When pores become blocked, the natural oils of the skin (sebum) can get trapped under the surface. As bacteria grow in the trapped oil, blockage can occur. If the pore wall ruptures, inflammation can develop in the form of raised, swollen pustules. This condition is known as acne.
Although acne is most common in teenagers and young adults, you can develop acne at any age. For many people, childhood acne can continue well into adulthood. Active acne breakouts can cause feelings of self-consciousness. Some types of acne, such as cystic acne, may even be painful to the touch. Severe acne can leave permanent scars on the face, back, chest or anywhere breakouts occur.
Wellness & Prevention
The precise cause of acne is unknown, but we do know that there are many contributing factors. These can include genetics (severe acne tends to run in families) and environmental influences. Hormone levels, too, can play a role in the development of acne. Diet seems to play a role as well, with high-glycemic index diets (eating foods high in simple sugars and starches) being associated with acne. Dairy or other specific foods may also be triggers for some people.
Daily cleansing is important, and medicated washes that contain ingredients such as benzoyl peroxide, salicylic acid or alpha-hydroxy acids can help control acne. Be aware though that these medicated washes, as well as toners, astringents, exfoliants and peels, can all dry out the skin and may be too irritating, especially if also using a topical treatment.
It is also important to avoid oily, “comedogenic” products that can plug pores. Most skincare products these days are non-comedogenic and can be safely used, but hair products often are not and can make forehead acne worse.
There are several different types of acne that can be diagnosed:
- Acne Vulgaris: This is the most common form of acne, and can usually be identified easily. This type of acne may have skin-colored bumps or black bumps. Either papules (small, red, solid bumps) or pustules (pimples filled with pus) may form. Usually, acne vulgaris can be treated at home with topical treatments like a special facial wash or cream.
- Acne Rosacea: Similar in some ways to acne vulgaris, acne rosacea can also include rashes in addition to pimples. Women and those over the age of 30 are most commonly affected. This type of acne may need a stronger treatment.
- Nodular or Cystic Acne: Nodular and cystic acne can both result when a blockage forms under the skin and becomes inflamed. Nodules are hard, and cysts are filled with pus. Nodulocystic acne can be severe and painful, with a single pimple lasting for weeks or even months. These outbreaks can occur in anyone, but are seen most often in teenage boys and young men. It’s not uncommon for nodulocystic acne to result in facial scarring.
The best treatment for acne depends on the type of acne diagnosed and the underlying causes. For example, adult women may have acne as the result of a hormonal imbalance, and correcting this imbalance may help improve their complexion.
In many cases, over-the-counter or prescription topical acne medications are enough to help clear acne. Benzoyl peroxide, salicylic acid and retinoids can all be helpful for improving blemishes. Retinoids can be especially effective for people with lots of whiteheads and blackheads. For many mild to moderate acne-sufferers, this is the only treatment needed.
For people with lots of inflammatory acne, topical antibiotics can be added. Other topicals, such as those containing sulfur, sulfacetmide or anti-inflammatory botanical products can also be helpful.
More severe acne may require oral medications, the most common of which are antibiotics. A few-month course of oral antibiotics can calm down active acne, after which topicals alone can hopefully do the job.
For women, oral contraceptive pills or another hormonal medication may be good alternatives to antibiotics. For acne that does not respond to any of the above methods, isotretinoin (Accutane™) may be needed.
For people with numerous blackheads, manual extraction can improve the appearance of acne. Extraction causes minimal discomfort and is performed in our office with a special comedone extractor tool.
Other Procedural Treatments
Chemical peels (such as salicylic acid, glycolic acid and stronger peels) can be a great addition to other acne treatments. Microdermabrasion is another procedure that can help, especially for blackhead/whitehead acne.
The main concern of acne’s aftereffects is the possibility of scarring. The first step in addressing acne scars is figuring out if true scarring is present, and if so, which type. Scarring means that there is a change in the texture of the skin. In other words, if you rub your finger over the scarred area it will feel different than normal skin.
If true scarring is present, there can be depressed scars which consist of pits or dips in the skin. Keloid-type scars, which are raised above the normal skin, may also develop. Keloid-type scars can sometimes be flattened with steroid injections, while depressed scars usually need to be treated with lasers.
Even more common than scarring is “post-inflammatory hyperpigmentation,” which are brown or reddish dots at the site of previous acne. These dots do not have any textural change, and unlike scars, they are not permanent. However, they can last for months to years. Bleaching creams can often help fade the spots more quickly.
The best way to prevent scarring is to treat acne early and aggressively. This is especially important with inflammatory (red bumps, pus bumps) or nodulocystic acne.
Remember that the first step is getting active acne under control. Laser treatments for scarring can sometimes make acne worse if there is a lot of active acne still present. Once the acne is cleared up, then laser skin resurfacing can be a great option, with fractionated lasers such as Fraxel™ being the current gold-standard treatment. For small ice-pick scars, mini-high strength chemical peels can deliver excellent results.