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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
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.
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
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.
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.
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.
you have acne cysts, your doctor may suggest a stronger medicine, such as isotretinoin. This medicine works very well for some kinds of acne.
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.
Learning about acne:
Living with acne:
Health Tools help you make wise health decisions or take action to improve your health.
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
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.
conditions of the
endocrine system, such as
polycystic ovary syndrome and
Cushing's syndrome, can lead to outbreaks of
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
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
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
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
Acne usually gets better in the adult years when your
body produces less testosterone. Still, some women have
premenstrual acne flare-ups well into
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
menstruation also are more likely to develop acne.
Many women have acne flare-ups in the days just before their menstrual
Acne can be irritated or made worse by:
Athletes or bodybuilders who take anabolic steroids are also at risk for getting acne.1
Call a doctor if:
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 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.
The following health professionals can
diagnose and treat acne:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
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).
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
Treatment for mild acne (whiteheads, blackheads, or pimples) may
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.
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
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.
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
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.
Although you can't prevent
acne, there are steps you can take at home to keep
acne from getting worse.
Treatment at home can help reduce
Examples of some over-the-counter products used to treat
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.
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
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.
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
The most common types of medicines that doctors use
to treat acne include:
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.
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.
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
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.
There are no surgeries to treat
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 dermabrasion, microdermabrasion, and laser skin resurfacing 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.
The American Academy of Dermatology (AAD) provides information
about the care of skin. You can locate a dermatologist in your
area by using their "Find a Dermatologist" tool. Or you can read the latest news in dermatology. "SPOT Skin Cancer" is the AAD's program to reduce deaths from melanoma. There is also a link called "Skin Conditions" that has information about many common skin problems.
The American Academy of Facial Plastic and
Reconstructive Surgery (AAFPRS) is the world's largest association of facial
plastic and reconstructive surgeons and is dedicated to the highest quality of
facial plastic and reconstructive surgery. It offers information to the public
on facial plastic surgery and can help you locate a certified surgeon in your
area. Most members are board-certified in otorhinolaryngology (ear, nose, and
throat specialty), dermatology, plastic surgery, or ophthalmology.
The American Society for Dermatologic Surgery was founded in 1970
to promote excellence in the subspecialty of dermatologic surgery and to foster
the highest standards of patient care. Information on the treatment of skin
conditions and referral lists are available online and by calling the ASDS.
The National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) is a governmental institute that serves the public
and health professionals by providing information, locating other information
sources, and participating in a national federal database of health
information. NIAMS supports research into the causes, treatment, and prevention
of arthritis and musculoskeletal and skin diseases and supports the training of
scientists to carry out this research.
The NIAMS website provides
health information referrals to the NIAMS Clearinghouse, which has information
packages about diseases.
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.
Feldman SR, Fleischer AB (2011). Acne vulgaris and rosacea. In ET Bope et al., eds., Conn's Current Therapy 2011, pp. 807–810. Philadelphia: Saunders.
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.
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.
January 23, 2013
Kathleen Romito, MD - Family Medicine & E. Gregory Thompson, MD - Internal Medicine
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