Topic Overview

What is acne?

Acne, or acne vulgaris, is
a skin problem that starts when oil and dead skin cells clog up your pores.
Some people call it blackheads, blemishes, whiteheads, pimples, or zits. When
you have just a few red spots, or pimples, you have a mild form of acne. Severe
acne can mean hundreds of pimples that can cover the face, neck, chest, and
back. Or it can be bigger, solid, red lumps that are painful (cysts).

Acne is very common among teens. It usually gets better after
the teen years. Some women who never had acne growing up will have it as an adult, often right before their
menstrual periods.

How you feel about your acne may not be related
to how bad it is. Some people who have severe acne are not bothered by it. Others
are embarrassed or upset even though they have only a few pimples.

The good news is that there are many good treatments that can help you
get acne under control.

What causes acne?

Acne starts when oil and dead
skin cells clog the skin’s pores
. If germs get into the pores, the result can
be swelling, redness, and pus.

For most people, acne starts during the teen
years. This is because hormone changes make the skin oilier after puberty
starts.

Using oil-based skin products or cosmetics can make acne worse. Use skin products that don’t clog your pores. They will say “noncomedogenic” on the label.

Acne can run in families. If one of your parents had severe
acne, you are more likely to have it.

What are the symptoms?

Symptoms of acne include
whiteheads, blackheads, and
pimples. These can occur on the face, neck, shoulders,
back, or chest. Pimples that are large and deep are called
cystic lesions. These can be painful if they get
infected. They also can scar the skin.

How is acne treated?

To help control acne, keep
your skin clean. Avoid skin products that clog your pores. Look for products
that say “noncomedogenic” on the label. Wash your skin once or twice a day with
a gentle soap or acne wash. Try not to scrub or pick at your pimples. This can
make them worse and can cause scars.

If you have just a few
pimples to treat, you can get an acne cream without a prescription. Look for
one that has adapalene, benzoyl peroxide, or salicylic acid. These work best when used just
the way the label says.

It can take time to get acne under
control. But if you haven’t had good results with nonprescription products after trying them for 3 months, see your doctor. A prescription gel or skin cream may be all you need. If you are a woman, taking certain birth control pills may help.

If
you have acne cysts, your doctor may suggest a stronger medicine, such as isotretinoin. This medicine works very well for some kinds of acne.

What can be done about acne scars?

There are many skin
treatments, such as laser resurfacing or dermabrasion, that can help acne scars look better and feel smoother. Ask your
doctor about them. The best treatment for you depends on how severe the
scarring is. Your doctor may refer you to a plastic surgeon.

Frequently Asked Questions

Learning about acne:

Being diagnosed:

Getting treatment:

Living with acne:

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Cause

There are
different types of acne. The most common
acne is the type that develops during the teen years.
Puberty causes hormone levels to rise, especially
testosterone. These changing hormones cause skin glands
to start making more oil (sebum). Oil releases from the pores to protect the
skin and keep it moist. Acne begins when oil mixes with dead cells and clogs
the skin’s pores. Bacteria can grow in this mixture. And if this mixture leaks
into nearby tissues, it causes swelling, redness, and pus. A common name for
these raised bumps is
pimples.

Certain medicines, such as corticosteroids or lithium, can cause acne to develop. Talk to your doctor about any medicines you are taking.

It isn’t just
teens who are
affected by acne. Sometimes newborns have acne because
their mothers pass hormones to them just before delivery. Acne can also appear
when the stress of birth causes the baby’s body to release hormones on its own.
Young children and older adults also may get acne.

A few
conditions of the
endocrine system, such as
polycystic ovary syndrome and
Cushing’s syndrome, can lead to outbreaks of
acne.

Symptoms

Acne develops
most often on the face, neck, chest, shoulders, or back and can range from mild
to severe. It can last for a few months, many years, or come and go your entire
life.

Mild acne usually causes only
whiteheads and blackheads. At times, these may develop
into an infection in the skin pore (pimple).

Severe acne can produce hundreds of pimples that cover large areas of
skin.
Cystic lesions are pimples that are large and deep.
These lesions are often painful and can leave scars on your skin.

Acne can lead to low self-esteem and sometimes
depression. These conditions need treatment along with
the acne.

What Happens

Acne develops most often in the teen and young adult
years. During this time, both males and females usually produce more
testosterone than at any other time in life. This
hormone causes oil glands to produce more oil (sebum). The extra oil can clog
pores and cause acne. Bacteria can grow in this mixture. And if the mixture
leaks into nearby tissues, it causes swelling, redness, and pus
(pimples).

