Acne: More Than a Cosmetic Problem

Guido R. Zanni

Your skin is covered with many tiny holes, commonly referred to as hair follicles or pores, which contain oil glands that help keep skin and hair moisturized. During puberty, hormones can cause the skin to make too much oil, resulting in clogged pores, also known as pimples. If the top of a pimple is dark, it's called a blackhead; if the top is white, it's called a whitehead.

Acne symptoms include redness around pimples and small red bumps. If a clogged pore breaks open, additional swelling and red bumps can occur; acne that is deep in the skin can be especially painful. Most pimples occur on the face, but can also appear on the neck, back, chest and shoulders. Acne and acne scars often result in depression and stress.

Several factors can trigger acne. As previously mentioned, hormonal changes in adolescence increase the skin's oil content. Likewise, high humidity, sweat and stress also aggravate acne. Certain medications can contribute. Additionally, some scientists believe genetics plays a role: if a parent had acne as a teenager, his or her children are likely to have acne. Table 1 lists common acne myths.

Table 1: Acne Myths
The following are not true:
Adults don't get acne.
Wearing makeup causes acne.
Eating greasy foods causes acne.
Stress causes acne.
Scrubbing gets rid of acne.
Poor hygiene causes acne.

People of all ages, including babies and elders, can develop acne. Even people in their 30s, 40s and 50s can develop acne. Up to 80 percent of people ages 11 to 30 have acne outbreaks, with 27 percent having severe acne, often leading to scaring. During adolescence, acne is more common in boys; in adults, acne is more common in women. At 40 years old, 5 percent of women and men still have acne.

Acne and Diet

Diet, as a cause of acne, has been controversial. Chocolate, pizza and nuts don't appear to cause acne, while there is some evidence that diets high in refined sugars and dairy products may be related to acne. There is a stronger connection between skim milk and acne compared with other dairy products: People who drink two glasses of skim milk daily have a 44 percent greater chance of developing acne. White bread, rice, potatoes and pasta may likewise play a role.


Treatments focus on four goals:

-- Heal existing acne.

-- Prevent new lesions from forming.

-- Prevent scarring.

-- Minimize psychological stress and embarrassment.

Most dermatologists use a combination of treatments that can be expensive and require multiple sessions before results are noticeable. Even with treatment, there is no guarantee that a person will be acne-free. Table 2 lists several medications used to treat acne. Table 3 lists tips for managing acne. If OTC products do not get the desired result, dermatologists can prescribe stronger medications. Most of these medications help break down blackheads and whiteheads by unclogging skin pores. All medicines have side effects, and your doctor or pharmacist will discuss these with you.

Table 2: Acne Medications
Oral antibiotics.
Topical antibiotics applied to the skin.
Medications called spironolactone and isotretinoin.
Retinoic acid cream or gel.
Azelaic acid applied to the skin.
Other agents, such as sulfur and benzoyl peroxide.
Table 3: Tips for Managing Acne
Wash your face twice daily after sweating. Perspiration worsens acne.
Use your fingers to apply gentle, nonabrasive face cleaners. Using a washcloth or sponge may irritate the skin.
Avoid scrubbing acne.
Shave carefully.
Shampoo regularly. If you have oily hair, shampoo daily. Also, keep hair away from your face.
Avoid wearing hats, headbands and baseball caps.
Avoid touching your face, which may cause flare-ups.
Choose makeup carefully. Select oil-free products, and never leave makeup on overnight.
Avoid sun and tanning beds. Some acne medications result in the skin being very sensitive to sunlight and tanning devices.
Find the right OTC product for your skin type. These creams, washes and soaps work in different ways to reduce oil production in the pores.
Consult a dermatologist if OTC products are ineffective.
If acne depresses you, talk to your doctor.
Don't squeeze or pop pimples, blackheads and whiteheads. This can lead to scarring.

Acne Scars

Acne scarring ranges from mild to severe, the latter being associated with deep tissue scars. Laser skin resurfacing, dermabrasion, chemical peels and the use of fillers are four procedures used to treat acne scars. Laser skin resurfacing removes skin layer by layer, with precision, so that skin cells formed during healing give the skin a tighter, younger-looking surface. Dermabrasion, also called sanding, removes layers of skin, as well. Chemical peels involve applying a chemical solution to the skin to make it "blister" and eventually peel off; the new skin revealed is usually smoother than the old skin. Fillers, which are injected, "plump" up scars and bring them closer to the surface, thereby making them less noticeable. The effects of fillers last between six and 18 months. Acne surgery is another treatment option. The surgery involves lifting the scar to make it less noticeable. Over time, some acne scars fade. Your doctor may use medications to prevent scarring. Bellafill was recently approved to treat acne scars. Isotretinoin is also very effective in treating and preventing scars; however, because isotretinoin can cause birth defects, it's not used in pregnant women.

Acne, left untreated, can lead to scars, depression and stress. Early treatment is critical to obtain the best results and minimize or prevent scarring.

Note: This article was originally published on April 17, 2015 on It has been edited and republished by U.S. News. The original version, with references, can be seen here.