Whiteheads (closed comedones) are the earliest lesions of acne. This image displays prominent sebaceous follicles. 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 several large, inflamed bumps typical of acne vulgaris. Acne frequently affects the back. This image shows a mix of red bumps, cystic acne, comedones ("whiteheads" and "blackheads"), and acne scars. <br /> Severe cystic acne on the back can leave permanent scars. This patient has numerous whiteheads (closed comedones) as well as red, inflammatory acne bumps on the forehead. 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 blackheads (open comedones) in the ear area typical of acne. This image displays numerous whiteheads (closed comedones) and acne pus-filled lesions on the forehead. 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. 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 small bumps and pus-filled lesions, as well as dark, flat marks, typical of acne.
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Acne (Acne Vulgaris)  Teen information

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.
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Overview
Acne vulgaris is the medical term for the very common skin condition known as blemishes, pimples, zits, and spots. Acne is "multifactorial," meaning that many different factors contribute to the problem. These factors include overgrowth of normal skin bacteria (so some acne is treated with antibacterial creams or pills), plugging of follicles (so some acne is treated with creams to promote clearing of follicles), and overproduction of natural oils (again, there are creams to treat this cause). These coupled with the normal hormonal changes of adolescence are the major causes of acne. Other factors include medications such as lithium, cortisone, and seizure medications; stress; and an unhealthy diet. Acne is often hereditary, meaning it runs in families. Acne is not caused by dirt, though skin that is irritated by environmental exposures may be more inflamed in general. Almost all acne can be improved by simple measures and treatments that your doctor can advise. Many people are bothered by their acne and embarrassed to talk about it, but it is very important to discuss it with your doctor because he/she will be able to give you tips and prescribe products that can make a big difference.
Who's At Risk
It is important to remember that every almost single person has acne at some point in their lives; the vast majority of people have acne in their teen years that goes away by adulthood, but some people have acne that persists into adulthood, and some adults develop acne for the first time.
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, and 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
  • Gently cleanse with mild soap or cleansers. (But don't scrub!)
  • Resist picking at lesions.
  • Avoid irritants (rubbing and other alcohols, abrasive scrubs) and oily creams, cosmetics, hair products, and sunscreens.
  • Use products labeled "water-based" or "noncomedogenic."
  • Keep hair, hands, and devices such as cell phones off the face.
  • Avoid greasy products on the skin and scalp.
Over-the-counter medications:
All over-the-counter therapies listed below should be used as a preventive therapy, applied in a thin to moderate quantity to entire regions. Acne treatment is not intended for existing individual lesions but is applied consistently over months to prevent new lesions. Expect slow improvement. Develop a skin care regimen that is modified slowly over time, not week to week.
  • Benzoyl peroxide (most effective), available in a variety of forms and strengths. Benzoyl peroxides tend to dry the skin. If you have dry skin, use a weaker concentration product; for oily skin, consider higher strengths.
  • A combination of a vitamin (nicotinamide) and zinc is available in cream and gel form.
  • Exfoliants (or peeling agents) such as salicylic acid, sulfur, resorcinol, alpha-hydroxy acids (glycolic, lactic, pyruvic, and citric acid).
  • Aluminum chloride hexahydrate (an antiperspirant available as Xerac-AC™) may be useful but can also be irritating.
  • Clinac OC is a copolymer that absorbs oil, helping reduce the look of "greasy skin." It also is produced combined with benzoyl peroxide.
Salon or office treatments:
Microdermabrasion performed every 7–10 days ("lunchtime peel") has been a popular (but costly) way to control mild acne. The same type of peeling agents (exfoliants) are available in over-the-counter products, which can be used at home at much less cost.

Of Note:

  • Acne can have significant psychological effects. Talk to your doctor about any feelings of depression.
  • Changes in diet have no proven effect.
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 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 the following:
  • Antibiotics such as tetracycline, minocycline, doxycycline, erythromycin, ampicillin, clindamycin, trimethoprim-sulfamethoxazole, azithromycin, or cephalosporins.
  • Hormone therapy with oral contraceptives or spironolactone.
  • 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 treatment also help acne and are often used with other treatment methods; however, 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