What causes acne?

What Causes Acne?
From Heather Brannon, MD, former About.com Guide
Updated October 13, 2004

About.com Health's Disease and Condition content is reviewed by the

Medical Review Board.

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All acne is a disorder of the pilosebaceous unit, which is made up of a hair follicle, sebaceous gland, and a hair. These units are found everywhere on the body except on the palms, soles, top of the feet, and the lower lip. The number of pilosebaceous units is greatest on the face, upper neck, and chest. Sebaceous glands produce a substance called sebum, which is responsible for keeping the skin and hair moisturized. During adolescence sebaceous glands enlarge and produce more sebum under the influence of hormones, also called androgens. After about age 20, sebum production begins to decrease.

Acne & Bacteria

A bacteria, known as Propionibacterium acnes, is a normal inhabitant of the skin. It uses sebum as a nutrient for growth, therefore increases in follicles during puberty. People with acne have more Propionibacterium acnes in their follicles than people without acne. The presence of bacteria attracts white blood cells to the follicle. These white blood cells produce an enzyme that damages the wall of the follicle, allowing the contents of the follicle to enter the dermis. This process causes an inflammatory response seen as papules (red bumps), pustules, and nodules. The bacteria also cause the formation of free fatty acids, which are irritants, increasing the inflammatory process in the follicle.

Normal Follicles

Sebum produced by the sebaceous gland combines with cells being sloughed off within the hair follicle and "fills up" the hair follicle. When the follicle is "full", the sebum spreads over the skin surface giving the skin an oily appearance. When this process works correctly, the skin is moisturized and remains healthy.

Obstructed Follicles

Problems arise when the sebum is trapped in the hair follicle. For reasons that are still unclear, some hair follicles become obstructed. The sebum is produced but gets trapped on the way out, and the cells that are normally sloughed off become "sticky", plugging up the follicle. The process of obstructing follicles is called comedogenesis. It causes some follicles to form a type of acne called comedones, also known as blackheads and whiteheads.

Acne Treatment Reviews
Acne is a common skin condition that involves changes in the amount of secretion of oils from the sebaceous glands, which are connected to hair follicles in the skin pore. When the gland is stimulated a hormone called an androgen, the unit secretes excessive amounts of oil, which attracts excessive dirt, foreign debris and subsequent bacteria. The condition occurs heaviest in areas where these glands are the most dense - the face, chest, neck and back. Finding the right solution involves addressing the bacteria buildup and cleansing the pores

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More Acne Facts
We aim to help find solutions and provide accurate information on the top acne products, as well as various types of acne including rosacea, acne vulgaris, teenage and cystic acne.
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Types of Acne

What is acne?

Acne is the most common of all skin diseases. Some figure has it that eighty percent of all people between the ages of twelve and twenty-four have some type of acne. It is a disorder of the oil glands in the skin. Contrary to some conventional conceptions, it is a problem suffered not exclusively by teenagers. Some people are plagued their whole lives with constant outbreaks of acne.


How acne develops?
The hair follicles, or pores, in our skin are connected with oil glands called sebaceous glands. These glands produce sebum, an oily substance that lubricates our hair and skin. At the same time, dead skin cells are expelled from the pore lining while sebum is being distributed to the exterior surface of the skin.

Most of the time the glands produce the right amount of sebum and the pores are fine. But sometimes when too much sebum is produced, a pore or two may get clogged up. This plug blocks the pore, preventing the sebum or dead skin cells from leaving the pore. The situation could further be aggravated by a build-up of bacteria that live on sebum. This leads to swelling around the pore and acne is the result. This could happen to anybody, young and old.

However, a few eruptions every now and then are not what concern us. We acne sufferers are concerned with those numerous and serious pimples that dotted our face and neck and never seem to go away. As soon as some old ones begin to subside, to our relief, more new ones pop up. The constant battles eventually turn into hopeless struggles.


What causes acne?
Why does acne occur? And why does acne have to be on the face, and not on some harmless spot, like, say...the sole?

The latter question has its answer in our body. It's because the oil glands in our skin are concentrated in the T-zone--the face, the neck, the chest, the back, and the shoulders.

Nobody knows for sure the exact cause of acne. We only know about some of the elements that influence its development, and they are:


heredity,
oily skin or hair,
an increased production of male hormones at puberty,
a hormonal imbalance in women,
some prescription medications,
cosmetics that contain chemicals and vegetable oil,
periods of high stress, and
possibly some nutritional deficiencies.

Types of Acne:

When excess sebum is produced by the oil gland, the dead skin cells around the pore may become more "sticky" and partially block the pore, restricting the flow of oil onto the skin surface. This results in solidification of the sebum which fills the hair duct forming a blackhead (open comedo). The dark color of the blackhead is not due to dirt, but is dried oil and from a pigment (melanin) of the shed skin cells in the openings of the hair follicles.

