Acne (Acne Vulgaris)

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Images of Acne Vulgaris

Overview

Acne, also known as pimples, zits, or blemishes, is thought to be caused by many factors. Rising levels of hormones cause overproduction of a normal oil on the skin, called sebum. This, coupled with insufficient shedding of exfoliated 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.

Contrary to popular myths, acne is not caused by chocolate or greasy foods.

There is no cure for acne, but certain steps 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. While it usually begins at puberty, it can start even younger. It is uncommon in children less than 8 years of age but can occur because of a hormonal imbalance and certain medications. People of all ethnic backgrounds get acne.

Signs and Symptoms

Acne most commonly occurs on the face, neck, chest, and back, where the most sebaceous glands are located. "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 hyperpigmentation, which is dark red or brown flat marks where the acne lesions were, and permanent scars, which can appear to be depressions in the skin.

Self-Care Guidelines

If your child has a hormonal imbalance, treating it will help the acne lesions resolve.

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 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. Children have sensitive skin and may experience very drying side effects from these medications. Use a weaker concentration of benzoyl peroxide (most effective); for oily skin, consider higher strengths. (Be careful, as it can 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 are not recommended because of their effects on more sensitive skin.

When to Seek Medical Care

Children younger than 8 years old with moderate to severe acne should be seen by their doctor to investigate its causes, such as a hormone imbalance or a medication side effect.

If your child is aged 8 years or older and has moderate or severe acne that has not improved effectively with self-care, seek medical help.

Treatments Your Physician May Prescribe

If your child has not reached puberty, blood tests might be done to look for a hormone imbalance.

Topical (external) treatments include creams, washes, or gels, including:

  • Antibacterial agents and antibiotics such as benzoyl peroxide, clindamycin, erythromycin, sulfur, sodium sulfacetamide, and azelaic acid.
  • Retinoids – vitamin A-based products such as tretinoin, tazarotene, and adapalene.
Oral (internal) treatments may include antibiotics.

Trusted Links

Clinical Information and Differential Diagnosis of Acne Vulgaris

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.