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Acne FAQ

What is acne?
Who gets acne?
What causes acne?
What are the different types of acne?
How is acne treated?

ACNE FAQ

What is acne?

Acne is a skin disease where red bumps, clogged pores, and tender cysts develop in the skin. Acne is generally found in areas of the skin with the greatest amount of hair follicles, including the face, the upper part of the chest, and the back. Severe acne is inflammatory, but acne can also appear in noninflammatory forms.

Who gets acne?

Acne typically develops during adolescence but is also common in adults. It affects anywhere from 85% to more than 95% of teenagers. Adult acne, in contrast to the type of acne found in adolescents, occurs more often in women. Acne is in fact so common in adults that about one in every five women over 25 has acne. While some adults have persistent acne, meaning they have lived with acne that started when they were teenagers, others have late-onset acne, which refers to getting acne for the first time in adulthood.

For most people, acne diminishes over time and tends to disappear, or at least decrease, after the early twenties. Unfortunately, there is no way to predict how long it will take to disappear entirely.

What causes acne?

Each acne blemish starts as a clogged pore (opening of hair follicles). Pores clog because the skin cells at the surface of some pores do not shed normally and stick together blocking the pore. When a pore is clogged, the natural oils (sebaceous material) from the hair follicle build up in the pore creating pressure and an airtight, warm environment for P. acnes, the bacteria responsible for acne, to grow and flourish. The combination of blocked sebum, bacteria, and white blood cells (pus) lead to inflammation and eventually noticeable and tender bumps referred to as acne. The process from clogged pore to visible pimples is about two weeks, meaning the bumps that are currently seen on the skin began about two weeks ago.

While hormones can contribute to acne, they are not the only factor. Most people who have acne do not have hormonal imbalances. One such hormone that can contribute to acne is cortisol, which is a hormone that releases when under stress and helps you stay alive in life or death situations. Cortisol increases sebaceous oil production and inflammation in the skin.

While certain “causes” of acne have been disproved, such as the link between chocolate or pizza and acne, cow’s milk, which contains hormones, and diets high in carbohydrates, which cause inflammation, can contribute to acne. Many skin care products also contain ingredients that can clog pores and trigger acne.

What are the different types of acne?

Acne can appear as noninflammatory or inflammatory acne.

Noninflammatory Acne

A microcomedo is the first stage of acne, which is the formation of a clogged pore. Micocomedones may enlarge becoming noninflammed skin blemishes called comedones. Comedones are the result of a clogged sebaceous gland that fills with the naturally occurring oil called sebum.

• Whiteheads (closed comedones): When the trapped sebum and bacteria stay below the surface, a whitehead is formed. Whiteheads may show up as tiny white or skin colored spots, or they may be so small that they are invisible to the naked eye. Whiteheads often appear in clusters.
• Blackheads (open comedones): A blackhead occurs when a severely clogged pore opens to the surface, and the sebum, which contains skin pigment melanin, oxidizes and turns a brown/black color. It is not dirt and cannot be washed away. Blackheads can last for a long time because the contents drain to the surface slowly.

A blackhead or whitehead can release its contents to the surface and heal. Alternatively, the follicle wall can rupture and inflammatory acne can ensue (described below). The follicle wall rupture can be caused by random occurrence or by picking or touching the skin, therefore, it is important to leave acne prone skin relatively untouched.

Inflammatory acne

The conditions of comedones can create an environment for P. acnes to cause inflammation, leading to inflammatory lesions, which can result in redness and scarring.

• Red bumps (papules): Papules occur when there is a break in the follicular wall. White blood cells rush in and the pore becomes inflamed. The result is a visibly inflamed and raised bump that usually appears redder than the surrounding skin with little or no pus.
• White bumps (pustules): A pustule forms several days after a papule when white blood cells make their way to the surface of the skin. Like a papule, a pustule is inflamed, but is now a pus- filled bump with the pus appearing as a white cap usually on top of the inflammation with a red- colored base. This is what people usually refer to as a “zit” or a “pimple.”
• Large & deep bumps (nodules): When a follicle breaks along the bottom, a total collapse can occur, causing a large inflamed bump called a nodule that can be sore to the touch. A nodule can cover an area as big as an inch in diameter and the inflammation can impact other pores in the surrounding area.
• Cysts (nodules): Sometimes a severe inflammatory reaction can result in very large pus filled lesions. Cysts are nodules that are filled with pus and liquid.

How is acne treated?

The main treatments for acne are currently exfoliants and benzoyl peroxide.