Whiteheads (closed comedones) are the earliest lesions of acne. This image displays small, slightly elevated lesions and scars in an adult with chronic acne. This image displays pus-filled lesions with whiteheads and blackheads (closed and open comedones) in an adult with moderate acne. This image displays one raised acne lesion and several flat, dark spots from prior inflammation, which may take months to resolve due to the patient's darker skin. This image displays multiple light skin scars typical of persistent acne over years. This image displays mild pus-filled lesions and bumps of acne on the chest. In people with darker skin, redness and inflammation of acne can be difficult to see. This image displays the overall redness of the cheeks with accompanying red bumps typical of inflammatory acne. This image displays several large, inflamed bumps typical of acne vulgaris. This image displays acne on the jaw line and neck.  This image displays blackheads and whiteheads (open and closed comedones).  This image displays darker color (pigment) in areas that had acne previously, which takes longer to heal in people with darker skin. In black patients, inflammatory lesions lead to unwanted dark spots, as displayed in this image.  This image displays whiteheads (closed comedones) on the chest. This image displays a large, inflamed acne cyst. This image displays a mix of pus-filled and inflammatory acne.  Blackheads (open comedones) are follicles plugged with scale and oil, as displayed in this image.  This image displays a mix of blackheads (open comedones), red bumps, and depressed scars typical of acne vulgaris. This image displays severe cystic acne. This image displays whiteheads and blackheads (open and closed comedones) on the forehead. This image displays blackheads (open comedones) in the ear area typical of acne. Multiple "blackheads" (open comedones) as well as a few red, inflammatory bumps are seen here on the nose. This image displays pus-filled lesions and blackheads (open comedones), as well as darkened areas from previous acne lesions. This image displays bumps, pus-filled lesions, and dark, flat pigmented marks from previous acne lesions. This image displays numerous whiteheads (closed comedones) and scattered acne bumps. This image displays small acne pus-filled lesions as well as darker marks from previous lesions on the forehead. This image displays bumps, pus-filled lesions, whiteheads (closed comedones), and flat, brown marks from old lesions typical of acne. Close-up of pustules and inflammatory skin lesions of acne. This image displays small bumps, pus-filled lesions, and residual flat, red marks typical of acne. This image displays bumps, pus-filled lesions, and residual flat, red marks typical of acne. This image displays numerous pink bumps and pus-filled lesions typical of acne. This image displays moderate inflammatory acne lesions. This image displays multiple bumps of inflammatory acne with faint redness of each lesion. As displayed in this image, moderate and severe inflammatory acne can leave depressed scars. This image displays small bumps and pus-filled lesions, as well as dark, flat marks, typical of acne.
Share |

Acne (Acne Vulgaris)  Information for adults

Picture of Acne (Acne Vulgaris): Whiteheads (closed comedones) are the earliest lesions of acne. Divider line
Whiteheads (closed comedones) are the earliest lesions of acne.
left arrow
right arrow
Overview
Acne, also known as acne vulgaris, is thought to be caused by multiple factors. Overproduction of a normal oil on the skin, called sebum, increases under the influence of hormones. This, coupled with insufficient shedding of exfoliating dead skin cells, plugs hair follicles. The plugged follicle can become inflamed and have increased growth of normal skin bacteria, Propionibacterium acnes. Medications such as lithium, cortisone, hormones, iodides, some seizure medications, or isoniazid can also cause acne lesions.

There is no cure for acne, but certain measures can help prevent more breakouts. Acne can result in scarring, so minimizing breakouts is important.
Who's At Risk
Acne affects 85–100% of people at some point in their lives, and it usually begins at puberty. Acne can persist into the 30s and beyond. In fact, 5% of people over 45 still have acne. People of all ethnic backgrounds get acne.
Signs and Symptoms
Acne results in a variety of lesions. The most common acne locations include the face, neck, chest, and back, where the most sebaceous glands are located. Along the jaw line is a common location in adults. "Blackheads" (open comedones) and "whiteheads" (closed comedones) are follicular plugs that are either sitting below the skin surface (whitehead) or oxidized from being exposed to the air (blackhead). Papules are small pink to reddish-brown bumps, pustules are pus-filled lesions, and nodules or cysts are deeper pus-filled lesions.

Mild acne consists of a few papules/pustules and/or comedones. Moderate acne has an increased number of lesions. Severe acne has numerous comedones, papules, pustules, and may have painful nodules.

Acne can result in permanent scars, which can appear to be depressions in the skin or hyperpigmentation, which is dark red or brown flat marks where the acne lesions were.
Self-Care Guidelines
Traditional treatments can help prevent acne. Cleanse the acne-prone areas with gentle soaps or cleansers. Avoid irritants, such as rubbing and other alcohols, and abrasive scrubs and greasy products on the skin and in the scalp. Products labeled "water-based" or "noncomedogenic" will help reduce clogged pores.

There are also a variety of over-the-counter medications that may help. These are meant to be preventative therapies and should be applied in a thin layer to the entire area on a regular basis. If applied consistently, you may see small improvements quickly, but results are generally seen after a few months. Benzoyl peroxide (most effective), is available in a variety of forms and strengths. Benzoyl peroxides tend to dry the skin, though, so if you have dry skin, use a weaker-concentration product; for oily skin, consider higher strengths. It can also bleach your clothing and towels. Peeling agents (exfoliants) such as salicylic acid, sulfur, resorcinol, and alpha-hydroxy acids (glycolic, lactic, pyruvic, and citric acid) can also help but will also cause some dryness of the skin.

Microdermabrasion performed every 7–10 days ("lunchtime peel") has been a popular albeit costly way to control mild acne and can be done by a health care professional or in a salon. The same types of peeling agents are available in over-the-counter products, which can be used at home at much less cost.
When to Seek Medical Care
If you have moderate or severe acne that has not improved enough with self-care, seek medical help.
Treatments Your Physician May Prescribe
Topical (or external) treatments for acne include one or more creams, washes, or gels that include:
  • Antibacterial agents and antibiotics such as benzoyl peroxide, clindamycin, erythromycin, sulfur, sodium sulfacetamide, and azelaic acid.
  • Retinoids – vitamin A-derived products such as tretinoin, tazarotene, and adapalene.
Oral treatments may include:
  • Antibiotics such as tetracycline, minocycline, doxycycline, erythromycin, ampicillin, clindamycin, trimethoprim-sulfamethoxazole, azithromycin, or cephalosporins.
  • Oral contraceptives and spironolactone have been found to help regulate hormones.
  • Isotretinoin, a strong drug with many side effects, for severe acne unresponsive to the above treatments.
Procedures:
  • Special "blue light" treatments are being investigated to treat acne but are usually not covered by insurance.
  • Several types of laser treatments also help acne and are often used with other treatment methods; treatments are expensive, must be repeated for several months, and have variable efficacy. Insurance may not cover laser therapy.
  • Laser resurfacing, plastic surgery, and/or dermabrasion may help reduce the prominence of old acne scars.

References

Bolognia, Jean L., ed. Dermatology, pp. 531-543. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp. 672-684. New York: McGraw-Hill, 2003.
Last Updated: 16 Jul 2009