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Acne
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 with 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 more oily after puberty starts.
Eating chocolate or greasy foods may cause some people to break out, but studies haven't proven that eating chocolate or high-fat foods increases the risk of acne. 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 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
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| Acne: Should I See My Doctor? | |
| Acne: Should I Take Isotretinoin for Severe Acne? | |
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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:
- Pediatricians
- Family medicine physicians or internists
- Nurse practitioners
- Physician assistants
- Dermatologists
To prepare for your appointment, see the topic Making the Most of Your Appointment.
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 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 and dermabrasion. 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.
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.
Medication 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 tretinoin (Retin-A), adapalene (Differin), and tazarotene (Tazorac).
- 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. The U.S. Food and Drug Administration (FDA) has announced that the companies that make isotretinoin have a program to register doctors who prescribe isotretinoin and the people who take it. The program is to ensure that women taking this medicine understand the risk of birth defects, take precautions to avoid pregnancy, and know what to do if they become pregnant. If your doctor suggests that you take isotretinoin, you must be registered with iPLEDGE in order to get the drug. You can get more information and register at www.ipledgeprogram.com or by telephone at 1-866-495-0654 (toll-free).
Using isotretinoin may be linked with depression, psychosis, and, in rare cases, suicidal thoughts or attempts. The link between this medicine and depression is not clear and is being watched very closely. Talk to your doctor about the side effects of isotretinoin to decide whether it is right for you. If you are taking isotretinoin and feel depressed, see your doctor for treatment.
Last Revised: February 3, 2011
Author: Healthwise Staff
Medical Review: Kathleen Romito, MD - Family Medicine & Alexander H. Murray, MD, FRCPC - Dermatology
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