What is acne?
Acne (acne vulgaris, common acne) is a disease of the hair follicles of the face, chest, and back that affects almost all teenagers during puberty; the only exception being members of a few primitive Neolithic isolated tribes living in isolation. It is not caused by bacteria, although bacteria play a role in its development. It is not unusual for some women to develop acne in their mid- to late-20s.
Acne appears on the skin as...
- occluded pores ("comedones"), also known as blackheads or whiteheads,
- tender red bumps also known as pimples or zits,
- pustules, and occasionally as
- Cysts (deep pimples, boils)
What causes acne?
No one factor causes acne. Acne occurs when sebaceous (oil) glands attached to the hair follicles are stimulated at the time of puberty by circulating male hormones. Sebum (oil) is a natural substance which lubricates and protects the skin. Associated with increased oil production is a change in the manner in which the skin cells mature, predisposing them to clog the follicular pore. The clog can appear as a whitehead if it covered by a thin layer of skin or if exposed to the air the darker exposed portion of the plug is called a "blackhead." The plugged hair follicle gradually enlarges, producing a bump. As the follicle enlarges, the wall may rupture, allowing irritating substances and normal skin bacteria access into the deeper layers of the skin, ultimately producing inflammation. Inflammation near the skin's surface produces a pustule; deeper inflammation results in a papule (pimple); if the inflammation is deeper still, it forms a cyst.
Here are some factors that don't usually play a role in acne:
- Heredity: With the exception of very severe acne, most people do not have the problem exactly as their parents did. Almost everyone has some acne at some point in their life.
- Food: Parents often tell teens to avoid pizza, chocolate, greasy and fried foods, and junk food. While these foods may not be good for overall health, they don't cause acne or make it worse. Although some recent studies have implicated milk and pure chocolate in aggravating acne, these findings are very far from established.
- Dirt: "Blackheads" are oxidized oil, not dirt. Sweat does not cause acne and is produced by entirely separate glands in the skin. On the other hand, excessive washing can dry and irritate the skin.
- Stress: Some people get so upset by their pimples that they pick at them and make them last longer. Stress, however, does not play much of a direct role in causing acne.
In occasional patients, the following may be contributing factors:'
- Pressure: In some patients, pressure from helmets, chin straps, collars, suspenders, and the like can aggravate acne.
- Drugs: Some medications may cause or worsen acne, such as those containing iodides, bromides, or oral or injected steroids.
- Most cases of acne, however, are not drug related.
- Occupations: In some jobs, exposure to industrial products like cutting oils may produce acne.
- Cosmetics: Some cosmetics and skin-care products are pore clogging ("comedogenic"). Of the many available brands of skin-care products, it is important to read the list of ingredients and choose those which have water listed first or second if you are concerned about acne. These "water-based" products are usually best for those with acne.
When should you start acne treatment?
Since everyone gets acne at some time, the right time to treat it is when it bothers you or when the potential for scarring develops. This can be when severe acne flares suddenly, for mild acne that just won't go away, or even when a single pimple decides to show up the week before your prom or wedding. The decision is yours.
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