Acne is a skin condition that occurs when your hair follicles become plugged with oil and dead skin cells. It often causes whiteheads, blackheads or pimples, and usually appears on the face, forehead, chest, upper back and shoulders. Acne is most common among teenagers, though it affects people of all ages.
Effective treatments are available, but acne can be persistent. The pimples and bumps heal slowly, and when one begins to go away, others seem to crop up.
Depending on its severity, acne can cause emotional distress and scar the skin. The earlier you start treatment, the lower your risk of such problems.
Acne signs and symptoms vary depending on the severity of your condition:
Whiteheads (closed plugged pores)
Blackheads (open plugged pores)
Small red, tender bumps (papules)
Pimples (pustules), which are papules with pus at their tips
Large, solid, painful lumps beneath the surface of the skin (nodules)
Painful, pus-filled lumps beneath the surface of the skin (cystic lesions)
When to see a doctor
If self-care remedies don’t clear your acne, see your primary care doctor. He or she can prescribe stronger medications. If acne persists or is severe, you may want to seek medical treatment from a doctor who specializes in the skin (dermatologist).
For many women, acne can persist for decades, with flares common a week before menstruation. This type of acne tends to clear up without treatment in women who use contraceptives.
In older adults, a sudden onset of severe acne may signal an underlying disease requiring medical attention.
The Food and Drug Administration (FDA) warns that some popular nonprescription acne lotions, cleansers and other skin products can cause a serious reaction. This type of reaction is quite rare, so don’t confuse it with the redness, irritation or itchiness where you’ve applied medications or products.
Seek emergency medical help if after using a skin product you experience:
Swelling of the eyes, face, lips or tongue
Tightness of the throat
Four main factors cause acne:
Excess oil production
Hair follicles clogged by oil and dead skin cells
Excess activity of a type of hormone (androgens)
Acne typically appears on your face, forehead, chest, upper back and shoulders because these areas of skin have the most oil (sebaceous) glands. Hair follicles are connected to oil glands.
The follicle wall may bulge and produce a whitehead. Or the plug may be open to the surface and darken, causing a blackhead. A blackhead may look like dirt stuck in pores. But actually the pore is congested with bacteria and oil, which turns brown when it’s exposed to the air.
Pimples are raised red spots with a white center that develop when blocked hair follicles become inflamed or infected with bacteria. Blockages and inflammation that develop deep inside hair follicles produce cystlike lumps beneath the surface of your skin. Other pores in your skin, which are the openings of the sweat glands, aren’t usually involved in acne.
Factors that may worsen acne
These factors can trigger or aggravate acne:
Hormones. Androgens are hormones that increase in boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy and the use of oral contraceptives also can affect sebum production. And low amounts of androgens circulate in the blood of women and can worsen acne.
Certain medications. Examples include drugs containing corticosteroids, testosterone or lithium.
Diet. Studies indicate that certain dietary factors, including skim milk and carbohydrate-rich foods — such as bread, bagels and chips — may worsen acne. Chocolate has long been suspected of making acne worse. A small study of 14 men with acne showed that eating chocolate was related to a worsening of symptoms. Further study is needed to examine why this happens and whether people with acne would benefit from following specific dietary restrictions.
Stress. Stress can make acne worse.
How acne develops
These factors have little effect on acne:
Greasy foods. Eating greasy food has little to no effect on acne. Though working in a greasy area, such as a kitchen with fry vats, does because the oil can stick to the skin and block the hair follicles. This further irritates the skin or promotes acne.
Hygiene. Acne isn’t caused by dirty skin. In fact, scrubbing the skin too hard or cleansing with harsh soaps or chemicals irritates the skin and can make acne worse.
Cosmetics. Cosmetics don’t necessarily worsen acne, especially if you use oil-free makeup that doesn’t clog pores (noncomedogenics) and remove makeup regularly. Nonoily cosmetics don’t interfere with the effectiveness of acne drugs.
Risk factors for acne include:
Age. People of all ages can get acne, but it’s most common in teenagers.
Hormonal changes. Such changes are common in teenagers, women and girls, and people using certain medications, including those containing corticosteroids, androgens or lithium.
Family history. Genetics plays a role in acne. If both parents had acne, you’re likely to develop it, too.
Greasy or oily substances. You may develop acne where your skin comes into contact with oily lotions and creams or with grease in a work area, such as a kitchen with fry vats.
Friction or pressure on your skin. This can be caused by items such as telephones, cellphones, helmets, tight collars and backpacks.
Stress. Stress doesn’t cause acne, but if you have acne already, it may make it worse.