Acne usually gets better in the adult years when your
body produces less testosterone. Still, some women have
premenstrual acne flare-ups well into
adulthood.

What Increases Your Risk

The tendency to develop
acne runs in families. You are more likely to develop
severe acne if your parents had severe acne.

The risk of
developing acne is highest during the teen and young adult years. These are the
years when hormones such as
testosterone are increasing. Women who are at the age
of
menstruation also are more likely to develop acne.
Many women have acne flare-ups in the days just before their menstrual
periods.

Acne can be irritated or made worse by:

  • Wearing straps or other tight-fitting items
    that rub against the skin (such as a football player wearing shoulder pads), as
    well as using equipment that rubs against the body (such as a violin held
    between the cheek and shoulder). Helmets, bra straps, headbands, and turtleneck
    sweaters also may cause acne to get worse.
  • Using skin and hair care
    products that contain
    irritating substances.
  • Washing the face
    too often or scrubbing the face too hard. Using harsh soaps or very hot water
    can also cause acne to get worse.
  • Experiencing a lot of
    stress.
  • Touching the face a lot.
  • Sweating a
    lot.
  • Having hair hanging in the face, which can cause the skin to
    be oilier.
  • Taking certain
    medicines, such as corticosteroids, some barbiturates, or lithium.
  • Working with
    oils and harsh chemicals on a regular basis.

Athletes or bodybuilders who take anabolic steroids are also at risk for getting acne.footnote 1

When To Call a Doctor

Call a doctor if:

  • You are concerned about your or your child’s
    acne.
  • Your acne gets worse or does not
    improve after 3 months with home treatment.
  • You develop scars or marks after acne heals.
  • Your
    pimples become large and hard or filled with fluid.
  • You start to
    have other physical symptoms, such as facial hair growth in
    women.
  • Your acne began when you started a new medicine prescribed
    by a doctor.
  • You have been exposed to chemicals, oils, or other
    substances that cause your skin to break out.

You may want to seek medical assistance sooner if there is
a strong family history of acne, you are emotionally affected by acne, or you
developed acne at an early age.

Watchful waiting

Watchful waiting is a wait-and-see approach. If
you get better on your own, you won’t need treatment. If you get worse, you and
your doctor will decide what to do next.

Mild acne, with a few pimples that clear up on their own, may not need any treatment. But if you are worried about how much you are breaking out, see your doctor. Getting medical treatment early may prevent acne from getting worse or from causing scars.

If you have severe acne, if your acne does not clear up with home treatment, or if you develop acne scars,
call your doctor.

Who to see

The following health professionals can
diagnose and treat acne:

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

When you see a doctor about
acne, you’ll have a
physical exam, and your doctor will ask about your
medical history. Women may be asked questions about
their menstrual cycles. This information can help your doctor find out if
hormones are playing a role in acne flare-ups. Most often, you won’t have any
special tests to diagnose acne.

You may need other tests if your
doctor suspects that acne is a symptom of another medical problem (such as
higher-than-normal amounts of
testosterone in a woman).

Treatment Overview

Acne treatment
depends on whether you have a
mild, moderate, or severe type of acne. Sometimes your doctor
will combine treatments to get the best results and to avoid developing
drug-resistant bacteria. Treatment could include
lotions or gels you put on blemishes or sometimes entire areas of skin, such as
the chest or back (topical medicines). You might also take medicines by mouth
(oral medicines).

Mild acne

Treatment for mild acne (whiteheads, blackheads, or pimples) may
include:

  • Gentle cleansing with warm water and a mild soap, such as
    Dove or Cetaphil.
  • Applying a topical retinoid (such as adapalene gel, or Differin).
  • Applying benzoyl peroxide (such as Brevoxyl or
    Triaz).
  • Applying salicylic acid (such as Propa pH or Stridex).

If these treatments do not work, you may want to see your
doctor. Your doctor can give you a prescription for stronger lotions or creams.
You may try an
antibiotic lotion. Or you may try a lotion with
medicine that helps to unplug your pores.

Moderate to severe acne

Sometimes acne needs treatment with stronger
medicines or a combination of therapies. Deeper blemishes, such as nodules and
cysts, are more likely to leave scars. As a result, your doctor may give you
oral antibiotics sooner to start the healing process. This kind of acne may
need a combination of several therapies. Treatment for moderate to severe acne
may include:

  • Applying benzoyl peroxide.
  • Draining
    of large pimples and cysts by a doctor.
  • Applying prescription
    antibiotic gels, creams, or lotions.
  • Applying prescription
    retinoids.
  • Applying azelaic acid.
  • Taking prescription oral
    antibiotics.
  • Taking prescription oral retinoids (such as
    isotretinoin).

