What is acne?
Illustration of Comedones: Blackheads and Whitehead by MedicalRF.com
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 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 vulgaris is typical teenage acne which is characterized by three types of lesions:
Acne appears on the skin as
- occluded pores (“comedones“), also known as blackheads or whiteheads,
- tender red bumps also are known as pimples or zits,
- pustules (bumps containing pus), and occasionally as
- cysts (the deep pimples and boils of cystic acne).
One can do a lot to treat acne using products available at a drugstore or cosmetic counter that does not require a prescription. However, for tougher cases of acne, one should consult a physician for treatment options.
Acne & Rosacea
Is rosacea like acne?
Unlike common acne, rosacea is not primarily a plague of teenagers but occurs most often in adults (ages 30-50), especially in those with fair skin. Different than acne, there are usually no blackheads or whiteheads in rosacea.
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 or due to other hormonal changes. Sebum (oil) is a natural substance that 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 plug the follicular pore. The plug can appear as a whitehead if it is 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:
- Food: Parents often tell teens to avoid pizza, greasy and fried foods, and junk food. While these foods may not be good for overall health, they don’t play an important causal role in acne. Although some recent studies have implicated a high-carbohydrate diet, milk, and pure chocolate in aggravating acne, these findings are 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:
- Heredity: If one of your parents had severe acne, it is likely that your acne will be more difficult to control.
- 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 (either the medically prescribed prednisone [Deltasone, Orasone, Prednicen-M, Liquid Pred] or the steroids that bodybuilders or athletes sometimes take). Other drugs that can cause or aggravate acne are anticonvulsant medications and lithium (Eskalith, Lithobid). 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 skincare products are pore-clogging (“comedogenic”). Of the many available brands of skincare products, it is important to read the list of ingredients and choose those which have water listed first or second if one is concerned about acne. These “water-based” products are usually best for those with acne.
What other skin conditions can mimic acne symptoms and signs?
- Rosacea: This condition is characterized by pimples but not comedones and occurs in the middle third of the face, along with redness, flushing, and superficial blood vessels. It generally affects people in their 30s and 40s and older.
- Pseudofolliculitis: This is sometimes called “razor bumps” or “razor rash.” When cut too close to the skin, growing hairs twist into the skin and produce tender bumps. This is a mechanical problem, and treatment involves shaving less (growing a beard, laser hair removal). Pseudofolliculitis can, of course, occur in patients who have acne, too.
- Folliculitis: Pimples can occur on other parts of the body, such as the abdomen, buttocks, or legs. These represent not acne but inflamed follicles. If these don’t go away on their own, doctors can prescribe oral or external antibiotics, generally not the same ones used for acne.
- Gram-negative folliculitis: Some patients who have been treated with oral antibiotics for long periods of time develop pustules filled with bacteria that are resistant to the antibiotics that were previously used. Bacterial culture tests can identify these germs, leading the doctor to prescribe different antibiotics or other forms of treatment.