Acne is a skin condition that occurs when your hair follicles become plugged with oil and dead skin cells. It causes whiteheads, blackheads or pimples. Acne is most common among teenagers, though it affects people of all ages.
Effective acne 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.
Acne signs vary depending on the severity of your condition:
Acne usually appears on the face, forehead, chest, upper back and shoulders.
If self-care remedies don't clear your acne, see your primary care doctor. He or she can prescribe stronger medications. If acne persists or is severe, you may want to seek medical treatment from a doctor who specializes in the skin (dermatologist or pediatric dermatologist).
For many women, acne can persist for decades, with flares common a week before menstruation. This type of acne tends to clear up without treatment in women who use contraceptives.
In older adults, a sudden onset of severe acne may signal an underlying disease requiring medical attention.
The Food and Drug Administration (FDA) warns that some popular nonprescription acne lotions, cleansers and other skin products can cause a serious reaction. This type of reaction is quite rare, so don't confuse it with any redness, irritation or itchiness that occurs in areas where you've applied medications or products.
Seek emergency medical help if after using a skin product you experience:
Four main factors cause acne:
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 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.
Certain things may trigger or worsen acne:
These factors have little effect on acne:
People with darker skin types are more likely than are people with lighter skin to experience these acne complications:
Risk factors for acne include:
If you've tried over-the-counter (nonprescription) acne products for several weeks and they haven't helped, ask your doctor about prescription-strength medications. A dermatologist can help you:
Acne medications work by reducing oil production and swelling or by treating bacterial infection. With most prescription acne drugs, you may not see results for four to eight weeks. It can take many months or years for your acne to clear up completely.
The treatment regimen your doctor recommends depends on your age, the type and severity of your acne, and what you are willing to commit to. For example, you may need to wash and apply medications to the affected skin twice a day for several weeks. Topical medications and drugs you take by mouth (oral medication) are often used in combination. Treatment options for pregnant women are limited due to the risk of side effects.
Talk with your doctor about the risks and benefits of medications and other treatments you are considering. And make follow-up appointments with your doctor every three to six months until your skin improves.
The most common topical prescription medications for acne are:
Retinoids and retinoid-like drugs. Drugs that contain retinoic acids or tretinoin are often useful for moderate acne. These come as creams, gels and lotions. Examples include tretinoin (Avita, Retin-A, others), adapalene (Differin) and tazarotene (Tazorac, Avage, others). You apply this medication in the evening, beginning with three times a week, then daily as your skin becomes used to it. It prevents plugging of hair follicles. Do not apply tretinoin at the same time as benzoyl peroxide.
Topical retinoids increase your skin's sun sensitivity. They can also cause dry skin and redness, especially in people with skin of color. Adapalene may be tolerated best.
Azelaic acid and salicylic acid. Azelaic acid is a naturally occurring acid produced by a yeast. It has antibacterial properties. A 20% azelaic acid cream or gel seems to be as effective as many conventional acne treatments when used twice a day. Prescription azelaic acid (Azelex, Finacea) is an option during pregnancy and while breast-feeding. It can also be used to manage discoloration that occurs with some types of acne. Side effects include skin redness and minor skin irritation.
Salicylic acid may help prevent plugged hair follicles and is available as both wash-off and leave-on products. Studies showing its effectiveness are limited. Side effects include skin discoloration and minor skin irritation.
Evidence is not strong in support of using zinc, sulfur, nicotinamide, resorcinol, sulfacetamide sodium or aluminum chloride in topical treatments for acne.
Antibiotics. For moderate to severe acne, you may need oral antibiotics to reduce bacteria. Usually the first choice for treating acne is a tetracycline (minocycline, doxycycline) or a macrolide (erythromycin, azithromycin). A macrolide might be an option for people who can't take tetracyclines, including pregnant women and children under 8 years old.
Oral antibiotics should be used for the shortest time possible to prevent antibiotic resistance. And they should be combined with other drugs, such as benzoyl peroxide, to reduce the risk of developing antibiotic resistance.
Severe side effects from the use of antibiotics to treat acne are uncommon. These drugs do increase your skin's sun sensitivity.
Combined oral contraceptives. Four combined oral contraceptives are approved by the FDA for acne therapy in women who also wish to use them for contraception. They are products that combine progestin and estrogen (Ortho Tri-Cyclen 21, Yaz, others). You may not see the benefit of this treatment for a few months, so using other acne medications with it for the first few weeks may help.
Common side effects of combined oral contraceptives are weight gain, breast tenderness and nausea. These drugs are also associated with increased risk of cardiovascular problems, breast cancer and cervical cancer.
Isotretinoin. Isotretinoin (Amnesteem, Claravis, others) is a derivative of vitamin A. It may be prescribed for people whose moderate or severe acne hasn't responded to other treatments.
Potential side effects of oral isotretinoin include inflammatory bowel disease, depression and severe birth defects. All people receiving isotretinoin must participate in an FDA-approved risk management program. And they'll need to see their doctors regularly to monitor for side effects.
For some people, the following therapies might be helpful, either alone or in combination with medications.
Most studies of acne drugs have involved people 12 years of age or older. Increasingly, younger children are getting acne as well. The FDA has expanded the number of topical products approved for use in children. And guidelines from the American Academy of Dermatology indicate that topical benzoyl peroxide, adapalene and tretinoin in preadolescent children are effective and don't cause increased risk of side effects.
If your child has acne, consider consulting a pediatric dermatologist. Ask about drugs to avoid in children, appropriate doses, drug interactions, side effects, and how treatment may affect a child's growth and development.
Some alternative and integrative medicine approaches might be helpful in reducing acne:
More research is needed to establish the potential effectiveness and long-term safety of these and other integrative approaches, such as biofeedback and ayurvedic compounds. Talk with your doctor about the pros and cons of specific treatments before you try them.
You can try to avoid or control mild or moderate acne with nonprescription products, good basic skin care and other self-care techniques:
Wash problem areas with a gentle cleanser. Twice a day, use your hands to wash your face with mild soap or a gentle cleanser (Cetaphil, Vanicream, others) and warm water. If your hair is oily, shampoo every day. And be gentle if you're shaving affected skin.
Avoid certain products, such as facial scrubs, astringents and masks. They tend to irritate the skin, which can worsen acne. Too much washing and scrubbing also can irritate the skin.
Try over-the-counter acne products to dry excess oil and promote peeling. Look for products containing benzoyl peroxide as the active ingredient. You might also try products containing salicylic acid, glycolic acid or alpha hydroxy acids. It may take a few weeks of using a product before you see any improvement.
Creams are less irritating than gels or ointments. Nonprescription acne medications may cause initial side effects — such as redness, dryness and scaling — that often improve after the first month of using them.
Acne and acne scars can cause anxiety and may affect your social relationships and self-image. Sometimes it can help to talk with your family, a support group or a counselor.
Stress can worsen acne. Try to manage stress by getting enough sleep and practicing relaxation techniques.
If you have acne that's not responding to self-care and over-the-counter treatments, make an appointment with your doctor. Early, effective treatment of acne reduces the risk of scarring and of lasting damage to your self-esteem. After an initial examination, your doctor may refer you to a specialist in the diagnosis and treatment of skin conditions (dermatologist).
Here's some information to help you get ready for your appointment.
Below are some basic questions to ask your doctor about acne. If any additional questions occur to you during your visit, don't hesitate to ask.
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your doctor may ask:
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