1. Questions & Answers About Acne
What Is Acne?
Acne is a disorder resultingfrom theactionof hormones andothersubstances on the skin’s oil glands (sebaceous glands) and hair follicles. These
factors leadtopluggedpores andoutbreaks of lesions commonly calledpimples or zits. Acne lesions usually occur on theface, neck, back,chest,
andshoulders. Although acne is usually not a serious healththreat, it canbe a source of significant emotionaldistress. Severe acne canleadto
permanent scarring.
Doctors describe acne as a disease of the pilosebaceous units (PSUs). Foundover most of thebody, PSUs consist ofa sebaceous glandconnected
to a canal, calleda follicle, that contains a fine hair(see "Normal Pilosebaceous Unit"diagram). These units are most numerous on theface,
upper back, andchest. Thesebaceous glands make anoily substance calledsebum that normallyempties onto the skinsurfacet hrough the
openingof the follicle,commonly calleda pore.Cells calledkeratinocytes linethe follicle.
Normal Pilosebaceous Unit
The hair, sebum, andkeratinocytes that fill the narrowfollicle may produce a plug, which is an early sign of acne. The plug prevents sebum from
reachingthesurface ofthe skin through a pore.Themixtureof oil andcells allows bacteria Propionibacteriumacnes (P.acnes)that normallylive
on the skin to growin the pluggedfollicles. These bacteriaproduce chemicals andenzymes andattract white bloodcells that cause inflammation.
(Inflammation is a characteristicreactionof tissues todisease or injuryandis markedby four signs: swelling, redness, heat, andpain.)
When the wall of thepluggedfollicle breaks down, it spills everythingintothe nearby skin – sebum, shedskin cells, andbacteria – leadingto
lesions or pimples. People withacne frequentlyhave a variety oflesions, someof which areshown in the diagrams below. The basic acne lesion,
calledthe comedo (KOM-e-do),is simply an enlargedandpluggedhair follicle. If the pluggedfollicle,or comedo, stays beneath theskin, it is
calleda closedcomedo andproduces a white bump calleda whitehead. A comedo that reaches the surfaceof the skinandopens up is calledan
open comedoor blackheadbecause it looks black on theskin’s surface. This black discolorationis due to changes in sebum as it is exposedtoair.
It is not due to dirt. Bothwhiteheads andblackheads maystayin the skinfora longtime.
Types of Lesions
Other troublesomeacne lesions candevelop, includingthe following:
Papules –
inflamedlesions that usually appear as small, pinkbumps on theskin andcanbe tendertothe touch
Pustules (pimples) –
papules toppedby white or yellowpus-filledlesions that maybe redat the base
Nodules –
large, painful, solidlesions that are lodgeddeep withinthe skin
Cysts –
deep, painful, pus-filledlesions that cancause scarring.
What Causes Acne?
The exact cause of acneis unknown, but doctors believe it results fromseveral relatedfactors.One important factor is an increase in hormones
calledandrogens (male sex hormones). These increase in bothboys andgirls duringpuberty andcause the sebaceous glands to enlarge andmake
more sebum. Hormonal changes relatedto pregnancyorstartingor stoppingbirthcontrol pills canalso cause acne. Another factoris heredity or
genetics. Researchers believethat the tendencytodevelopacne canbe inheritedfrom parents. Forexample, studies have shown that many
school-age boys with acne have a family historyof the disorder. Certain drugs, includingandrogens andlithium,are known to cause acne. Greasy
cosmetics mayalter thecells of the follicles andmake themstick together, producinga plug.

2. Factors That Can Make Acne Worse, Factors that can cause an acne flare include:
Changinghormone levels in adolescent girls andadult women 2 to7 days beforetheirmenstrual periodstarts Oil fromskin products
(moisturizers or cosmetics) or grease encounteredin the work environment (for example,a kitchenwith fry vats) Pressure from sports helmets
or equipment,backpacks, tight collars, or tight sports uniforms Environmental irritants, such as pollutionandhigh humiditySqueezingor
pickingat blemishes Hardscrubbingof the skin Stress.
Myths About the Causes of Acne
There are manymyths about what causes acne. Chocolate andgreasyfoods are oftenblamed, but there is little evidence that foods have much
effect on thedevelopment andcourse ofacnein most people. Anothercommonmythis that dirtyskin causes acne; however,blackheads and
other acne lesions are not causedby dirt. Stress doesn’t cause acne, but research suggests that forpeoplewho haveacne, st ress can make it worse.
