Acne

Acne

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.

Description

Acne 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 are

relatively 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 hormonal

increase 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 and

cysts 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,