Acne

Acne is the most common skin problem in the United States, which means most of us will have it at some point in our lives. But even though it's super common, there are plenty of misconceptions about acne. A better understanding of how it develops will help you successfully treat it.

What Is Acne?

Acne is a chronic inflammatory disease of the skin. At its most basic, acne is a disorder of the pilosebaceous unit or what we typically call the hair follicle or pore.

Acne is characterized by the presence of pimples or "zits", blackheads, and whiteheads. It can affect the face, neck, chest, back, upper arms, and shoulders. There are two basic categories of acne:

1. Non-inflamed acne breakouts consist of microcomedones (blemishes too small to see with the naked eye), blackheads, and milia. These types of blemishes aren't red or painful. They may not look like your stereotypical acne blemishes, rather just bumps or bumpiness across the skin's surface or an uneven skin texture.

1. Inflamed acne is what typically comes to mind when we think acne. Breakouts are red and inflamed. People with inflammatory acne have papules, pustules, and possibly larger, deeper blemishes like nodules and cysts.

Acne varies in development from very mild to extremely severe. You may have only a few blemishes here and there. Acne can also cause redness, swelling, and irritation of the skin, along with possible crusting, oozing, or scabbing breakouts.

Top Five Things to Know About Acne

Although we don't know everything there is to know about why some people get acne while others don't, there are plenty of things we do know about how it develops and what can be done about it.

1. Acne is caused by three main factors. There are many myths about what causes acne out there. So just know that because you've eaten chocolate or touched your face, you haven't done anything to cause your acne. In fact, there is no precise cause of acne. Rather, it is a result of many factors coming together:
   • We know that people with acne tend to have overactive sebaceous glands—the glands that make our skin's oil. Acne-prone skin also doesn't shed dead skin cells as effectively. It also has a higher amount of Propionibacteria acnes—bacteria linked to inflamed acne blemishes—within the pores.
   • Other factors that contribute to acne development include oily cosmetics, comedogenic skin care or hair care products, certain drugs such as steroids, and estrogen medications.
   • Acne also tends to run in families. If your parents had acne at any point in their lives, your chance of developing it is higher. 
2. All breakouts begin as a blocked pore. All acne blemishes form when oil and dead skin cells become trapped within the hair follicle, creating a plug within the pore. This plug of dead cells and oil is called a comedo (plural for comedo is comedones). Blackheads and whiteheads are examples of non-inflamed comedones. 
   
   As the breakout progresses and bacteria invade, the wall of the hair follicle can rupture within the dermis, creating inflammation and redness. Inflamed blemishes vary in severity depending on the damage to the follicle wall and the amount of infection present. Severe damage to the follicle can create deeper lesions and cysts.

1. Hormones trigger acne development. There's a reason why acne most often develops during puberty—all those hormones are raging. During puberty, there is a surge of androgen hormones within the body.  Androgen hormones, specifically testosterone, significantly influence acne development. They also stimulate the sebaceous glands, creating an oilier complexion and one more prone to breakouts.
   
   In addition to puberty, women may see considerable hormonal fluctuations during
   menstruation, pregnancy, menopause, and perimenopause. During these life phases, acne is most likely to develop or flare up.
2. Acne can happen at (nearly) any age. We think of acne as being a teenage problem, but that's not the case at all. Of course, teen acne and preteen acne is common. But acne is not limited to teens. Many men and women have adult-onset acne breakouts. Acne can also occur in babies, toddlers, and children. Basically, if you have skin, you can get acne!
3. There are many different types of acne. Did you know there are many different forms of acne?
   • Acne vulgaris is the technical term for your typical acne breakouts and it is by far the most common form of acne. It can vary in severity. With mild acne vulgaris, you'll have just minor blemishes. More inflamed, widespread breakouts are considered moderate acne.
      
   • Severe acne vulgaris can be broken down even further depending on the type of blemishes present on the skin.
      
   • Nodular acne is a severe form of acne vulgaris. People with nodular acne have deep, inflamed breakouts called nodules. Nodules affect deeper layers of the skin than typical pimples.
      
   • Cystic acne is another severe type of acne that causes painful cysts. Acne cysts are different than pimples. Cysts are deep, fluid-filled blemishes that often need to be drained by a dermatologist. Nodulocystic acne is a term used to describe severe acne vulgaris that causes both nodules and acne cysts.
      
   • Comedonal acne is a type of non-inflammatory acne. Instead of inflamed pimples, people with get blackheads, milia and closed comedones. The skin looks and feels rough and bumpy.
      
   • Got acne on your back and shoulders where your backpack rests? Or on your forehead under your hat band? You have acne mechanica. This type of acne develops where there is excess heat, pressure, or friction on the skin. It's very common for athletes to develop this type of acne where clothing or sports gear rests/rubs.
      
   • Acne cosmetica is a type of acne that is caused by skin care, hair care, or cosmetic products clogging the pores. Suspect this form of acne if you've begun breaking out after starting a new cosmetic product or if you're breaking out in a specific place (like around your hairline where you apply pomades or hairspray).
      
   • Excoriated acne isn't caused by the factors that trigger acne vulgaris. Rather, excoriated acne is created by picking at blemishes, real or imagined. Occasionally popping pimples doesn't cause excoriated acne. It develops when the picking becomes compulsive and damages the skin.
      
   • Acne rosacea is a skin condition that also causes redness and pimples. Unlike acne vulgaris, rosacea appears only across the face (especially the cheeks, nose, and chin) and not on the body. Although we don't know exactly what causes rosacea, doctors speculate it may be the result of a bacterium, microscopic mite, or simply sensitive capillaries.

There are many other skin conditions besides acne that also cause pimples or red, bumpy skin. If you're not absolutely sure what you're dealing with is common acne, a trip to the dermatologist or your primary care physician is a good idea. 

Acne Treatment

No matter what type of acne you have, its severity, or at what age you're breaking out, there is an acne treatment out there for you.  Although we tend to think we can clear acne on our own with drugstore products, the reality is most cases need to be seen by a dermatologist and treated with prescription medications.

A Word From Verywell

Acne is a complex problem, but one we are learning more about every day. While there is no cure, nearly every case of acne can be cleared successfully.  Your first step should be a trip to the dermatologist. A dermatologist can not only prescribe medication that's the right fit for you  but also give you plenty of tips and tricks to help clear your skin. It does take time and patience, which is hard to come by when you feel like your skin is out of control.

But stick with it! With the right medication, a bit of time, and consistent treatment, your acne can be cleared.

Sources:

"Questions and Answers About Acne." National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Jan 2006. National Institutes of Health.

Zaenglein AL, Pathy AL, Schlosser BJ, Alikhan A, Baldwin HE, et. al. "Guidelines of Care for the Management of Acne Vulgaris." Journal of the American Academy of Dermatology 74.5 (2016): 945-73.