If the partial blockage becomes complete, excess sebum can't escape. The bacteria "Propionibacterium acnes" (short form P. acnes) that are normally present on the skin are trapped in the pore as well. They make an enzyme that breaks down sebum into a substance called "free fatty acid." Free fatty acid is very irritating stuff, and can cause swelling, redness and pus formation. This is called a whitehead (closed comedo).

Similar but a bit more serious formations are called pustules (pus-filled yellowish bumps), and nodules (firm, larger inflamed swellings below the skin).

Acne vulgaris is the medical term for common acne, which is comprised of open and closed comedones.

If the inflammation is deep and severe, or if the spot is manipulated or squeezed, the pus can burst deep into the skin tissues rather than onto the surface. Swelling and pain take place as the body's activated defence mechanism sends bacteria-fighting white cells to the area. This deep-rooted inflammation and infection results in cyst formation. Cystic acne is the most severe and stubborn of all types of acne, and carries the biggest threat of scarring.

Acne Rosacea mostly appears in middle-aged adults. It is characterized by flushing of the face, and the formation of inflamed bumps on the forehead, cheeks, nose, and chin. The redness on the face sometimes misleads people to think that excessive drinking causes this type of acne. Actually, drinking has nothing to do with the eruption, but is believed to magnify the symptoms. The exact causative factor for this disorder is not known.

For some adults, Acne Rosacea never goes away. Over time, the development of Rhinophyma, or a bulbous nose, can occur, particularly in men.

Perioral Dermatitis is almost exclusive to young women. The presence of tiny papules (red bumps), pustules (pus-filled yellowish bumps) and scaling with intense itching are signs of perioral dermatitis. It is usually localized to the surrounding area of the mouth and on the chin, or extend to involve the eyelids and the forehead.

Some causes of Perioral Dermatitis are due to the use of fluorinated toothpaste, facial creams, or irritants such as strong benzoyl peroxide or cinnamon in the area.

The use of steroids could cause Corticosteroid Acne, among other side-effects to the body. Nasty cases of pustular acne on the face, chest, back, arms and thighs, together with cessation of menstruation, development of body hair, thinning of scalp hair have been reported with the taking of dehydroepiandrosterone. This drug that is supposed to help reverse the effects of aging, increase metabolism, aid in weight loss, help increase energy, among other things, is easily available over-the-counter. Extreme care should be exercised when using this product.

Acne Excoriee des Jeunes Filles is a condition commonly seen in young girls. In this case, minimal acne lesions on the face are exacerbated by neurotic squeezing and pressing of the pimples, trying to rid the contents with the fingers. As a result, hyperpigmentation and stellate contracted scars occur, while often the original underlying acne has healed.

We have listed above the most common acne-type skin disorders. For a more complete list and their images, see Links to Acne Images.


Acne's Natural Cycles
Even if you do nothing to the acnes, most of them gradually heal themselves. As each of these pimples heal, others tend to appear. The healing pimples usually fade to a pink mark that generally disappears in time. However, some pimples leave scars that look like small pits or bumps.

A few other symptoms may be present in women who develop acne due to a hormonal imbalance.

These are:


hair loss,
excessive hair growth, and
weight gain in the upper body only.



Home Care for Acne
Despite the fact that acne negatively impacts people's confidence and self-esteem, the majority of acne patients allow their problem to continue as opposed to only 16% who have seeked medical care. If you are among those who prefer to handle the problem yourself, here are some generally accepted home care steps that can be used to help relieve acne.

These include:


keeping the skin of the face as dry and clean as possible,
washing the face carefully and gently twice a day with an anti-bacteria soap,
using a light, non oil-based moisturizer on the face after each washing,
avoiding cosmetics that contain synthetic chemicals and vegetable oils,
keeping hair clean and off the face,
avoiding picking at or touching blemishes,
avoiding pressure on irritated skin from tight collars or head-gear,
and using over-the-counter products that contain sulfur plus resorcinol that can be applied to the skin to unclog pores and heal acne.
Pregnant women should consult their physician prior to taking any over-the-counter medication. Parents of children and persons with medical conditions are advised to read product labels carefully and consult a pharmacist if they have questions about use.


Western Treatments:

If the above measures do not help with your acne problem, or if your acne becomes infected or swollen, you should go see your doctor first. Your doctor may prescribe:


oral antibiotics,
topical antibiotics applied to the skin, or
other drug therapies.
The choice of drug therapy will vary from person to person and depend on the severity of the acne.

We'll cover in more detail the various treatment options in Conventional Western Treatments.


