Acne
Acne vulgaris; Cystic acne; Pimples; Zits
Acne is a skin condition that causes pimples or "zits." Whiteheads, blackheads, and red, inflamed patches of skin (such as cysts) may develop.
You can call them blackheads, pimples or zits, but by any name, acne can really ruin your day. Waking up to find a giant pimple in the middle of your forehead or chin, especially if it's picture day at school, or you have a big date, can be a real bummer. So, what causes acne? All over your skin you've got tiny little holes called pores. These holes are openings to your hair follicles. Each hole also contains an oil gland. The oil helps keep your skin lubricated and removes dead skin cells. Sometimes your oil glands work overtime, producing too much of the slimy stuff. The extra oil can fill up and block your pores, causing a backup of dirt, bacteria, and cells. At the top of the blockage sits a plug. If the top of the plug is white, you've got a whitehead, the type of pimple many of us are so tempted to pop. If the top of the plug is dark, you've got a blackhead. If the plug bursts open, you'll have a swollen red bump. The most common place to find acne is on your face. But you can also get breakouts on your shoulders, arms, legs, back, and buttocks. Although acne is known as a teenage affliction, you can get pimples at any age, especially if you sweat a lot, use greasy cosmetics, or eat a high-sugar diet. Hormones can also trigger acne outbreaks. Women who are just starting their period may notice more pimples than usual. You may also discover a few pimples on the day of a big test or presentation, because stress can lead to breakouts. So, you may ask, how do you get rid of acne? First, here's something you should never do when you've got acne. Don't squeeze or pick at the bumps. In fact, try not to touch your face at all. You'll just make the acne worse, and you could even leave permanent scars. To treat acne, the first step is gently cleaning your face twice a day with a pH balanced cleanser, such as Cetaphil or Dove. Use warm (not hot) water, and pat dry. Aggressive scrubbing may make acne worse. Many people benefit from adding an over-the-counter acne medicine that contains ingredients like benzoyl peroxide. These creams dry up the extra oil in your skin and kill bacteria. They may make your skin a little red or cause it to peel at first, but they work pretty well at clearing up breakouts. If over-the-counter treatments don't work, see your doctor or a dermatologist. Prescription creams or gels are stronger and may be more effective at clearing up stubborn acne. Many will prescribe antibiotics such as tetracycline, erythromycin, or doxycycline. You can either take these by mouth, or rub them on your skin. Another option is to have a laser treatment or skin peel. Talk to your doctor about these treatments if medicines haven't cleared up your acne. Acne is a rite of passage for teenagers, but pimples can plague people well into their 30s or 40s. You don't have to live with acne, because there are several very effective treatments for it. See your doctor or a dermatologist to discuss your options. Also make an appointment if your acne is getting worse even with treatment, or you've got scarring where your acne used to be.
Each pore on the surface of the skin is an opening to a canal called a follicle. The follicle also contains a hair and an oil gland (sebaceous gland). The oil gland helps remove old skin cells, keeps the skin lubricated, and prevents drying of tissues.
Baby acne is usually seen on the cheeks, chin, and forehead. It can be present at birth but usually develops around 3 to 4 weeks of age. Baby acne occurs when hormonal changes in the body stimulate oil glands in the babys skin. The condition can look worse when the baby is crying or fussy, or any other instance that increases blood flow to the skin. Baby acne is harmless and usually resolves on its own within several weeks.
Acne lesions frequently contain pus. This close-up photograph shows small acne pustules with surrounding inflammation (erythema).
Blackheads, or open comedones, are common in acne. Clogged hair follicles reflect light irregularly to produce this black hue.
Cystic acne may occur across the upper chest as well as on the back.
The face is the most common location of acne. Here, there are 4 to 6 millimeter red (erythematous) pustules, some with bridging scars and fistulous tract formation (connecting passages). Severe acne may have a profound psychological impact and may cause scarring. Effective treatments are available for this type of acne.
Acne frequently occurs on the back. Here, there are 2 to 6 millimeter wide erythematous (red) pustules with large open and closed comedones. Permanent scarring may follow a severe case of acne. Men are more often affected on their shoulders and back than are women.
Acne affects the areas of the skin that contain sebaceous glands, including the face, upper chest, and back. Acne occurs most commonly during adolescence. Many new treatment regimens are available for acne, especially for the most severe types.
Acne is a skin condition that causes whiteheads, blackheads, and inflamed red lesions to form. These growths are commonly called pimples or zits. Three out of four teenagers have acne to some extent.
Causes
Acne occurs when tiny holes on the surface of the skin become clogged. These holes are called pores.
- Each pore opens to a follicle. A follicle contains a hair and an oil gland. The oil released by the gland helps remove old skin cells and keeps your skin soft.
- The glands can become blocked with a mixture of oil and skin cells. The blockage is called a plug or comedone. If the top of the plug is white, it is called a whitehead. It is called a blackhead if the top of the plug is dark.
- If bacteria become trapped in the plug, the body's immune system may react to it, causing pimples.
- Acne that is deep in your skin can cause hard, painful cysts. This is called nodulocystic acne.
Acne is most common in teenagers, but anyone can get acne, even babies. The problem tends to run in families.
Some things that may trigger acne include:
- Hormonal changes that make the skin oilier. These may be related to puberty, menstrual periods, pregnancy, birth control pills, or stress.
- Greasy or oily cosmetic and hair products.
- Certain drugs (such as steroids, testosterone, estrogen, and phenytoin). Birth control devices, such as some drug-containing IUDs, can make acne worse.