Treatment for acne scars

There are many procedures to remove acne scars, such as laser resurfacing, chemical peels, and dermal fillers. Some scars shrink and fade with time. But if your scars bother you, talk to your doctor. He or she may refer you to a dermatologist or a plastic surgeon.

What to think about

Most treatments for acne take time. It often
takes 6 to 8 weeks for acne to improve after you start treatment. Some treatments may cause acne to get worse before it gets
better.

If your acne still hasn’t improved after several tries with
other treatment, your doctor may recommend that you take an oral retinoid, such
as isotretinoin. Doctors prescribe this
medicine as a last resort, because it has some rare but serious side effects
and it is expensive.

Certain low-dose birth control pills may help
control acne in women who tend to have flare-ups before menstruation.

Prevention

Although you can’t prevent
acne, there are steps you can take at home to keep
acne from getting worse.

  • Gently wash and care for your skin every day.
    Avoid scrubbing too hard or washing too often.
  • Avoid heavy
    sweating if you think it causes your acne to get worse. Wash soon after
    activities that cause you to sweat.
  • Wash your hair often if your
    hair is oily. Try to keep your hair off of your face.
  • Avoid hair
    care products such as gels, mousses, cream rinses, and pomades that contain a
    lot of oil.
  • Avoid touching your face.
  • Wear soft, cotton
    clothing or moleskin under sports equipment. Parts of equipment, such as chin
    straps, can rub your skin and make your acne worse.
  • Avoid exposure
    to oils and harsh chemicals, such as
    petroleum.
  • Protect your skin from too much sun.

Home Treatment

Treatment at home can help reduce
acne flare-ups.

  • Wash your face (or other affected skin) gently one or
    two times a day.
  • Do not squeeze pimples, because that often leads
    to infections, worse acne, and scars.
  • Use a moisturizer to keep your skin from drying out. Choose one that says “noncomedogenic” on the label.
  • Use
    over-the-counter medicated creams, soaps, lotions, and
    gels to treat your acne. Always read the label carefully to make sure you are
    using the product correctly.

Examples of some over-the-counter products used to treat
acne include:

  • Benzoyl peroxide (such as Brevoxyl or
    Triaz), which unplugs pores.
  • Alpha hydroxy acid, which dries up blemishes and
    causes the top skin layer to peel. You’ll find alpha hydroxy acid in some
    moisturizers, cleansers, eye creams, and sunscreens.
  • Salicylic acid (such as Propa pH or Stridex), which dries up
    blemishes and causes the top skin layer to peel.
  • Tea tree oil, which kills bacteria. You’ll find tea tree oil in some gels,
    creams, and oils.

Some skin care products, such as those with alpha hydroxy acid, will make your skin very sensitive to ultraviolet (UV) light. Protect your skin from the sun and other sources of UV light.

Medications

Medicines can help manage the severity
and frequency of
acne outbreaks. A number of medicines are available.
Your treatment will depend on the type of acne you have (pimples,
whiteheads, blackheads, or
cystic lesions). These medicines improve acne
by:

  • Unplugging skin pores and stopping them from
    getting plugged with oil (tretinoin, which is sold as
    Retin-A).
  • Killing bacteria (antibiotics).
  • Reducing the
    amount of skin oil (isotretinoin).
  • Reducing the effects of hormones
    in producing acne (certain oral contraceptive pills for women).

The best medical treatment for acne often is a combination
of medicines. These could include medicine that you put on your skin (topical)
and medicine that you take by mouth (oral). Or you may take medicines such as clindamycin/benzoyl peroxide, a gel that contains two topical medicines.

Medicine choices

Treatment of acne depends on whether
inflammation or bacteria are present. Some acne
consists only of red bumps on the skin with no open sores (comedonal acne).
Topical creams and lotions work best for this type of acne. But if bacteria or
inflammation is present with open sores, oral antibiotics or isotretinoin may
work better.