Chinese Herbal Treatments

Other than Western doctors, I've also tried traditional Chinese medicine.

In Chinese medical theory, "heat" is nearly always involved in acne: wind-heat; damp-heat in the intestines and stomach; or heat in the blood, which appears in severe acne. Emotions also may play a role and may be related to the liver (when there is anger), the heart (sad or overjoy), or the spleen (worry).

Since I have had acne for a long time, my case was diagnosed as chronic acne. Chinese physician would told me it was caused by stagnant qi (energy) and blood. Their approach is to use herbal medicine to rescue heat and cool the body until it finds balance again. In my case, certain herbs were used to disperse the blood so that it did not stagnate to cause acne.

Did it work? Yes and no.

A good, experienced Chinese physician would be able to pinpoint the exact syndrome (in Chinese medicine, a physician will treat syndromes, not diseases or symptoms), use the right kind and right amount of herbal ingredients for the formula. However, there is always a gap between theory and practice. Simple as it may sound, a good physician who can cure chronic diseases, or acne in our case, is always lacking. I have known a couple of good Chinese physicians who have cured acne patients before my eyes. However, the best they could do for me was to improve my conditions.


Alternative Approach

I have found that most Chinese herbal physicians, like their western counterparts, are helpless in dealing with acne. I will talk in more detail about Chinese herbal treatment in the corresponding page. For me, what finally helped control my acne and cleared my face was the alternative approach. This approach combines Chinese and Western medical disciplines. If you can't find solution for your acne problem from either your doctor or purely herbal treatment, try my method. I am confident it can help you. Whether you know it or not, acne is a disease that, if left untreated, may have psychological effects that take a long time to heal. Good luck!

Acne of Back

Back Acne
uestion: Why Do I Get ‘Back Acne’?
Answer: ‘Bacne’ is another term for back acne or body acne. It tends to form on the back, upper arms and the buttocks and can take several forms: pimples, blackheads, pustules and cysts, which are painful and form deep under the skin's surface.

What Causes Bacne?
There is no scientific explanation for what causes back acne.
According to this article on the Acne Resource Center, back acne tends to occur around puberty when the sebaceous glands, which produce sebum, start functioning. When too much sebum is produced, pores and hair follicles can become clogged, attracting bacteria. This can lead to acne.

Stress, oily or fatty foods, excessive sweating and even genes do not seem to play a role in the causes of back acne, according to the Acne Resource Center. There is also no proof back acne is developed from tight clothing, excessive sweating and heavy backpacks (although it is possible 'bacne' is exacerbated by this).


How to Treat Back Acne?
For milder versions of back or body acne a topical 10 percent benzoyl peroxide cream or gel may suffice. Severe acne, including cysts, should be treated by a dermatologist.
To treat mild back acne:

Step 1 Wash the back with an anti-bacterial cleanser formulated for the face, such as Cetaphil. Stay away from regular soap. Let skin dry.

Step 2 Follow with a 10 percent benzoyl peroxide gel or cream. These are available over-the-counter or via prescription. Check out these options here. Let dry.

Step 3 (optional) Some experts suggest using the benzoyl peroxide in tandem with an alpha hydroxy treatment such as Alpha Hydrox Enhanced Lotion is optimal. Check out other options.

For severe back acne, consult a dermatologist for prescription treatment. Cysts can be treated in the office.


How to Prevent Back Acne
Exfoliation is a great way to get rid of dead skin cells that tend to build up on the back, buttocks and back of the arms. Use a sugar scrub (milder than salt scrubs) in the shower on a weekly basis.
For more comprehensive information on back acne, try this article from the Acne Resource Center.

Acne Treatment for Sensitive Skin

Acne Treatment for Sensitive Skin

Sensitive skin is the toughest of all to handle. First of all, it is highly prone to all kinds of skin problems like blackheads, whiteheads, zits, pimples, blemishes and spots. The second major problem with this type of skin is that it needs a very gentle treatment for all these acne conditions. Therefore, the product that you use on sensitive skin has to be very light, yet very effective.

One such acne treatment that works really well on the sensitive skin is Clearpores Skin Cleansing System. It follows a three step approach that helps treat all the acne and acne related conditions instantly. It helps reduce swelling, redness and scarring and is very effective in reducing blackheads and whiteheads. After you start using this product, you would notice drastic reduction in blemishes and spots.
Although Clearpores Skin Cleansing System works equally well for all skin types, it is very gentle and effective on the sensitive skin. Clearpores contains Salicylic acid and SD Alcohol 40. Both of these ingredients are accompanied by Aloe Vera that helps soothe the skin and facilitates the healing process. The SD Alcohol 40 contained in Clearpores keeps the sensitive skin optimally moisturized and thus helps treat blackheads and whiteheads without harming the skin.

