Acne

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Types

Stress can be a key trigger of acne in some cases.

Acne pimples vary in size, color, and level of pain.

The following types are possible:

  • Whiteheads: These remain under the skin and are small
  • Blackheads: Clearly visible, they are black and appear on the surface of the skin
  • Papules: Small, usually pink bumps, these are visible on the surface of the skin
  • Pustules: Clearly visible on the surface of the skin. They are red at their base and have pus at the top
  • Nobules: Clearly visible on the surface of the skin. They are large, solid, painful pimples that are embedded deep in the skin
  • Cysts: Clearly visible on the surface of the skin. They are painful and filled with pus. Cysts can cause scars.
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Overview

Acne is a skin condition that occurs when your hair follicles become plugged with oil and dead skin cells. It often causes whiteheads, blackheads or pimples, and usually appears on the face, forehead, chest, upper back and shoulders. Acne is most common among teenagers, though it affects people of all ages.

Effective treatments are available, but acne can be persistent. The pimples and bumps heal slowly, and when one begins to go away, others seem to crop up.

Depending on its severity, acne can cause emotional distress and scar the skin. The earlier you start treatment, the lower your risk of such problems.

Symptoms

Acne signs and symptoms vary depending on the severity of your condition:

  • Whiteheads (closed plugged pores)
  • Blackheads (open plugged pores)
  • Small red, tender bumps (papules)
  • Pimples (pustules), which are papules with pus at their tips
  • Large, solid, painful lumps beneath the surface of the skin (nodules)
  • Painful, pus-filled lumps beneath the surface of the skin (cystic lesions)

Causes

Four main factors cause acne:

  • Excess oil production
  • Hair follicles clogged by oil and dead skin cells
  • Bacteria
  • Excess activity of a type of hormone (androgens)

Acne typically appears on your face, forehead, chest, upper back and shoulders because these areas of skin have the most oil (sebaceous) glands. Hair follicles are connected to oil glands.

The follicle wall may bulge and produce a whitehead. Or the plug may be open to the surface and darken, causing a blackhead. A blackhead may look like dirt stuck in pores. But actually the pore is congested with bacteria and oil, which turns brown when it's exposed to the air.

Pimples are raised red spots with a white center that develop when blocked hair follicles become inflamed or infected with bacteria. Blockages and inflammation that develop deep inside hair follicles produce cystlike lumps beneath the surface of your skin. Other pores in your skin, which are the openings of the sweat glands, aren't usually involved in acne.

Factors that may worsen acne

These factors can trigger or aggravate acne:

  • Hormones. Androgens are hormones that increase in boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy and the use of oral contraceptives also can affect sebum production. And low amounts of androgens circulate in the blood of women and can worsen acne.
  • Certain medications. Examples include drugs containing corticosteroids, testosterone or lithium.
  • Diet. Studies indicate that certain dietary factors, including skim milk and carbohydrate-rich foods — such as bread, bagels and chips — may worsen acne. Chocolate has long been suspected of making acne worse. A small study of 14 men with acne showed that eating chocolate was related to a worsening of symptoms. Further study is needed to examine why this happens and whether people with acne would benefit from following specific dietary restrictions.
  • Stress. Stress can make acne worse.

Mild acne

A variety of steroidal and non-steroidal creams and gels are available to treat acne, and many are effective.

Mild acne can be treated with over-the-counter (OTC) medications, such as gels, soaps, pads, creams, and lotions, that are applied to the skin.

Creams and lotions are best for sensitive skin. Alcohol-based gels dry the skin and are better for oily skin.

OTC acne remedies are the following active ingredients:

  • Resorcinol: helps break down blackheads and whiteheads
  • Benzoyl peroxide: kills bacteria, accelerates the replacement of skin, and slows the production of sebum
  • Salicylic acid: assists the breakdown of blackheads and whiteheads and helps reduce swelling
  • Sulfur: exactly how this works is unknown
  • Retin-A: helps unblock pores through cell turnover
  • Azelaic acid: strengthens cells that line the follicles, stops sebum eruptions.

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