What is acne?

Acne is a disorder of the hair follicles and sebaceous glands. With acne, the sebaceous glands are clogged, which leads to pimples and cysts.

Acne is very common--nearly 80 percent of individuals in the U.S. between 11 and 30 years old will be affected by this condition at some point. Acne most often begins in puberty. During puberty, the male sex hormones (androgens) increase in both boys and girls, causing the sebaceous glands to become more active--resulting in increased production of sebum. While acne is most common during puberty it can happen at any age.  

How does acne develop?

The sebaceous glands produce oil (sebum) which normally travels via hair follicles to the skin surface. However, skin cells can plug the follicles, blocking the oil coming from the sebaceous glands. When follicles become plugged, skin bacteria (called Propionibacterium acnes, or P. acnes) begin to grow inside the follicles, causing inflammation. Acne progresses in the following manner:

1. Incomplete blockage of the hair follicle results in blackheads (a semisolid, black plug).
2. Complete blockage of the hair follicle results in whiteheads (a semisolid, white plug).
3. Infection and irritation cause whiteheads to form.

Eventually, the plugged follicle bursts, spilling oil, skin cells, and the bacteria onto the skin surface. In turn, the skin becomes irritated and pimples or lesions begin to develop. The basic acne lesion is called a comedo.

Acne can be superficial papules or pustules (pimples without abscesses) or deep nodules or cysts (when the inflamed pimples push down into the skin, causing pus-filled cysts that rupture and result in larger abscesses).

What causes acne?

Rising hormone levels during puberty may cause acne. In addition, acne is often inherited or genetic. Other causes of acne may include the following:

• Hormone level changes during the menstrual cycle in women, hormone changes during pregnancy or changes when women start or stop birth control.  
• Certain drugs (such as corticosteroids)
• Oil and grease from the scalp, mineral or cooking oil, oil, hair spray, and certain cosmetics may worsen acne
• Bacteria inside pimples
• Stress
• Tight clothes that rub or cause irritation may cause acne on the body. 

Acne can be aggravated by squeezing the pimples or by scrubbing the skin too hard.

What are the symptoms of acne?

Acne can occur anywhere on the body. However, acne most often appears in areas where there is a high concentration of sebaceous glands, including the following:

• Face
• Chest
• Upper back
• Shoulders
• Neck

The following are the most common symptoms of acne. However, each child may experience symptoms differently. Symptoms may include:

• Blackheads
• Whiteheads
• Pus-filled lesions that may be painful
• Nodules (solid, raised bumps)

The symptoms of acne may resemble other skin conditions. Always consult your child's primary care provider for a diagnosis.

Treatment of acne

Specific treatment will be determined by your child's primary care provider based on:

• Your child's age, overall health, and medical history
• Severity of the acne
• Your child's tolerance for specific medications, procedures, or therapies
• Expectations for the course of the condition
• Your opinion or preference

The goal of acne treatment is to minimize scarring and improve appearance. Treatment for acne will include topical or systemic drug therapy. Many effective over-the-counter topical medications are available. When buying lotions or makeup, effort should be made to find products labeled "noncomedogenic or nonacnegenic," since these products do not clog pores. Depending on the severity of acne, topical medications (medications applied to the skin) or systemic medications (medications taken orally) may be prescribed by your child's primary care provider. In some cases, a combination of both topical and systemic medications may be recommended.

Topical medications to treat acne

Topical medications are often prescribed to treat acne. Topical medication can be in the form of a cream, gel, lotion, or solution. Examples include:

Benzoyl peroxide

Kills the bacteria (P. acnes)

Antibiotics

Helps stop or slow down the growth of P. acnes and reduces inflammation

Tretinoin

Stops the development of new acne lesions (comedones) and encourages cell turnover, unplugging pimples

Adapalene

Decreases comedo formation

Systemic medications to treat acne

Systemic antibiotics are often prescribed to treat moderate to severe acne, and may include the following:

• Doxycycline
• Erythromycin
• Tetracycline

Treatment for severe, cystic, or inflammatory acne

Isotretinoin (Accutane, Sotret, Claravis, Amnesteem), an oral drug, may be prescribed for individuals with severe, cystic, or inflammatory acne that cannot be effectively treated by other methods to prevent extensive scarring. Isotretinoin reduces the size of the sebaceous glands that produce the skin oil, increases skin cell shedding, and affects the hair follicles, thereby reducing the development of acne lesions. Isotretinoin can clear acne in 85 percent of patients. However, the drug has major unwanted side effects, including psychiatric side effects. It is very important to discuss this prescription medication with your child's primary care provider.

Isotretinoin must not be taken by women who are pregnant or who are able to become pregnant, because there is a very high likelihood of birth defects occurring in babies whose mothers took the medication during pregnancy. Isotretinoin can also cause miscarriage or premature birth. Because of these effects and to minimize fetal exposure, isotretinoin is approved for marketing only under a special restricted distribution program approved by the FDA. This program is called iPLEDGE.

The goal of the iPLEDGE program is to prevent pregnancies in females taking isotretinoin and to prevent pregnant females from taking isotretinoin. Requirements of the iPLEDGE program include:

• Isotretinoin must only be prescribed by prescribers who are registered and activated with the iPLEDGE program.
• Isotretinoin must only be dispensed by a pharmacy registered and activated with iPLEDGE.
• Isotretinoin must only be dispensed to patients who are registered with and meet all the requirements of iPLEDGE
• Female patients who can get pregnant are required to use birth control for one month prior to treatment, during treatment, and for one month after stopping treatment.
• Pregnancy tests are required before, during, and after treatment.