Understanding Acne

Acne can cause great distress, especially for adult women. Although it usually begins in puberty, adults can develop acne in their twenties, thirties, forties or even fifties.

And it can be annoyingly persistent. As one pimple begins to heal, others inevitably appear.

Acne is the most common skin condition in the United States, affecting 40 million to 50 million Americans of all ages, according to the American Academy of Dermatology.

But contrary to popular belief, acne is not caused by greasy foods, chocolate or dirt. Rather, it is caused by the overproduction of oil, the irregular shedding of dead skin cells and the buildup of bacteria.

Causes and Symptoms

Acne occurs when the hair follicles, or pores, become clogged with oil and dead skin cells. Hair follicles are connected to sebaceous glands, which secrete an oily substance called sebum to lubricate the hair and skin. Normally, sebum travels up the hair shafts to the surface of the skin. But when the body produces too much oil and dead skin cells, they can plug the follicles, creating an environment where bacteria can thrive.

These plugs can cause inflammatory or non-inflammatory lesions on the face, neck, chest, back or shoulders, the areas of skin with the most oil glands.

Acne may appear as blackheads, clogged follicles that are open at the skin’s surface and dark in appearance; whiteheads, clogged follicles that are closed and skin-colored; papules, small, raised, red bumps; or pustules, red, tender bumps with white pus at the tips. Severe blockages that occur deep inside the follicles may result in nodules or cysts, large, solid, painful lumps beneath the skin’s surface. Depending on its severity, acne can cause scarring.

Risk Factors

However, a number of other factors can contribute to and worsen acne.

Hormonal changes — notably in teenagers, females a week before their periods and pregnant women — can cause the sebaceous glands to enlarge and produce more sebum. Certain medications, including corticosteroids, androgens and lithium, also can cause acne.

Direct contact with greasy substances or certain cosmetics, or even the pressure of a cell phone against the skin, can clog pores and cause acne breakouts. Acne also tends to run in families, so if your parents or siblings have it, you may develop it, too. Although stress doesn’t cause acne, it can make it worse.


If you suffer from this common condition, don’t fret. Here are some steps you can take to help prevent acne breakouts.

  • Wash your face with a gentle cleanser twice a day. Harsh products and excessive washing or scrubbing can irritate the skin.
  • Avoid oily or greasy cosmetics or sunscreens. Use “water-based” or “non-comedogenic” products. If you wear makeup, use powder instead of a heavy liquid or cream foundation.
  • Remove makeup before going to bed.
  • Shower after exercising. Oil and sweat on your skin can trap bacteria.
  • Don’t touch your face, and avoid resting your hands or objects, such as cell phones, against your skin. Also, keep your hair clean and off your face.
  • Don’t pick or squeeze blemishes. This can cause infection or scarring, and the oils from your hands can cause new breakouts.


If these preventative measures don’t ward off dreaded breakouts, there are numerous treatment options available to eradicate problematic acne. These treatments can reduce oil production, speed up skin cell turnover, fight bacterial infection, reduce inflammation or a combination of the above.

Over-the-counter topical treatments containing benzoyl peroxide, sulfur, resorcinol or salicylic acid may help dry excess oil, kill bacteria and slough off dead skin cells in people with mild acne.

However, for those with moderate or severe acne, prescription topical treatments may be more effective. These may contain such vitamin A derivatives as tretinoin, adapalene or tazarotene; prescription-strength benzoyl peroxide, sulfur, resorcinol or salicylic acid; azelaic acid; or a combination of benzoyl peroxide and topical antibiotics.

Oral antibiotics may be needed in some cases of severe acne, but usually for only a short time. Some oral contraceptives may also be effective.

Cosmetic treatments also can help treat acne. Chemical peels, which involve applying glycolic or alphahydroxy acids to the skin, can help improve acne by removing the top layer of skin, stimulating new cell growth and minimizing scars. Microdermabrasion, a non-chemical procedure, removes the outermost layer of skin using a diamond-tipped wand.

For those with scarring, intense pulsed-light therapy uses a light-based device to heat the dermis and stimulate new cell growth, targeting acne scars and unwanted discoloration.

If you suffer from acne, ask your skin care provider which treatments are best for you.


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