum combines with dead, sticky skin cells, a hard plug, or comedo, forms that blocks the pore. Mild noninflammatory acne consists of the two types of comedones, whiteheads and blackheads.
Moderate and severe inflammatory types of acne result after the plugged follicle is invaded by Propionibacterium acnes, a bacteria that normally lives on the skin. A pimple forms when the damaged follicle weakens and bursts open, releasing sebum, bacteria, and skin and white blood cells into the surrounding tissues. Inflamed pimples near the skin’s surface are called papules; when deeper, they are called pustules. The most severe type of acne consists of cysts (closed sacs) and nodules (hard swellings). Scarring occurs when new skin cells are laid down to replace damaged cells.
The most common sites of acne are the face, chest, shoulders, and back since these are the parts of the body where the most sebaceous follicles are found.
Causes and symptoms
The exact cause of acne is unknown. Several risk factors have been identified:
- Age. Due to the hormonal changes they experience, teenagers are more likely to develop acne.
- Gender. Boys have more severe acne and develop it more often than girls.
- Disease. Hormonal disorders can complicate acne in girls.
- Heredity. Individuals with a family history of acne have greater susceptibility to the disease.
- Hormonal changes. Acne can flare up before menstruation, during pregnancy, and menopause.
- Diet. No foods cause acne, but certain foods may cause flare-ups.
- Drugs. Acne can be a side effect of drugs including tranquilizers, antidepressants, antibiotics, oral contraceptives, and anabolic steroids.
- Personal hygiene. Abrasive soaps, hard scrubbing, or picking at pimples will make them worse.
- Cosmetics. Oil-based makeup and hair sprays worsen acne.
- Environment. Exposure to oils and greases, polluted air, and sweating in hot weather aggravate acne.
- Stress. Emotional stress may contribute to acne.
Acne is usually not conspicuous, although inflamed lesions may cause pain, tenderness, itching, or swelling. The most troubling aspects of these lesions are the negative cosmetic effects and potential for scarring. Some people, especially teenagers, become emotionally upset about their condition, and have problems forming relationships or keeping jobs.
Acne patients are often treated by family doctors. Complicated cases are referred to a dermatologist, a skin disease specialist, or an endocrinologist, a specialist who treats diseases of the body’s endocrine (hormones and glands) system.