Acne is the most frequent skin condition in the United States. It is characterized by pimples that appear on the face, back and chest. Every year, about 80% of adolescents have some form of acne and about 5% of adults experience acne.

Acne is made up of two types of blemishes:

  • Whiteheads/Blackheads, also known as comedones, are non-inflammatory and appear more on the face and shoulders. As long as they remain uninfected, they are unlikely to lead to scarring.
  • Red Pustules or Papules are inflamed pores that fill with pus.  These can lead to scarring.  Large, deep papules are referred to as "nodules" or "cysts", and these are even more inclined to produce scars.

Causes

In normal skin, oil glands under the skin, known as sebaceous glands, produce an oily substance called sebum. The sebum moves from the bottom to the top of each hair follicle and then spills out onto the surface of the skin, taking with it sloughed-off skin cells. With acne, the structure through which the sebum flows gets plugged up. This blockage traps sebum and sloughed-off cells below the skin, along with bacteria and bacterial waste products, preventing them from being released onto the skin’s surface. If the pore’s opening is fully blocked, this produces a pale bump called a "comedo". If the pore’s opening is open, this produces blackheads. When either a whitehead or blackhead becomes inflamed, they can become red pustules or papules.

Sebum production, and the resulting acne, is strongly influenced by male hormones, which are present in both men and women.  Because of hormone fluctuations, women often notice changes in their complexion during different phases of their menstrual cycle.  Male hormone production may also be influenced by diet, and some patients notice improvement in their complexion when they lower  their intake of dairy products and carbohydrates with a high glycemic index (those which cause an increase in blood sugar levels).

It is important for patients not to pick or scratch at individual lesions because it can make them inflamed and can lead to long-term scarring.

Treatment

Treating acne is a relatively slow process; there is no overnight remedy. Some treatments include:

  • Benzoyl Peroxide — Used in mild cases of acne, benzoyl peroxide reduces the blockages in the hair follicles.
  • Oral and Topical Antibiotics — Used to reduce bacterial growth in sebaceous glands. Best if combined with benzoyl peroxide.
  • Hormonal Treatments — Can be used for adult women and teens with hormonally induced acne.
  • Retinoids — Derivatives  of Vitamin A, retinoids help unplug the blocked-up material in whiteheads/blackheads. They have become a mainstay in the treatment of acne. Tretinoin, adapalene, and tazarotene are all retinoid medications.
  • Extraction — Removal of whiteheads and blackheads using a small metal instrument that is centered on the comedone and pushed down, extruding the blocked pore.
  • Isotretinoin---This is the most powerful treatment available for severe acne.  It is an oral medication usually taken for 4-6 months. Since it causes birth defects if it is taken during pregnancy, its use is carefully monitored and controlled through the the "I-Pledge program".