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 17 million people in the US are affected by this condition. 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. Sebaceous glands are located in the dermis (the middle layer of skin) and secrete oil onto the skin.

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 (pimples without abscesses) or deep (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. Other causes of acne may include the following:

• hormone level changes during the menstrual cycle in women
• 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 humid conditions)

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 signs/symptoms of acne. However, each adolescent 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 physician for a diagnosis.

Treatment of acne:

The goal of acne treatment is to minimize scarring and improve appearance. Specific treatment will be determined by your child's physician 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

Treatment for acne will include topical or systemic drug therapy. Depending upon the severity of acne, topical medications (medications applied to the skin) or systemic medications (medications taken orally) may be prescribed by your child's physician. In some cases, a combination of both topical and systemic medications may be recommended.

Topical medications to treat acne:

Prescription 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 medications, or oral antibiotics, are often prescribed to treat moderate to severe acne and include the following:

• doxycycline
• erythromycin
• tetracycline

Treatment for severe, cystic, or inflammatory acne:

Isotretinoin, an oral drug, may be prescribed for individuals with severe, cystic, or inflammatory acne 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 90 percent of patients. However, the drug has major unwanted side effects. It is very important to discuss this medication with your child's physician.

Antibiotics and Acne

Antibiotics are one of the few effective treatments for acne. However, new research indicates that one specific bacterium associated with severe acne, Propionibacterium acnes, is becoming increasingly resistant against antibiotic treatment. This trend may lead to decreased effectiveness of antibiotics in the treatment of future acne, according to the researchers. The researchers recommend that dermatologists restrict their use of antibiotic treatment for acne and test other regimens, including different antibiotics and alternative therapies. 

Always consult your child's physician for more information.