The most common types of medicines that doctors use
to treat acne include:

  • Benzoyl peroxide, such as Brevoxyl or
    Triaz.
  • Salicylic acid, such as Propa pH or Stridex.
  • Topical and oral antibiotics, such as clindamycin, doxycycline, erythromycin,
    and tetracycline.
  • Topical retinoid medicines, such as adapalene (Differin), tazarotene (Tazorac), and tretinoin
    (Retin-A).
  • Azelaic acid, such as Azelex, a topical
    cream.
  • Isotretinoin, an oral retinoid.
  • Low-dose birth control pills that contain
    estrogen (such as Estrostep, Ortho Tri-Cyclen, or
    Yaz), which work well on moderate acne in women and for premenstrual flare-ups.
  • Androgen blockers, such as spironolactone. Androgen
    blockers can be useful in treating acne. These medicines decrease the amount of
    sebum (oil) made in your pores.

What to think about

If you are pregnant, talk to
your doctor about whether you should take antibiotics for acne. Some
antibiotics aren’t safe to take during pregnancy.

Over time,
bacteria can become resistant to antibiotics, which means that the antibiotics
are no longer effective at killing or controlling the bacteria causing the
acne. This is called
drug resistance. When this occurs, a different
antibiotic may be used.

After acne is under control, you often
need ongoing treatment to keep it from returning. This is the maintenance phase
of treatment. Your doctor may suggest treatments other than antibiotics for
long-term use, to avoid the risk of drug resistance.

Topical
medicines usually have fewer and less serious side effects than oral medicines.
But topical medicines may not work as well as oral medicines for severe
acne.

Isotretinoin (such as Sotret) and tazarotene
(Tazorac) can have serious side effects. Women who take isotretinoin or
tazarotene need to use an effective birth control method, to avoid having a
baby with serious birth defects.

Surgery

There are no surgeries to treat
acne.

Other Treatment

Photodynamic therapy (PDT) and other light and laser-based therapies are being used to treat acne. These include the use of blue light, red light, intense pulsed light (IPL), and infrared or pulsed dye lasers. Sometimes these therapies are used along with medicines, but they may also help people who cannot be treated with medicines.

Treatments like laser skin resurfacing and chemical peels can also help. They can make acne scars less noticeable. Dermal fillers also work well for some types of acne scars.

Your doctor may suggest other
types of therapies to treat
acne or acne scars.

Other Places To Get Help

Organizations

American Academy of Dermatology
www.aad.org

National Institute of Arthritis and Musculoskeletal and Skin Diseases (U.S.)
www.niams.nih.gov

References

Citations

  1. Hall JC (2010). Seborrheic dermatitis, acne, and rosacea. In JC Hall, ed., Sauer’s Manual of Skin Diseases, 9th ed., pp. 149-159. Philadelphia: Lippincott Williams and Wilkins.

Other Works Consulted

  • American Academy of Dermatology (2007). Guidelines of care for acne vulgaris management. Journal of the American Academy of Dermatology, 56(4): 651-663. Also available online: http://www.aad.org/education-and-quality-care/clinical-guidelines/current-and-upcoming-guidelines.
  • Del Rosso JQ (2012). Acne vulgaris and rosacea. In EG Nabel, ed., ACP Medicine, section 5, chap. 12. Hamilton, ON: BC Decker.
  • Habif TP, et al. (2011). Acne. In Skin Disease: Diagnosis and Treatment, 3rd ed., pp. 102-108. Edinburgh: Saunders.
  • Purdy S, de Berker D (2011). Acne vulgaris, search date February 2010. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
  • Tsatsou F, Zouboulis CC (2010). Acne vulgaris. In MG Lebwohl et al., eds., Treatment of Skin Disease: Comprehensive Therapeutic Strategies, 3rd ed., pp. 6-11. Philadelphia: Mosby Elsevier.
  • Van Durme DJ, Johnson LM (2015). Acne vulgaris. In ET Bope et al., eds., Conn’s Current Therapy 2015, pp. 219-220. Philadelphia: Saunders.
  • Zaenglein Al, et al. (2012). Acne vulgaris and acneiform eruptions. In LA Goldman et al., eds., Fitzpatrick’s Dermatology in General Medicine, 8th ed., vol. 1, pp. 897-917. New York: McGraw-Hill.

Credits

ByHealthwise Staff
Primary Medical Reviewer Kathleen Romito, MD – Family Medicine
Adam Husney, MD – Family Medicine
E. Gregory Thompson, MD – Internal Medicine
Martin J. Gabica, MD – Family Medicine
Elizabeth T. Russo, MD – Internal Medicine
Specialist Medical Reviewer Ellen K. Roh, MD – Dermatology

Current as ofOctober 5, 2017