Acne

About

Acne

What is acne?

Acne is an almost universal skin problem caused by clogged pores or hair follicles (the root of a hair), and linked to normal hormonal changes. At least 80% of people between ages 11 to 30 will have acne at some point in their lives. Some people escape it as teenagers only to have it develop as an adult. Most acne appears on the face, chest, shoulders and upper back. When skin pores become blocked by oil, bacteria and dead skin cells, they can cause whiteheads, blackheads and pimples. Severe, persistent acne can produce painful cysts and nodules. There are effective over-the-counter treatments but acne can be persistent, and stronger prescription medications can improve most acne. Good skin care and early treatment of breakouts can help keep it under control. 

Are there different types of acne?

Mild acne can cause skin eruptions, mainly on the face, that include:

  • Blackheads -- clogged follicles, filled with oil (sebum) and dead skin, turn dark when the plug opens to the air 
  • Whiteheads -- closed clogged follicles develop when the follicle wall bulges and fills with oil and dead skin
  • Papules -- small, red, tender bumps

Moderate acne causes multiple eruptions on the face, and may affect the back and chest. Moderate acne includes:

  • Pimples (pustules) -- small, red, raised, tender bumps with pus at their tips
  • Inflamed papules -- small reddish bumps caused by blocked hair follicles that become inflamed or infected with bacteria

Grade 3 is moderately severe, with many papules and pustules and an occasional inflamed nodule; besides the face, the back and chest may also be affected

Severe acne includes numerous large, painful and inflamed eruptions that include:

  • Cysts -- pus-filled lumps caused by oil and dead skin blockages, and inflammation deep in the skin; they can be painful and cause scarring
  • Nodules -- large, solid, and painful lumps under the skin
  • Pustules -- pimples filled with pus that resemble a whitehead encircled with a red ring; can cause scarring if you pick at it
  • Fungal acne can be moderate to severe, becoming itchy and inflamed because of an excess of yeast in hair follicles

Causes

What causes acne?

Acne is caused by:

  • Sensitivity to hormones or hormone fluctuations
  • Excess oil production resulting from hormones that trigger oil glands to enlarge and make more sebum
  • Skin bacteria
  • Pores and hair follicles clogged with oil and dead skin cells
  • Inflammation can make pores swell and break down the walls of the pore

Acne can get worse if these conditions are present:

  • Picking or squeezing pimples, blackheads or sores
  • Excess oil from oily lotions, creams or hair products, or from working around frying oil or greasy food surfaces
  • Fluctuating hormone levels, especially before a woman’s period, or in midlife, especially in women
  • Irritation or skin pressure from tight clothing, masks, backpacks, or hats and sport helmets
  • Stress increases the hormone cortisol, triggering acne breakouts
  • Diet high in sugar, sugary soft drinks, and high-carbohydrate foods (bread and chips); there may also be a link to skim milk and whey protein
  • Taking certain medications (corticosteroids, testosterone, lithium)
  • Family history of acne -- if both parents had acne, you’re likely to have it
  • Air pollution and high humidity

What does not cause acne?

  • Chocolate has never been directly linked to acne, but a high-sugar diet has. If you eat a lot of chocolate, instead of a well-balanced diet, the sugar in the chocolate may be causing acne.
  • Greasy foods don’t cause acne. However, if greasy, fried foods dominate your diet, you’re probably not getting enough fresh fruits and vegetables, and lean protein that helps decrease acne.
  • Dirty skin doesn’t cause acne. Skin is delicate and scrubbing too hard with harsh soaps or chemicals irritates skin and can worsen acne. However, if dirty means you’re not regularly washing away the excess oil and dead skin cells that clog pores, then your poor hygiene may be contributing to acne. 
  • Make-up and cosmetics don’t make acne worse, unless you don’t remove it every night. Consider using oil-free makeup that won’t clog pores, called non-comedogenic.

With Insurance

Dermatology

Your copay
Depending on insurance

Without Insurance

Dermatology

$89

Initial Visit

$75

Follow Up

Symptoms

What are the signs of acne?

Skin eruptions with various stages of severity. Acne can also be itchy and cause pain.

Does acne have other symptoms? 

  • Scarring, pitted skin and thick scars (keloids) can happen if acne damages deeper skin layers
  • Changes in skin color to darker (hyperpigmentation) or lighter (hypopigmentation)
  • Emotional distress from having severe acne breakouts or scars

Diagnosis

How is acne diagnosed?

Your doctor or dermatologist (medical doctor who treats skin problems) will do a physical exam of your skin, and ask about your stress level and family history of acne. In older people, a sudden and severe acne outbreak can be a symptom of another disease requiring medical attention.

