Acne

Acne: Signs and symptoms

Acne signs

Many people think that acne is just pimples. But a person who has acne can have any of these blemishes:

• Blackheads.
• Whiteheads.
• Papules.
• Pustules (what many people call pimples).
• Cysts.
• Nodules.

Acne can appear on the back, chest, neck, shoulders, upper arms and buttocks.

Acne symptoms

Acne can cause more than blemishes. Studies show that people who have acne can have:

• Low self-esteem: Many people who have acne say that their acne makes them feel bad about themselves. Because of their acne, they do not want to be with friends. They miss school and work. Grades can slide, and absenteeism can become a problem because of their acne.
• Depression: Many people who have acne suffer from more than low self-esteem. Acne can lead to a medical condition called depression. The depression can be so bad that people think about what it would be like to commit suicide. Many studies have found that teens who believe that they have “bad” acne were likely to think about committing suicide.
• Dark spots on the skin: These spots appear when the acne heals. It can take months or years for dark spots to disappear.
• Scars (permanent): People who get acne cysts and nodules often see scars when the acne clears. You can prevent these scars. Be sure to see a dermatologist for treatment if you get acne early — between 8 and 12 years old. If someone in your family had acne cysts and nodules, you also should see a dermatologist if you get acne. Treating acne before cysts and nodules appear can prevent scars.

Acne: Who gets and causes

Who gets acne?

If you have a bad case of acne, you may feel like you are the only one. But many people have acne. It is the most common skin problem in the United States. About 40 to 50 million Americans have acne at any one time.

Most people who have acne are teenagers or young adults, but acne can occur at any age. Newborn babies can get acne. Men and women get acne. Some women get acne when they reach middle age.

What causes acne?

Acne appears when a pore in our skin clogs. This clog begins with dead skin cells. Normally, dead skin cells rise to surface of the pore, and the body sheds the cells. When the body starts to make lots of sebum (see-bum), oil that keeps our skin from drying out, the dead skin cells can stick together inside the pore. Instead of rising to the surface, the cells become trapped inside the pore.

Sometimes bacteria that live on our skin, p. acnes, also get inside the clogged pore. Inside the pore, the bacteria have a perfect environment for multiplying very quickly. With loads of bacteria inside, the pore becomes inflamed (red and swollen). If the inflammation goes deep into the skin, an acne cyst or nodule appears.

Acne: Diagnosis and treatment

How do dermatologists diagnose acne?

To diagnose acne, a dermatologist will first examine your skin to make sure you have acne. Other skin conditions can look like acne. If you have acne, the dermatologist will:

• Grade the acne. Grade 1 is mild acne. Grade 4 is severe acne.
• Note what type, or types, of acne appear on your skin.

How do dermatologists treat acne?

Today, there are many effective acne treatments. This does not mean that every acne treatment works for everyone who has acne. But it does mean that virtually every case of acne can be controlled.

People who have mild acne have a few blemishes. They may have whiteheads, blackheads, papules, and/or pustules (aka pimples). Many people can treat mild acne with products that you can buy without a prescription. A product containing benzoyl peroxide or salicylic acid often clears the skin. This does not mean that the acne will clear overnight.

Despite the claims, acne treatment does not work overnight. At-home treatment requires 4-8 weeks to see improvement. Once acne clears, you must continue to treat the skin to prevent breakouts.

When to see a dermatologist

If you have a lot of acne, cysts, or nodules, a medicine that you can buy without a prescription may not work. If you want to see clearer skin, you should see a dermatologist. Dermatologists offer the following types of treatment:

Acne treatment that you apply to the skin: Most acne treatments are applied to the skin. Your dermatologist may call this topical treatment. There are many topical acne treatments. Some topicals help kill the bacteria. Others work on reducing the oil. The topical medicine may contain a retinoid, prescription-strength benzoyl peroxide, antibiotic, or even salicylic acid. Your dermatologist will determine what you need.

Acne treatment that works throughout the body: Medicine that works throughout the body may be necessary when you have red, swollen types of acne. This type of treatment is usually necessary to treat acne cysts and nodules. Your dermatologist may prescribe one or more of these:

• Antibiotics (helps to kill bacteria and reduce inflammation).
• Birth control pills and other medicine that works on hormones (can be helpful for women).
• Isotretinoin (the only treatment that works on all that causes acne).

Procedures that treat acne: Your dermatologist may treat your acne with a procedure that can be performed during an office visit. These treatments include:

• Lasers and other light therapies: These devices reduce the p. acnes bacteria. Your dermatologist can determine whether this type of treatment can be helpful.
• Chemical peels: You cannot buy the chemical peels that dermatologists use. Dermatologists use chemical peels to treat 2 types of acne — blackheads and papules.
• Acne removal: Your dermatologist may perform a procedure called “drainage and extraction” to remove a large acne cyst. This procedure helps when the cyst does not respond to medicine. It also helps ease the pain and the chance that the cyst will leave a scar. If you absolutely have to get rid of a cyst quickly, your dermatologist may inject the cyst with medicine.

Outcome

Waiting for acne to clear on its own can be frustrating. Without treatment, acne can cause permanent scars, low self-esteem, depression, and anxiety.

To avoid these possible outcomes, dermatologists recommend that people treat acne. When the skin clears, treatment should continue. Treatment prevents new breakouts. Your dermatologist can tell you when you no longer need to treat acne to prevent breakouts.

Acne: Tips for managing

You can reduce your acne by following these skin care tips from dermatologists.

1. Wash twice a day and after sweating. Perspiration, especially when wearing a hat or helmet, can make acne worse, so wash your skin as soon as possible after sweating.
2. Use your fingertips to apply a gentle, non-abrasive cleanser. Using a washcloth, mesh sponge or anything else can irritate the skin.
3. Be gentle with your skin. Use gentle products, such as those that are alcohol-free. Do not use products that irritate your skin, which may include astringents, toners and exfoliants. Dry, red skin makes acne appear worse.
4. Scrubbing your skin can make acne worse. Avoid the temptation to scrub your skin.
5. Rinse with lukewarm water.
6. Shampoo regularly. If you have oily hair, shampoo daily.
7. Let your skin heal naturally. If you pick, pop or squeeze your acne, your skin will take longer to clear and you increase the risk of getting acne scars.
8. Keep your hands off your face. Touching your skin throughout the day can cause flare-ups.
9. Stay out of the sun and tanning beds. Tanning damages you skin. In addition, some acne medications make the skin very sensitive to ultraviolet (UV) light, which you get from both the sun and indoor tanning devices.
   • Using tanning beds increases your risk for melanoma, the deadliest form of skin cancer, by 75 percent.
10. Consult a dermatologist if:
    • Your acne makes you shy or embarrassed.
    • The products you've tried have not worked.
    • Your acne is leaving scars or darkening your skin.

Today, virtually every case of acne can be successfully treated. Dermatologists can help treat existing acne, prevent new breakouts and reduce your chance of developing scars. If you have questions or concerns about caring for your skin, you should make an appointment to see a dermatologist.

Related resources:

• Hidradenitis suppurativa - A skin disease called hidradenitis suppurativa (HS) can look like everyday acne. It is a long-term skin disease, which often goes undiagnosed. If you have acne in your armpit, on your groin, or under your breasts, you might have HS.
• Hidradenitis Suppurativa Foundation
• Suicide hotline - (800) 784-2433
  Available 24 hours a day, 7 days a week in the United States.