- Heavy sweating and humidity.
- Excessively touching, resting on, or rubbing the skin.
Research does not show that chocolate, nuts, and greasy foods cause acne. However, diets high in refined sugars or dairy products may be related to acne in some people, but this connection is controversial.
Symptoms
Acne commonly appears on the face and shoulders. It may also occur on the trunk, arms, legs, and buttocks. Skin changes include:
- Crusting of skin bumps
- Cysts
- Papules (small red bumps)
- Pustules (small red bumps containing white or yellow pus)
- Redness around the skin eruptions
- Scarring of the skin
- Whiteheads
- Blackheads
Exams and Tests
Your health care provider can diagnose acne by looking at your skin. Testing is not needed in most cases. Bacterial culture may be performed with certain patterns of acne or to check for infection if large pus bumps persist.
Treatment
SELF-CARE
Steps you can take to help your acne:
- Clean your skin gently with a mild, nondrying soap (such as Dove, Neutrogena, Cetaphil, CeraVe, or Basics).
- Look for water-based or "noncomedogenic" formulas for cosmetics and skin creams. (Noncomedogenic products have been tested and proven not to clog pores and cause acne in most people.)
- Remove all dirt or make-up. Wash once or twice a day, including after exercising.
- Avoid scrubbing or repeated skin washing.
- Shampoo your hair daily, especially if it is oily.
- Comb or pull your hair back to keep the hair out of your face.
What NOT to do:
- Try not to aggressively squeeze, scratch, pick, or rub the pimples. This can lead to skin infections, slower healing, and scarring.
- Avoid wearing tight headbands, baseball caps, and other hats.
- Avoid touching your face with your hands or fingers.
- Avoid greasy cosmetics or creams.
- DO NOT leave make-up on overnight.
If these steps do not clear up the blemishes, try over-the-counter acne medicines that you apply to your skin. Follow the directions carefully and apply these products sparingly.
- These products may contain benzoyl peroxide, sulfur, resorcinol, adapalene, or salicylic acid.
- They work by killing bacteria, drying up skin oils, or causing the top layer of your skin to peel.
- They may cause redness, drying, or excessive peeling of the skin.
- Be aware that benzoyl peroxide containing preparations can bleach or discolor towels and clothing.
A small amount of sun exposure may improve acne slightly, but tanning mostly hides the acne. Too much exposure to sunlight or ultraviolet rays is not recommended because it increases the risk for wrinkles and skin cancer.
MEDICINES FROM YOUR PROVIDER
If pimples are still a problem, your provider can prescribe stronger medicines and discuss other options with you.
Antibiotics may help some people with acne:
- Oral antibiotics (taken by mouth) such as tetracycline, doxycycline, minocycline, erythromycin, trimethoprim-sulfamethoxazole, and amoxicillin
- Topical antibiotics (applied to the skin) such as clindamycin, erythromycin, or dapsone
Creams or gels applied to the skin may be prescribed:
- Derivatives of vitamin A such as retinoic acid cream or gel (tretinoin, tazarotene)
- Prescription formulas of benzoyl peroxide, sulfur, resorcinol, or salicylic acid
- Topical azelaic acid
For women whose acne is caused or made worse by hormones:
- A pill called spironolactone may help.
- Birth control pills may help in some cases, though they may make acne worse in some women.
Minor procedures or treatments may also be helpful:
- Photodynamic therapy may be used. This is a treatment where a chemical that is activated by blue light is applied to the skin, followed by exposure to the light.
- Your provider may also suggest chemical skin peeling; removal of scars by dermabrasion; or removal, drainage, or injection of cysts with cortisone.
People who have cystic acne and scarring may try a medicine called isotretinoin. You will be watched closely when taking this medicine because of its side effects.
Pregnant women should NOT take isotretinoin, because it causes severe birth defects.
- Women taking isotretinoin must use 2 forms of birth control before starting the drug and enroll in the iPledge program.
- Men also need to be enrolled in the iPledge program.
- Your provider will follow you on this drug and you will have regular blood tests.
Outlook (Prognosis)
Most of the time, acne goes away after the teenage years, but it may last into middle age. The condition often responds well to treatment, but responses may take 6 to 8 weeks, and acne may flare up from time to time.
Scarring may occur if severe acne is not treated. Some people become very depressed if acne is not treated.
When to Contact a Medical Professional
Contact your provider if:
- Self-care steps and over-the-counter medicine do not help after several months.
- Your acne is very bad (for example, you have a lot of redness around the pimples, or you have cysts).
- Your acne is getting worse.
- You develop scars as your acne clears up.
- Acne is causing emotional stress.
If your baby has acne, contact the baby's provider if acne does not clear up on its own within 3 months.
References
Dinuos JGH. Acne, rosacea, and related disorders. In: Dinulos JGH, ed. Habif's Clinical Dermatology. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 7.
James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM. Acne. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews' Diseases of the Skin: Clinical Dermatology. 13th ed. Philadelphia, PA: Elsevier; 2020:chap 13.
Kim WE. Acne. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 689.
Moon M, Guerrero AM, Li X, Koch E, Gehris RP. Dermatology. In: Zitelli BJ, McIntire SC, Nowalk AJ, Garrison J, eds. Zitelli and Davis' Atlas of Pediatric Physical Diagnosis. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 8.
Version Info
Last reviewed on: 7/1/2023
Reviewed by: Ramin Fathi, MD, FAAD, Director, Phoenix Surgical Dermatology Group, Phoenix, AZ. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