Treatment

How is acne treated?

Treatment depends on the type and severity of your acne. Options include:

  • Non-prescription medications are available over-the-counter. If they don’t help, or they worked at first but don’t help anymore, you may need stronger prescription medication. 
  • Oral medications include:
  1. Antibiotics are used to treat moderate to severe acne.
  2. Oral contraceptives can reduce acne breakouts associated with menstrual periods.
  3. Isotretinoin is an oral retinoid for very severe acne. It shrinks the size of oil glands and can dry the skin. Because it can cause birth defects, and has possible risks for ulcerative colitis and depression, patients must join a Food and Drug Administration (FDA)-approved risk management program.
  • Topical medications (applied on the skin), that are available over-the-counter (OTC) include:
  1. Benzoyl peroxide (Clearasil, Stridex or PanOxyl) is left on skin to target bacteria. Dryness is a common side effect. Some products include antibiotics to kill bacteria that can make acne swell.
  2. Salicylic acid helps remove the top layer of damaged skin, and dissolves dead skin cells to keep pores from clogging.
  3. Azelaic acid kills germs and reduces swelling.
  4. Dapsone is an antibacterial for inflamed acne
  5. Vitamin A derivatives (retinoids) can break up blackheads, whiteheads and prevent clogged pores when applied to the entire affected area
  • Light therapy targets a type of bacteria that causes redness and swelling; repeat treatments are needed.
  • Steroids are sometimes injected into large nodules and cysts to more quickly reduce the inflammation.

What makes acne better?

  • Eat a healthy diet with lots of vegetables, fruits, lean meats and fish.
  • Wash affected areas twice a day, and after heavy sweating. Use fingertips to apply a gentle, non-abrasive cleanser; wash gently--do not scrub; rinse with lukewarm water.
  • Avoid products with alcohol, astringents and exfoliants.
  • Shampoo hair regularly; daily if you have oily hair.
  • Never pick, squeeze or pop acne because it increases risk of acne scars.
  • Keep your hands off your face.
  • Avoid the sun and tanning beds because tanning damages skin; some acne medications make skin very sensitive to ultraviolet light.

Can acne scars be removed?

Often a combination of the following treatments works best to remove acne scars. Treatments depend on your skin type, and severity of your acne and scars.

  • Sunscreen can reduce the contrast between normal skin and scars.
  • Soft tissue filler (collagen, fat or other substances) is injected under the skin at indented scars. Repeat treatments are needed to maintain smoothness.
  • Steroid injections into raised scars can help the skin’s appearance.
  • Lasers and other energy-based resurfacing methods target scarred collagen under your skin to accelerate new skin growth. Usually requires repeat treatments.
  • Dermabrasion, for severe scars, removes the top layer of skin.
  • Chemical peels remove the top layer of skin over a scar and generate new skin growth; mild peels can be repeated, but a deep peel can be done only once. 
  • Skin needling uses a needle-studded device to stimulate collagen production in underlying skin; may need repeat treatments.
  • Punch excision surgery cuts out individual scars, repairing the wound with stitches or a skin graft.
  • Botox is used if skin around a scar puckers to relax the skin; repeat treatments are needed.

If OTC treatments aren’t working on your acne, see your doctor for prescription medications. If your acne is severe or isn’t getting better you may want to see a dermatologist.

References

Mayo Clinic. (n.d.). Acne. Retrieved 8-25-21, {https://www.mayoclinic.org/diseases-conditions/acne/symptoms-causes/syc-20368047}
Gibson, L., MD. (n.d.). Acne Scars: What’s the Best Treatment? Mayo Clinic. Retrieved 8-25-21, {https://www.mayoclinic.org/diseases-conditions/acne/expert-answers/acne-scars/faq-20058101}
Mayo Clinic. (Aug. 2020). Acne treatments: Medical procedures may help clear skin. Retrieved 8-25-21, {https://www.mayoclinic.org/diseases-conditions/acne/in-depth/acne-treatments/art-20045892}
American Academy of Dermatology. (n.d.). Acne: Tips for Managing. Retrieved 8-25-21, {https://www.aad.org/public/diseases/acne/skin-care/tips}
Cleveland Clinic. (Sep. 2020). Acne. Retrieved 8-25-21, {https://my.clevelandclinic.org/health/diseases/12233-acne}

Information

Medically reviewed by:

Dr. Javeed Siddiqui, MD, MPH

Dr. Siddiqui is the Chief Medical Officer at TeleMed2U responsible for clinical and technical program development as well as maintaining a thriving telemedicine practice in infectious diseases which includes specialized care of Hepatitis and HIV.

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Your copay
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Initial Visit

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Follow Up