Who Gets Acne?
People of all races andages get acne. It is most commonin adolescents andyoungadults. An estimated80 percent of all people betweenthe ages
of 11 and30 haveacne outbreaks at somepoint. Formost people,acne tends to go away by thetime theyreach their thirties; however,some
people in their forties andfifties continue to havethis skin problem.
How Is Acne Treated?
Acne is often treatedby dermatologists (doctors who specialize in skinproblems). These doctors treat all kinds of acne,particularlysevere cases.
Doctors who are general orfamily practitioners,pediatricians, or internists may treat patients with mildercases of acne. The goals of treatment
are to heal existinglesions, stopnewlesions from forming, prevent scarring, andminimize thepsychological stress andembarrassment causedby
this disease.
Drug treatment is aimedat reducingseveral problems that play a part in causingacne: abnormalclumpingof cells in the follicles increasedoil
productionbacteria inflammation.
All medicines can have side effects.
Some medicines andside effects are mentionedin this booklet. Some side effects maybe moreseverethanothers. Youshouldreviewthe
package insert that comes with your medicine andask your health care provider orpharmacist if youhave any questions about the possible side
effects.
Dependingon the extent ofthe problem, thedoctormayrecommendone ofseveral over-the-counter (OTC) medicines and/or prescription
medicines. Some of these medicines maybe topical(appliedtothe skin),andothers maybe oral (taken by mouth).Thedoctor maysuggest using
more thanone topical medicine orcombiningoral andtopical medicines.
Treatment for Blackheads, Whiteheads, and Mild Inflammatory Acne
Doctors usually recommendan OTC or prescriptiontopical medicine for people with mildsigns of acne. Topical medicine is applieddirectlyto
the acne lesions or tothe entire area of affectedskin.
There are several OTC topical medicines usedfor mildacne. Each works a little differently.Followingare themost common ones:
Benzoyl peroxide –
destroys P. acnes, andmayalso reduce oil production
Resorcinol –
can help break down blackheads andwhiteheads Salicylic acid– helps break down blackheads andwhiteheads. Alsohelps cut down the
sheddingof cells liningthe hair follicles

3. Sulfur –
helps break down blackheads andwhiteheads.
Topical OTC medicines are available in many forms, such as gels, lotions, creams, soaps, or pads. Insome people,OTC acne medicines may
cause side effects such as skin irritation, burning, or redness, which oftenget better or go away with continueduse of the medicine. If you
experience severe or prolongedside effects, youshouldreport themtoyourdoctor.
OTC topical medicines are somewhat effective in treatingacnewhen usedregularly; however, it maytake up to 8 weeks beforeyousee
noticeable improvement.
Treatment for Moderate to Severe Inflammatory Acne
Peoplewith moderatetosevereinflammatoryacnemaybe treatedwith prescriptiontopical ororal medicines, alone orin combination.
Prescription Topical Medicines Several types of prescription topical medicines are usedto treat acne. Theyinclude:
Antibiotics –
help stop orslowthe growth ofbacteria andreduce inflammation
Vitamin A derivatives (retinoids) –
unplugexistingcomedones (plural ofcomedo), allowingother topical medicines, such as antibiotics, to enter thefollicles. Some mayalso help
decrease the formationof comedones. These drugs contain analteredform ofvitaminA. Some examples are tretinoin(Retin-A2), adapalene
(Differin), andtazarotene (Tazorac).
Others –
may destroyP. acnes andreduce oil productionor help stopor slowthegrowthof bacteria andreduce inflammation.Some examples are
prescriptionstrengthBenzoyl peroxide, sodium sulfacetamide/sulfur-containingproducts,or Azelaicacid(Azelex). Like OTC topical
medicines, prescription topical medicines come as creams, lotions,solutions,gels, or pads. Your doctor will consider your skin type when
prescribinga product.Creams andlotions provide moisture andtendto be goodchoices forpeoplewith sensitive skin.If youhaveveryoilyskin
or live in a hot, humidclimate, youmaypreferan alcohol-basedgel or solution, which tends todry the skin. Your doctorwill tell youhowto
apply themedicine andhowoftentouse it.
For some people, prescriptiontopical medicines cause minor side effects, includingstinging, burning, redness, peeling, scaling, or discoloration
of the skin. With some medicines, such as tretinoin, theseside effects usually decrease or go away after themedicine is usedfor a periodof time.
If side effects are severe ordon’t go away, notify your doctor.
