Acne

Acne is a chronic disorder of the hair follicles and sebaceous glands (commonly called oil glands) located in the middle layer of the skin. In acne, the sebaceous glands are clogged, which leads to pimples and cysts. While a mild case of acne may resolve on its own, more serious cases may need medical assistance to stop outbreaks and prevent long-term scarring.

Acne is a common condition that affects millions of people in the U.S. It most often begins in puberty, when male sex hormones — known as androgens — increase in both boys and girls, causing the sebaceous glands to become more active and produce more sebum, commonly known as oil.

Acne can occur anywhere on the body but most often appears on the face, chest, upper back, shoulders, and neck in the form of blackheads, whiteheads, pus-filed cysts, and solid, raised bumps. Depending on the severity of the acne, it can be treated with topical medications, oral medications, or a combination of the two. Oral medications include hormonal therapy, retinoids, and antibiotics.

The sebaceous glands, located in the middle layer of skin, produce sebum (or oil) which normally travels to the skin's surface through the hair follicles. When skin cells plug the follicles, in turn blocking the oil, skin bacteria (called Cutibacterium acnes, or C. acnes) begin to grow inside the follicles, leading to inflammation.

Incomplete blockage of the hair follicle results in blackheads (a semisolid black plug). Complete blockage of the hair follicle results in whiteheads (a semisolid white plug). Inflammation and irritation can cause angry red bumps (“papules”) to form, which may contain pus (called “pustules”). Cysts, nodules, and abscesses (larger pus-filled collections) are due to inflamed lesions that form deeper in the skin.

Acne can occur anywhere on the body but most often appears in areas where there is a high concentration of sebaceous glands, located in the middle layer of skin, including the following:

• Face
• Chest
• Upper back
• Shoulders
• Neck

Although each adolescent may experience different acne symptoms, these are the most common signs:

• Blackheads
• Whiteheads
• Papules (small, inflamed bumps)
• Nodules (solid, deeper bumps)
• Pustules (small pus-filled lesions)
• Abscesses (large pus-filled lesions)

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

• Hormone level changes during the menstrual cycle 
• Certain drugs (such as corticosteroids, lithium, and barbiturates)
• Oil and grease from the scalp, mineral or cooking oil, and certain cosmetics
• Friction or pressure from helmets, backpacks, or tight collars
• Environmental conditions (such as pollution or humidity)

Contrary to popular belief, research has shown that chocolate, greasy foods, and dirty skin are not risk factors for acne.

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

A dermatologist will examine your child's skin to diagnose acne in an in-office visit to determine the severity of the acne.

There are many available options for acne treatment. Because everyone’s skin is different, patients may need to try multiple treatments until they find the one best for them.

If your child has mild acne, with only a few blemishes, whiteheads, blackheads, or pimples, their doctor may recommend over-the-counter products. These often contain benzoyl peroxide or salicylic acid. Remember, acne treatment does not work overnight. Generally, at-home treatments take four to eight weeks before producing a noticeable improvement.

If your child has more severe acne, with many pimples or with cysts or nodules, over-the-counter treatments may not be enough. The most severe cases are treated with the oral drug isotretinoin (brand names include Accutane and Absorica), which is extremely effective but may have unwanted side effects. The most severe side effects include psychiatric issues like depression and birth defects in patients who take the medication while pregnant. You may need to schedule an appointment with a dermatologist, who can offer several different forms of treatment:

• Topical acne treatment
• Oral antibiotics to kill bacteria and reduce inflammation
• Birth control pills and medicines that affect hormone levels (in female patients)
• Isotretinoin, which shrinks oil glands, prevents plugging of pores, and decreases bacteria

Your dermatologist may opt to treat your child's acne with a procedure, such as:

• Lasers and other light therapies to reduce bacteria
• Chemical peels to remove upper layers of skin
• Drainage and/or steroid injections to treat large acne cysts/nodules