Acne is a skin problem that affects almost all teenagers. The condition results from the action of hormones on the skin's oil glands, known as sebaceous glands. These glands make an oily substance called sebum, which empties on to the skin surface through the hair follicle opening (pore). The mixture of oil and cells allows bacteria that normally live on the skin to grow in the follicle openings. When this happens pores become clogged and spots develop.
Spots can be one of the following kinds:
- Comedones: Non-inflammatory papules that can be open ( blackheads) or closed (whiteheads).
- Papules: Lesions that are inflamed and can be tender to the touch. These usually appear as small pink bumps on the skin.
- Pustules (spots): Lesions that are inflamed and filled with pus. They may be red at the base.
- Nodules: Solid lesions that are large, painful and lodged deep within the skin.
- Cysts: Pus-filled lesions deep under the skin. These may cause scarring and pain.
In most cases spots occur on the face, neck, back, chest and shoulders. Acne does not present a serious health risk, but severe acne can result in permanent scarring. It can also have significant physical and psychological consequences such as causing a poor self-image, social inhibition and anxiety.
Why do some people get acne and others don't?
It is not clear why some people are more prone to acne than others. The exact cause of acne is not known, but one important factor is an increase in male sex hormones called androgens. Androgens increase in both boys and girls during puberty. Androgens cause the sebaceous glands (oil glands) to get larger and produce more sebum. Androgens can also increase because of hormonal changes related to pregnancy or starting or stopping birth control pills.
Another factor in the cause of acne is genetics. Researchers believe that the tendency to develop acne can be inherited from parents. In addition some medicines - for example anti-epilepsy medication, prednisolone, androgens and lithium - are known to cause acne. Cosmetics that have a greasy consistency may change the cells of the follicles, causing them to stick together and resulting in a plugged pore. Water-based products are less likely to cause acne.
Things that can make acne worse include:
- Friction caused by leaning on or rubbing the skin; harsh scrubbing
- Picking or squeezing blemishes
- Pressure from bike helmets, rucksacks or tight collars
- Changing hormone levels in adolescent girls and adult women two to seven days before the start of a period (menstruation)
Other factors that were previously thought to make acne worse do not seem to have an effect on the development of acne. These factors include chocolate, greasy foods and dirty skin.
What does acne look like?
Acne can appear as one of the following:
- Whiteheads: White dots that are pores impacted with oil and skin covered by skin layers.
- Blackheads: Black bumps that are impacted pores in which material pushes out through the follicles. The black colour is not from dirt. It may be from bacteria and matter that react with oxygen.
- Papules, pustules or nodules: More severe lesions appearing red and swollen due to inflammation or infection of the tissue around the clogged follicles, which are often painful and feel hard.
- Cysts: Deep, painful pus-filled lesions that can cause scarring.