Brandnames includedin this booklet are providedas examples only, andtheir inclusion does not meanthat these products are endorsedby the
National Institutes of Healthor anyotherGovernment agency. Also, if a particular brandnameis not mentioned, this does not meanor implythat
the product is unsatisfactory.
As with OTC medicines, the benefits of prescriptiontopical medicines are not immediate.Your skin may seemworse beforeit gets better.It may
take from4 to8 weeks tonotice improvement.
Prescription Oral Medicines
For patients with moderate tosevere acne, doctors oftenprescribe oral antibiotics. Oral antibiotics are thought to helpcontrol acne by curbing
the growth ofbacteria andreducinginflammation. Prescriptionoral andtopical medicines maybe combined. Common antibiotics usedto treat
acne are tetracycline (AchromycinV), minocycline(Dynacin,Minocin),anddoxycycline(Adoxa, Doryx,andMonodox). Otheroral medicines
less commonlyusedare clindamycin (Cleocin),erythromycin, or sulfonamides (Bactrim).
Some people takingthese antibiotics haveside effects, such as an upset stomach, dizziness or lightheadedness, changes in skin color, and
increasedtendencytosunburn. Because tetracyclines mayaffect tooth andbone formation in fetuses andyoungchildren, these drugs are not
given to pregnant women orchildrenunder age 14.

4. There is some concern, although it has not been proven, that tetracycline andminocycline maydecrease theeffectiveness of birthcontrol pills.
Therefore, a backup oranother formof birth control may be needed.
Prolongedtreatment withoral antibiotics maybe necessary to achieve the desiredresults. Treatment for Severe Nodular or Cystic Acne People
with nodules or cysts shouldbe treatedby a dermatologist. Forpatients with severe inflammatoryacne that does not improve with medicines such
as those describedabove,a doctor mayprescribe isotretinoin(Accutane), a retinoid(vitamin A derivative). Isotretinoin is an oral drugthat is
usually taken onceor twice a day with foodfor15 to 20weeks. It markedly reduces the size of the oil glands so that muchless oil is produced. As
a result, the growth of bacteriais decreased.
Advantages of Isotretinoin (Accutane)
Isotretinoinis a very effective medicine that can helpprevent scarring. After 15to20weeks of treatment with isotretinoin, acne completelyor
almost completely goes away in most patients. Inthose patients where acnerecurs aftera course of isotretinoin, the doctormayinstitute another
course of the same treatment orprescribe other medicines.
Disadvantages of Isotretinoin (Accutane)
Isotretinoincan cause birthdefects in thedevelopingfetus of a pregnant woman. It is important that women ofchildbearingage are not pregnant
anddo not get pregnant while takingthis medicine. Womenmust use two separate effective forms of birthcontrol at the same time for1 month
before treatment begins, duringthe entire course of treatment,andfor 1 full monthafterstoppingthedrug. Youshouldask your doctorwhen it is
safe to get pregnant afteryouhave stoppedtakingisotretinoin.
Some people with acnebecome depressedby the changes in the appearanceof theirskin.Changes in moodmay be intensifiedduringtreatment or
soon aftercompletinga course of medicines like isotretinoin. There havebeen a number ofreportedsuicides andsuicide attempts in people
takingisotretinoin; however, the connectionbetweenisotretinoin andsuicide or depression is not known. Nevertheless, if youor someoneyou
knowfeels unusually sador has other symptoms of depression, such as loss of appetite,loss of interest in once-lovedactivities, or trouble
concentrating, it’s important toconsult your doctor. Otherpossible side effects ofisotretinoin include: dryeyes,mouth, lips, nose, orskin (very
common), itchingnosebleeds muscle aches sensitivitytothe sun poor night visionchanges in the blood, such as an increasein fats in the blood
(triglycerides andcholesterol) change in liverfunction. Tobe able to determine if isotretinoinshouldbe stoppedif side effects occur, your
doctor maytest your bloodbefore youstart treatment andperiodicallyduringtreatment.Side effects usually go away afterthe medicine is
stopped.
Treatments for Hormonally Influenced Acne in Women
In some women,acneis causedby an excess of androgen(male) hormones.Clues that this maybe the case include hirsutism(excessive growth
of hair on the face orbody),premenstrual acne flares, irregularmenstrual cycles, andelevatedbloodlevels of certainandrogens. Thedoctormay
prescribe one of several drugs to treat women withthis typeof acne:
Birth control pills –
to help suppress theandrogen producedby theovaries
Low-dose corticosteroid drugs, such as prednisone (Deltasone) or dexamethasone (Decadron,Hexadrol)
–
to help suppress theandrogen producedby theadrenal glands
Antiandrogen drugs such as spironolactone (Aldactone) –
to reduce the excessive oil production. Side effects of antiandrogendrugs may include irregular menstruation, tenderbreasts,headaches, and
fatigue.
