While acne is commonly believed to happen during teenage years, it is actually a condition that can affect people at any age. Many people still experience acne well into their adult years (commonly referred to as adult acne). Various factors, such as hormone fluctuations, bacterial and fungal infections, and genetics may play a role in an individual's susceptibility to acne.
While the term acne could medically be used to describe a wide array of skin diseases with eruptive lesions, it is most commonly used to refer to the dermatological condition known as acne vulgaris. It may appear as one distinctive bump or a cluster of blemishes with varying degrees of inflammation, swelling and irritation.
Acne vulgaris is not the only skin condition that causes blemishes and lesions. There are many other conditions that have similar physical appearance, such as keratosis pilaris (a genetic follicular condition), rosacea (red rash sometimes accompanied with skin blemishes) and milia (keratin-filled cysts).
How Acne Develops
Acne is a result of overactive sebaceous glands on the skin, which can be found almost everywhere on the body except the palms of the hands and the soles of the feet. These glands, which connect to hair follicles with microscopic openings known as pores, naturally secrete oils known as sebum to lubricate the skin. However, when overactive sebaceous glands excrete too much sebum, pores on the skin become congested, trapping bacteria and dead skin cells, in turn causing inflamed blemishes known as acne. Sebaceous glands are a lot more congregated around the face, back and chest, so the skin around these areas are more prone to cases of acne.
Causes And Risk Factors
While the exact cause for acne breakouts remains unclear, there are several factors that may lead to overactive sebaceous glands:
- Genetics: Individuals with a family history of acne are more susceptible to acne vulgaris. According to a study from the Journal of Investigative Dermatology, 81 percent of the variance of acne is attributed to genetic factors. However, science has yet to isolate a specific gene that makes a person more susceptible to acne.
- Hormones: Studies have shown that androgens, a type of steroid hormone, have a strong correlation in the formation of acne, because they stimulate sebaceous glands to produce more sebum. Androgen production is the most active between the ages of 11 to 14, when most boys and girls undergo puberty. Thus, women undergoing menopause or experiencing premenstrual symptoms (PMS) are also more prone to acne, as levels of androgen may fluctuate and undergo changes during these periods of time.
- Lifestyle: Stress is often correlated to acne due to the change in hormones in the adrenal glands. When stress sets in, androgens significantly increase, and the body is more prone to inflammation, as white blood cells get ready to fight potential infections under times of stress.
Symptoms And Types
Depending on each individual, the symptoms of acne may vary. Some people experience only mild irritation and a few small blemishes, while others experience large and painful cysts.
Symptoms of acne can be broken down by the various types of acne, which include:
- Blackheads: small, dark spots known, also known as open comedones.
- Whiteheads: white, raised bumps, also known as closed comedones.
- Papules: small, red bumps. This type of acne is what people commonly refer to as pimples or zits, although other types of acne are often identified with these labels.
- Cysts: closed pockets of tissue that can be filled with air, pus or some form of fluid.
- Pustules: small, inflamed lesions that look like blisters and can be filled with pus.
Other symptoms that accompany the various types of acne include:
- Crust around skin bumps.
- Red areas around acne breakouts.
- Scarred skin that may leave tiny indents, or craters.
Tests And Diagnosis
To diagnose the problem, most doctors perform a simple visual test by examining the affected skin, and by categorizing acne into four grades to help determine the course of treatment:
- Grade I: Grade I acne include whiteheads, blackheads and minor pimples without inflammation. This is the mildest form of acne, and can usually be treated with over-the-counter treatments.
- Grade II: Considered moderate acne, Grade II includes widespread blackheads and whiteheads, as well as frequent papules and pustules. Over-the-counter products may still be effective to a certain extent, but improvement usually stops after six to eight weeks.
- Grade III: Known as moderate to severe acne, Grade III acne consists of widespread and inflamed papules and pustules. Nodular acne is also present.
- Grade IV: Grade IV is known as severe acne and is characterized by a proliferation of heavily inflamed pustules as well as nodular and cystic acne. Blackheads and whiteheads are also present.
Treatment And Prevention
Usually, episodes of acne flare-ups may be cleared with over-the-counter (OTC) products and home care. If they persist for more than several months, become severe or are accompanied by other side effects, it is advisable to see your doctor or dermatologist for follow-up tests to alleviate the symptoms and rule out the possibility of other more serious conditions.
- Home Care: Gently clean the skin with mild, nondrying soap to avoid irritation while removing dirt. Apply OTC acne medication, which may contain benzoyl peroxide, sulfur, salicylic acid or resorcinol. There are also OTC facial cleaners, creams and other products that may help treat or prevent acne, although their affects may vary from person to person.
- Prescription medication: For severe cases of acne, a physician might prescribe oral or topical antibiotics, which include tetracycline, doxycycline or clindamycin. Special creams or gels may also be prescribed, some containing stronger formulas of OTC medication like benzoyl peroxide or salicylic acid.
- Hormone treatment: Women who are experiencing acne or acne flare-ups due to hormone issues might be advised be their physician to take birth control pills or a pill called spironolactone.
- Medical procedures: Photodynamic therapy, which is a laser procedure, might help treat acne. Other procedures include dermabrasion (skin smoothing surgery), cortisone injections or chemical skin peeling.
Things You Shouldn't Do To Prevent Acne
- Do not scratch, squeeze, pop, poke, pick or rub acne. This can lead to further complications like infections and scarring.
- Avoid greasy cosmetic or hair care products that might cause acne flare-ups or make conditions worse.
- Avoid wearing tight headbands or hats that can trap oil or sweat.
- Try not to touch your face, especially if your hands are dirty.
- Make sure to remove makeup at night to free up your pores. If possible, also look for noncomedogenic makeup to help prevent acne.
- Avoid overexposing yourself to sunlight.
Excessive scarring of the skin as a result of these blemishes is a warning sign that the condition has become severe. Acne scars can range from atrophic, pitted scars to hypertrophic, raised scars. These scars are often unsightly and can be sensitive to the sun. Sometimes, skin discoloration accompanies the scars, as skin pigmentation is the aftermath of acne inflammation. In such cases, the attention of a dermatologist will be needed to minimize future scarring, as serious cases of scarring may lead to permanent disfiguration.
When acne interferes with an individual's quality of life, it is a warning sign that the condition needs immediate medical attention. Psychological disturbances, such as depression, decreased self-esteem, social anxiety and thoughts of suicide are warning signs that acne is negatively impacting a person’s life. While there may be other factors other than acne that contributes to these psychological disturbances, it is extremely important to seek medical help, as these are serious conditions that require immediate attention.