What Is Acne?

Your Basic Guide to Understanding Acne

Pre-teen boy suffering from Acne
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Acne at its most basic is a disorder of the pilosebaceous unit, or what is commonly called the hair follicle or pore. According to the American Academy of Dermatology, it is the most common skin disorder in the United States. Acne vulgaris, as common acne is known, is classified as a chronic inflammatory disease of the skin.

What Is Acne?

Acne is characterized by the presence of pimples or "zits", blackheads, and whiteheads.

It chiefly affects the face, neck, chest, back, and/or upper arms of sufferers. Rarely will you find acne in other areas of the body. Acne varies in development from very mild to extremely severe.

There are two basic categories of acne: inflamed and non-inflamed. Non-inflamed acne breakouts consist of microcomedones, blackheads, and milia, which are generally not red or painful. Symptoms of non-inflamed acne include bumps or bumpiness across the skin's surface or an uneven skin texture.

If left untreated, non-inflamed acne may progress to inflamed acne, which is characterized by redness and inflammation. Sufferers may have microcomedones, blackheads, and milia, as well as papules, pustules, and possibly nodules and cysts. Symptoms also include redness, swelling, and irritation of the skin, along with possible crusting, oozing, or scabbing of the lesions. Inflamed acne ranges in acuity from very mild to extremely severe

About Cystic Acne

Cystic acne (sometimes called nodulocystic acne) is the most severe form of acne vulgaris. Deep, inflamed breakouts develop, with the blemishes becoming quite large; some measure up to several centimeters across.

Although many people use the term "cystic" to describe any type of severely inflamed acne, only those who develop cysts truly have cystic acne.

 Cysts feel like soft, fluid-filled lumps under the skin's surface, and can be very painful. 

Who Gets Acne?

Acne most frequently affects teens and preteens. Three out of four teens will experience acne. Acne strikes both sexes equally, but teen boys tend to have longer lasting and more severe acne than girls.

But acne is not limited to teens. Many men and women suffer from adult onset acne breakouts. Acne can also occur in babies, toddlers, and children.

How Does Acne Develop?

Acne occurs 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 comedone (or comedo). Blackheads and whiteheads are examples of non-inflamed comedones.

As the breakout progresses and bacteria invade, the follicle wall may 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 cases of acne may lead to deeper lesions and cysts.

Most people with acne have a number of non-inflamed lesions, or comedones. However, not every acne sufferer necessarily suffers from inflamed breakouts.

What Causes Acne?

There is no precise cause of acne; rather, it is a result of many factors coming together. Those who are prone to acne often have skin that is oilier than average. Excess oil can easily become trapped within the pore, creating an impaction.

Acneic skin also produces more dead skin cells than is normal, and those skin cells are not being shed properly (a condition called retention hyperkeratosis). These dead cells stick to the surface of the skin and inside the follicles, mixing with excess oil and creating a comedo.

When the pore becomes blocked by cellular debris and oil, a bacterium that is normally present within the pore grows unchecked. Propionibacteria acnes (P. acnes) are found in great numbers on acneic skin, causing inflamed breakouts.

Why Does Acne Occur?

Acne often first appears during puberty, when there is a surge of androgen hormones within the body. Androgens stimulate the sebaceous glands, creating an oilier complexion and one more prone to breakouts.

Most dermatologists agree androgen hormones significantly influence acne development. In addition to puberty, women may see considerable hormonal fluctuations are during menstruation, pregnancy, menopause and perimenopause. During these life phases, acne is most likely to develop or flare up.

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 tends to run in families. If your parents had acne at any point in their lives, your chance of developing acne is higher.

Is There a Cure for Acne?

Acne is a complex problem, but one we are learning more about every day. While there is no cure, many treatment options are available to those who have acne. It takes time and patience, but nearly every case of acne can be controlled successfully.

Mild acne can be treated at home with over-the-counter acne treatment products, such as benzoyl peroxide, salicylic acid, or sulfur and Resorcinol.

For moderate acne, prescription treatments may be necessary, and usually take the form of a cream or ointment. They can include topical antibiotics such as clindamycin, or other topical treatments like retinoids or azelaic acid.

Persistent or severe cases of acne may respond best to oral acne medications such as antibiotics, oral birth control pills, or isotretinoin.

Where Should I Go First?

Most mild cases of acne can be treated effectively at home, with good daily skin care and over-the-counter treatments. But if you are suffering from moderate to severe acne or home treatments are not working for you, contact your doctor. A dermatologist can help create a course of therapy that is right for you.

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