The facial skin is very sensitive and requires more care. Since Clearpores does not have Benzoyl Peroxide, it is not hard on the skin at all.

The three steps are aimed to unclog your skin pores, help your body fight acne from the within and maintain the long term success of the beautiful skin thus achieved. Since the sensitive skin is more prone to various forms of acne, it is very important that the results achieved after the treatment be maintained. The third step of the Clearpores skin Cleansing System is aimed at providing the long term relief and not just a short term solution for acne.

Thus, the final step of Clearpores skin cleansing system ensures that your sensitive skin stays acne free for a long time. The ingredients contained in Clearpores Skin Cleansing System like Dandelion Root, Aloe Vera, Yellow Dock, Echinacea Purpurea, Red Clover, Sarsaparilla Root, Licorice Root, Turmeric, and Cayenne are very effective in treating acne in sensitive skin. They are all natural ingredients that would not harm the skin and treat it for acne effectively.

So, if you are looking for a perfect acne treatment for your sensitive skin then Clearpores Skin Cleansing System is just the right option for you.

Acne Treatment For Pregnant Women

Acne Treatment For Pregnant Women

One thing must be gotten out of the way: it is not safe to second-guess medication if it's going to be taken or used by a pregnant woman! Even medications to alleviate common conditions - such as colds or acne - need to be carefully examined and determined safe before administering... and if you're not a health expert, it is not safe for you to do the determining, or the administering! Only a dermatologist can prescribe the best acne treatment for a woman who is pregnant.

Women who are pregnant, are planning to get pregnant, or are breastfeeding, need to take their bodies seriously. Whatever they take or apply to their skin may have adverse effects on the children who depend on their good health. Should women find themselves needing to take medicine of any kind, it is important for them to inform their specialists about their conditions of motherhood. This would affect the kind of medication that will be administered, and would also dictate if the medicine will need to be changed. To get the best acne treatment from your dermatologist, never omit to mention if you're a mother, or at least are planning to be one!

You may wonder why pregnant women will need to take acne medication in the first place, especially since for most of us, acne is a common condition that goes away after our teenage years. A blushing bride, glowing with good health, may suddenly find herself the victim of a serious acne outbreak in her late trimester. This is because acne is triggered by hormonal changes, which occurs during pregnancy. We could argue that a lot of pregnant women can afford to wait it out without taking acne medication, but there may be some cases where the acne condition is so severe that it causes a considerable amount of pain.

The best over-the-counter (OTC) acne treatment for use among pregnant women, which some doctors may well recommend, are topical (application only) products that contain benzoyl peroxide. ProActiv is one such medicine. Tetracycline, a popular anti-acne prescription medication, is deemed clinically safe for use by breastfeeding women, but not by pregnant women. Even if you're pregnant, never fear - your dermatologist still ought to be able to prescribe the best acne treatment.

Acne Treatment For Teenagers

Acne Treatment for Teenagers

Acne is a very troubling condition for those that suffer from it. When a person suffers from facial acne there is no hiding it and when acne is drawn out over a long time it can have damaging effects on the self-esteem of those that are struggling with it. Acne is not the hopeless skin disease that it once was, there is treatment for almost all types of acne. It is very important to learn as much information as possible about acne and to know what help and what treatments are available.

There are many types of acne all with varying levels of severity. Cystic acne is one of the most severe forms of acne. It can be painful and it can also lead to troublesome scarring. As much as possible, it is best to seek treatment for acne way before it ever reaches the level of cysts and nodules. However, if for some reason that has not been possible, aggressive treatment will be necessary to halt any further progression. The first step in gaining control of severe acne is to make an appointment with a doctor or dermatologist.

Acne cysts are larger than your average pimple or blackhead. A person that suffers from cystic acne is likely to have acne spots spread over fifty percent or more of their face and they are also likely to suffer some degree of pain. Acne cysts are usually more 5 millimeters in diameter and are formed when pockets of pus are trapped just below the surface of the skin. What makes these spots extremely frustrating for those that have them is that they can last for months without going away.

Although it is great to understand what is happening with your skin, for most people the most valuable information is how to solve the problem. Most people simply want a cure, a cure that works. First, let us talk about what should not be done. Under no circumstances should a person struggling with cystic acne try to squeeze or burst a cyst. This can have detrimental consequences. Often, this will serve only to make any infection deeper, causing the cyst to take longer to heal than if left alone.

Unfortunately, no simple, catch-all cure exists for acne, especially severe acne. Doctors do have methods to help prevent scarring, which is one of the reasons that any treatment that you undertake be done with advice from your doctor. Most people find that they have to try several types of treatment or combinations of treatments before they are able to hit upon a solution. More often than not, it is a combination of treatments that do the trick