Acne is a disease of the hair follicle, caused by a combination of both internal and external factors. Abnormal build-up of skin cells causes a plug at the opening of the hair follicle, creating a clogged pore, the first step in acne lesion formation. The clogged pore accumulates keratin, oil (sebum) and bacteria until it ruptures, releasing this mixture into the skin and causing inflammation. This inflammation can lead to painful cyst/abscess formation and scarring.
Who gets acne?
Acne is the most common disorder of the skin, affecting 40-50 million people each year in the US alone. It can affect both men and women of all ethnic groups and all ages. Three-quarters of 11 to 30 year-olds will get acne at some time, but it can be seen in people in their fifties and sixties as well.
Acne often produces self-consciousness and social isolation in affected patients. Recent studies have shown that severe acne can lead to depression and even increase the risk of suicide. The good news is there are many excellent acne treatments, which can be tailored to the individual patient, taking into consideration the person’s health condition, severity of acne and life style.
What are the characteristics of acne?
Acne is characterized by the presence of whiteheads and blackheads (comedones), papules, pustules and inflamed nodules and cysts, usually on the face, chest and back. Occasionally the inflammation is severe enough to cause scarring, a permanent change in the structure of the skin.
Mild to Moderate acne consists of the following:
Whiteheads (Closed comedones): Whiteheads result when a pore is completely blocked, trapping sebum (oil), bacteria, and dead skin cells, causing a white appearance on the surface.
Blackheads (Open comedones):Blackheads result when a pore is only partially blocked, allowing some of the trapped sebum (oil), bacteria, and dead skin cells to slowly drain to the surface. The black color is not caused by dirt. When the contents of the pore come in contact with air, they turn dark.
Papules: Papules are inflamed, red, tender bumps with no head.
Pustules: A pustule is inflamed, and appears as a red circle with a white or yellow center, which contains pus. Pustules are garden variety pimples.
Severe acne consists of the following, usually in combination with comedones, papules and pustules:
Nodules: As opposed to the lesions mentioned above, nodular acne consists of acne spots which are much larger, can be quite painful, and can sometimes last for months. Nodules are large, hard bumps under the skin's surface. Scarring is common. Unresolved nodules can sometimes leave an impaction behind, which can flare again and again
Cysts: An acne cyst can appear similar to a nodule, but is pus-filled, and is described as having a diameter of 5mm or more across. They can be painful. Again, scarring is common with cystic acne.
What does acne look like?
These photos courtesy Global Skin Atlas, Dermquest and NYU dermatology
Whiteheads (closed comedones)
Blackheads (open comedones) and Pustules
Comedones, papules, nodules
Papules, Pustules and Scars
Nodules, cysts and scars
These acne lesions have been scratched and squeezed, leading to scarring and persistent hyperpigmentation
What causes acne?
All types of acne — blackheads, whiteheads, pimples, and cysts — develop when pores in our skin become clogged. The culprit is sebum, an oil in our skin. Our bodies make more sebum when our hormones surge. This is why teens get acne. This is why women often breakout before their periods.
Since hormones fluctuate in the years leading up to menopause, many women in their 40s and 50s get acne. Individuals with certain hormonal disorders, like polycystic ovarian syndrome (PCOS) are at increased risk for developing acne. Patients with these conditions tend to have more severe acne that does not respond to standard therapy.
The bacteria present in acne lesions contribute significantly to the production of acne. The skin's own immune system also interacts with the bacteria to create inflammation.
Factors that Aggravate Acne
Other factors that contribute to the development of acne are stress, family history and sun exposure. Although the sun doesn't cause acne, it does aggravate the condition. The sun dries out your skin resulting in a clearer complexion for a short period of time. However the drying effects of the sun stimulate your sebaceous glands and increase oil production. Acne returns and is usually more severe.
Early treatment of acne is essential to prevent scarring. Dark spots (postinflammatory hyperpigmentation) as well as persistent redness and scarring may remain after inflammatory acne resolves. Acne scarring can also result from scratching or picking acne lesions. Follow this link to learn more about treatment of acne scars.
It is very important to seek the help and advice of a physician as soon as acne appears. Many effective treatment options are available.
Treatment of Acne
At Summit Medical Group, we perform a thorough history and physical examination, as well as a review all prescription and over-the-counter medications and cosmetics used by our patients, in order to create a maximally effective treatment plan. The main goal of treatment is to help improve the patient’s appearance and to prevent scarring. Since acne is caused by many factors, appropriate therapy often involves the use of more than one type of treatment to help the patient achieve optimal results.
Superficial chemical peels or cortisone injections are sufficient treatments for many patients.
Benzoyl peroxide, topical retinoids and antibiotics usually work well for mild acne.
Systemic antibiotics, antiandrogens or isotretinoin may be needed for more severe or resistant cases.
Laser and Light Treatments
Broad Band Light (BBL), MicroLaserPeel and ProFractional Laser treatments.
These therapies can be used alone or in combination with acne medications in order to achieve the best results in acne treatment.
For more information about effective treatments for acne scars / acne scarring, see our Acne Scar Treatment page
Summit Medical Groupprovides medical, surgical, and cosmetic dermatology for women, men, and adolescents in the tri-state area, including New York and New Jersey as well as Essex County, Morris County, Bergen County, Union County, Passaic County, Somerset County, Sussex County, and Livingston, NJ; Millburn, NJ; Short Hills, NJ; West Orange, NJ; Berkeley Heights, NJ; Caldwell, NJ; Cedar Grove, NJ; Cedar Knolls, NJ; Chatham, NJ; East Hanover, NJ; Englewood Cliffs, NJ; Essex Fells, NJ; Fair Lawn, NJ; Florham Park, NJ; Fort Lee, NJ; Glen Ridge, NJ; Jersey City, NJ; Kennelon, NJ; Madison, NJ; Maplewood, NJ; Mendham, NJ; Montclair, NJ; Montvale, NJ; Morristown, NJ; New Providence, NJ; North Caldwell, NJ; Parsippany, NJ; Randolph, NJ; Roseland, NJ; South Orange, NJ; Springfield, NJ; Summit, NJ; Union, NJ; Verona, NJ; West Caldwell, NJ; Whippany, NJ; and Westfield, NJ.
Disclaimer:The information on this Web site is solely for to educate patients. It is not intended to be medical advice and, therefore, should not be considered a substitute for consultation with a qualified medical professional. Communications to or from the Summit Medical Group Web site and any person will not be used to establish a relationship between a patient and doctor.