Acne - Overview

Here's how pimples generally develop:

• Your skin has millions of tiny hair follicles (also called pores), which are tiny holes in your skin.
• These pores are attached to oil glands under your skin, which make sebum - an oily, somewhat sticky substance that helps bring dead skin cells to the surface.
• Sometimes, these tiny hairs, sebum and dead skin cells clump together, forming a plug.
• The plug prevents the sebum from reaching the skin surface, causing further build-up of sebum.
• Sebum and dead skin cells create the perfect mix for a certain bacteria (Propionibacterium acnes) to grow.
• In response, your body's natural defenses send bacteria-fighting white blood cells to try to destroy the bacteria; this produces redness, swelling, heat and/or pain.
• Now, once the wall of the plugged follicle breaks down, the sebum, dead skin cells and bacteria spill into the nearby skin.
• And that's what leads to acne lesions.

Fighting Back Against Acne

Just about everyone has had a pimple at some point in life. Usually, acne starts between the ages of 10 and 13 and can last for five to 10 years. Adult women with acne tend to see it worsen around the time of their periods, during pregnancy, when they stop birth control pills or if they wear greasy cosmetics.

The exact cause is not clear. It is believed that acne is linked to androgens (male sex hormones). These androgens stimulate the oil glands and hair follicles, causing acne flare-ups.

Acne can be passed down from your mother or father. Some medications can also cause acne, including lithium (for bipolar disorder) and barbiturates (used for seizures). Also, rubbing the face, scrubbing too hard or picking at lesions can make acne worse. Acne is not caused by greasy foods, chocolate or dirt.

If you have acne with too much facial hair and thinning hair on your scalp, it could mean you have a condition called polycystic ovary syndrome, in which cysts form in the ovaries. If you suspect you might have this, see a doctor.

The good news is that acne can be treated. You can try over-the-counter medications, such as products containing:

• Benzoyl peroxide.
• Salicylic acid.
• Sulfur.
• Sulfur and resorcinol.

If over-the-counter medications don't help, check in with your primary care doctor or with a dermatologist. Most cases of acne can be treated successfully with pills or with creams or ointments applied to the skin. Have patience. Acne is not a quick fix. It may take six to eight weeks before you see any improvement. If not, you may need a new medication. Bear in mind that what works for one person may not necessarily work for you.

For women with acne, your dermatologist may try:

• Topical retinoids, topical antimicrobials (such as benzoyl peroxide and antibiotics) or oral antibiotics that are prescribed for more severe inflammation. For acne that is resistant to all other approaches, your doctor may proscribe oral retinoids; these, however, can cause severe birth defects if you get pregnant while taking them. Women must use at least 2 forms of birth control while on these drugs.
• Birth control pills. These may decrease androgen activity in women who have flare-ups around the time of their periods.
• Spironolactone, which prevents oil production by androgen and decreases androgen production, causing fewer acne flares.

To clean your face, gently wash with mild facial cleansers and don't scrub - this can make your acne worse. Toners that have glycolic acid or salicylic acid may help remove surface oils that can lead to flare-ups. You may need a moisturizer if your acne medication is making your skin dry.

Talk to your doctor about getting treatment.