Acne is a common disorder of the hair follicles and sebaceous glands with a number of causes and symptoms. The disorder typically leads to the development of pimples and cysts.
While people in their forties and fifties experience acne for various reasons, it often begins in early puberty. During puberty, the male sex hormones (androgens) increase in both boys and girls, causing the sebaceous glands to become more active, resulting in increased production of oil (sebum).
The sebaceous glands produce sebum that normally travels via hair follicles to the skin surface. However, skin cells can plug the follicles, blocking the sebum coming from the sebaceous glands. When follicles become plugged, skin bacteria (called Propionibacterium acnes or P. acnes) begin to grow inside the follicles, causing inflammation and pimples.
While the basic acne lesion is referred to as a comedo, there are several varieties of lesion. Not only can acne be superficial (pimples without abscesses) or deep (when the inflamed pimples push down into the skin, causing pus-filled cysts that rupture and result in larger abscesses) the National Institute of Arthritis and Musculoskeletal and Skin Diseases lists a number of common types of pimples/acne including:
- Whiteheads — these pimples stay under the skin's surface
- Blackheads — these rise to the surface of the skin; although these pimples are black, the color is not from dirt (a common misconception)
- Papules — tender, small pink bumps
- Pustules — these pimples have pus on the top and are red on the bottom of the lesion
- Nodules — hard, large, painful pimples that are deep in the skin
- Cysts — pus-filled, deep, painful pimples that result in scars
Acne can occur anywhere on the body. However, acne most often appears in areas where there is a high concentration of sebaceous glands, including the following:
- Upper back
The following are the most common types of acne pimples. However, each individual may experience acne symptoms differently. Acne symptoms may include:
- Pus-filled lesions that may be painful
- Nodules (solid, raised bumps)
It's important to note that acne symptoms may resemble other skin conditions. If you notice a change in your skin condition, you should immediately consult your physician for a diagnosis.
While acne is often associated with changes in hormones related to puberty, acne symptoms can also be attributed to genetic inheritance. Other acne causes include the following:
- Hormone level changes during the menstrual cycle in women
- Hormone changes during pregnancy
- Starting or stopping birth control pills
- Certain drugs (such as corticosteroids, lithium, and barbiturates)
- Oil and grease from the scalp, mineral or cooking oil, and certain cosmetics
Acne can be aggravated by squeezing the pimples or by scrubbing the skin too hard. Skin may also become irritated with friction or pressure from helmets, backpacks or tight collars. Some environmental conditions such as pollution or humid conditions can also irritate the skin.
Specific treatment for acne will be determined by your doctor based on:
- Your age, overall health, and medical history
- Severity of the acne
- Your tolerance for specific medications, procedures, or therapies
- Expectations for the course of the condition
- Your opinion or preference
The goal of acne treatment is to minimize scarring and improve appearance. Treatment for acne will include topical or systemic drug therapy. Depending on the severity of acne, topical medications (applied to the skin) or systemic medications (taken orally) may be prescribed by your doctor. In some cases, a combination of both topical and systemic medications may be recommended.