Other Treatments for Acne
Doctors mayuse other types ofprocedures in addition todrug therapytotreat patients withacne.For example,the doctor mayremove the
patient’s comedones duringoffice visits.Sometimes the doctorwill inject corticosteroids directly into lesions tohelpreduce the size andpainof
inflamedcysts andnodules. Earlytreatment is thebest way to prevent acne scars. Oncescarringhas occurred, the doctor may suggest a medical

5. or surgical procedure to help reduce thescars. A superficial laser maybe usedto treat irregular scars. Dermabrasion(or microdermabrasion),
which is a form of "sandingdown" scars, is sometimes used. Another treatment optionfor deepscars causedby cystic acne is the transfer offat
from anotherpart ofthe body tothe scar. A doctormayalso inject a syntheticfillingmaterial under thescar toimproveits appearance.
How Should People With Acne Care for Their Skin?
Clean Skin Gently
If youhave acne, youshouldgentlywash your face with a mildcleanser, once in themorningandonce in the evening, as well as after heavy
exercise. Wash your facefrom under thejawto the hairlineandbe sure to thoroughlyrinseyour skin. Ask your doctoror anotherhealth
professional foradvice onthe best type ofcleanser touse. Usingstrongsoaps orrough scrubpads is not helpful andcan actually make the
problem worse. Astringents are not recommendedunless theskin is veryoily,andthentheyshouldbe usedonly on oily spots. It is also
important toshampoo your hairregularly. If youhaveoily hair,you maywant to wash it everyday.
Avoid Frequent Handling of the Skin
Avoidrubbingandtouchingskin lesions. Squeezing, pinchingorpickingblemishes can leadtothe development ofscars or dark blotches.
Shave Carefully
Men who shave andwho have acne shouldtest bothelectric andsafetyrazors tosee which is morecomfortable.Whenusinga safety razor, make
sure the blade is sharp andsoften your beardthoroughly withsoap andwater before applyingshavingcream.Shave gentlyand onlywhen
necessary toreduce therisk ofnickingblemishes.
Avoid a Sunburn or Suntan
Many of the medicines usedto treat acne can makeyoumore prone to sunburn.A sunburn that reddens the skinor suntan that darkens the skin
may make blemishes less visible andmake the skinfeel drier.However, these benefits are onlytemporary,andthere areknown risks ofexcessive
sun exposure, such as more rapidskin aginganda risk of developingskin cancer.
Choose Cosmetics Carefully
While undergoingacne treatment,youmayneedto change some ofthe cosmetics youuse. All cosmetics, such as foundation, blush, eye shadow,
moisturizers,andhair-care products shouldbe oil free. Choose products labelednoncomedogenic(meaningtheydon’t promote the formationof
closedpores). In some people, however, even these products may make acne worse. For thefirst fewweeks of treatment,applyingfoundation
evenly maybe difficult because theskin maybe redor scaly, particularly withthe use of topical tretinoinor benzoyl peroxide.
What Research Is Being Done on Acne?
Medical researchers are workingon newdrugs to treat acne,particularlytopical antibiotics toreplacesome ofthose in current use. As with many
other types of bacterial infections,doctors are findingthat, over time, the bacteria that are associatedwith acne are becomingresistant to
treatment with certain antibiotics,though it is ot clearhowsignificant a problemthis resistance represents. Scientists are also tryingtobetter
understandthe mechanisms involvedin acne so that theycandevelopnewtreatments that work onthose mechanisms.For example,onegroup of
NIAMS-supportedresearchers is studyingthe mechanisms that regulate sebum productionin ordertoidentifyways to effectivelyreduce its
productionwithout the side effects of current medicines. Another groupis tryingtounderstandhowP. acnes activates the immune systemin
order to identifypossible immunologic interventions. Other areas of researchinvolve examiningthe effects of isotretinoinonan area ofthe brain
that might leadtodepressionanddevelopinga laser systemtotreat acne andacne-relatedscars without damagingtheouter layers of theskin.
Researchers in Germany, fundedby German institutions,have takenP.acnes andidentifiedits geneticinformation (genome). This information
may help researchers develop newtreatments totarget the bacteria.
This article copied from NIAMS website.