If you’ve tried over-the-counter (nonprescription) acne products for several weeks and they haven’t helped, your doctor can prescribe stronger medications. A dermatologist can help you:
Control your acne
Avoid scarring or other damage to your skin
Make scars less noticeable
Acne medications work by reducing oil production, speeding up skin cell turnover, fighting bacterial infection or reducing inflammation — which helps prevent scarring. With most prescription acne drugs, you may not see results for four to eight weeks, and your skin may get worse before it gets better. It can take many months or years for your acne to clear up completely.
The treatment regimen your doctor recommends depends on your age, the type and severity of your acne, and what you are willing to commit to. For example, you may need to wash and apply medications to the affected skin twice a day for several weeks. Often topical medications and drugs you take by mouth (oral medication) are used in combination. Pregnant women will not be able to use oral prescription medications for acne.
Talk with your doctor about the risks and benefits of medications and other treatments you are considering.
The most common topical prescription medications for acne are as follows:
Retinoids and retinoid-like drugs. These come as creams, gels and lotions. Retinoid drugs are derived from vitamin A and include tretinoin (Avita, Retin-A, others), adapalene (Differin) and tazarotene (Tazorac, Avage). You apply this medication in the evening, beginning with three times a week, then daily as your skin becomes used to it. It works by preventing plugging of the hair follicles.
Antibiotics. These work by killing excess skin bacteria and reducing redness. For the first few months of treatment, you may use both a retinoid and an antibiotic, with the antibiotic applied in the morning and the retinoid in the evening. The antibiotics are often combined with benzoyl peroxide to reduce the likelihood of developing antibiotic resistance. Examples include clindamycin with benzoyl peroxide (Benzaclin, Duac, Acanya) and erythromycin with benzoyl peroxide (Benzamycin). Topical antibiotics alone aren’t recommended.
Salicylic acid and azelaic acid. Azelaic acid is a naturally occurring acid found in whole-grain cereals and animal products. It has antibacterial property
Take action against acne
You can try to avoid or control mild acne with nonprescription products, good basic skin care and other self-care techniques:
Wash problem areas with a gentle cleanser. Twice a day, use your hands to wash your face with a mild soap and warm water. If you tend to develop acne around your hairline, shampoo your hair every day. And be gentle if you’re shaving affected skin.
Avoid certain products, such as facial scrubs, astringents and masks. They tend to irritate the skin, which can worsen acne. Excessive washing and scrubbing also can irritate the skin.
Try over-the-counter acne products to dry excess oil and promote peeling. Look for products containing benzoyl peroxide as the active ingredient. You might also try products containing salicylic acid, glycolic acid or alpha hydroxy acids, which may help with mild and moderate acne. It may take a few weeks before you see any improvement.
Nonprescription acne medications may cause initial side effects — such as redness, dryness and scaling — that often improve after the first month of using them.
Avoid irritants. Avoid oily or greasy cosmetics, sunscreens, hairstyling products or acne concealers. Use products labeled water-based or noncomedogenic, which means they are less likely to cause acne.
Protect your skin from the sun. For some people, the sun worsens acne. And some acne medications make you more susceptible to the sun’s rays. Check with your doctor to see if your medication is one of these. If it is, stay out of the sun as much as possible. Regularly use a nonoily (noncomedogenic) moisturizer that includes a sunscreen.
Avoid friction or pressure on your skin. Protect your acne-prone skin from contact with items such as phones, helmets, tight collars or straps, and backpacks.
Avoid touching or picking at the problem areas. Doing so can trigger more acne or lead to infection or scarring.
Shower after strenuous activities. Oil and sweat on your skin can lead to breakouts.
Alternative and integrative medicine approaches used in the treatment of acne include fish oil, brewer’s yeast, probiotics, oral zinc and topical tea tree oil. More research is needed to establish the potential effectiveness and long-term safety of these and other integrative approaches, such as biofeedback and traditional Chinese medicine. Talk with your doctor about the pros and cons of specific treatments before you try them.
Coping and support
Acne and acne scars can cause anxiety and may affect your social relationships and self-image. Sometimes it can help to talk with your family, a support group or a counselor.
Stress can worsen acne. Try to manage stress by getting enough sleep and practicing relaxation techniques.
Preparing for your appointment
If you have acne that’s not responding to self-care and over-the-counter treatments, make an appointment with your doctor. Early, effective treatment of acne reduces the risk of scarring and of lasting damage to your self-esteem. After an initial examination, your doctor may refer you to a specialist in the diagnosis and treatment of skin conditions (dermatologist).
Here’s some information to help you get ready for your appointment.
What you can do
List your key medical information, such as other conditions you’re dealing with and any prescription or over-the-counter products you’re using, including vitamins and supplements.
List key personal information, including any major stresses or recent life changes.
List questions to ask your doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.