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Understanding acne

Teens are often affected, but adults can get acne too.

Adolescence is full of challenges, and among the toughest is acne. Almost all teenagers have it at one time or another. And for some, it can be so severe it leaves lasting scars, both physical and psychological.

Acne is not curable, according to the American Academy of Pediatrics (AAP). But it can be controlled, and most lasting problems can be prevented.

Not just pimples

Acne usually begins around puberty, when changing hormones trigger oil ducts to produce more of an oily substance called sebum. This substance normally flows to the body surface through hair follicles to lubricate the skin. But according to the American Academy of Dermatology (AAD), in some people the excess oil can block the follicle.

That blockage is called a comedo, and it's the start of acne. According to the AAD and other medical experts, it can lead to one or all of these acne lesions:

Blackheads. These happen when the excess sebum in the follicle hardens and forms a small plug. If this plug reaches the surface of the skin, contact with air will turn it black.

Whiteheads. If the follicle remains sealed by keratin, the tough protein produced by the skin cells, the sebum hardens into these small white lumps.

Pimples. If the inside wall of a plugged follicle breaks, bacteria can cause the area to swell and redden. A break near the skin surface results in a pimple. These lesions often have yellow, pus-filled tips.

Acne nodules or cysts. These large, tender lumps can form if the follicle wall breaks deep under the skin. Nodules or cysts may not have an obvious head, but they can cause scarring.

Although acne usually happens in teenagers, adults can also get it. Females may have acne outbreaks due to hormonal fluctuations throughout the menstrual cycle. During pregnancy acne may get better, or it may get worse.

Your family history can also predict whether you get severe acne—it's more likely if one of your parents had it.

Clearing up acne

Acne usually clears up as you get older, but it can last for years. Treating acne means understanding what doesn't work as well as what does. The AAD and other medical experts offer these tips:

  • Do gently wash your face and other affected skin twice a day with water and mild soap. This helps remove excess oils and dead skin cells.
  • Don't scrub too hard or wash with hot water. This may irritate the skin and make acne worse.
  • Do try a nonprescription medication, such as benzoyl peroxide. Tell your doctor if the medication causes burning or redness that doesn't go away.
  • Don't squeeze or pick a blemish. This can force infected material deeper into the skin and may cause scarring.
  • Do wear only noncomedogenic or nonacnegenic cosmetics—or none at all. Remove cosmetics at night with mild soap and water.

If your acne persists despite these steps, your doctor may prescribe an antibiotic cream or oral antibiotic to help fight bacteria.

Severe cystic acne can be treated with a powerful medicine called isotretinoin, which is sold under several brand names. It should only be used exactly as directed. This drug can cause birth defects, so women shouldn't take it just before or during pregnancy.

Take acne seriously

It's important to start treating acne quickly. Early acne often becomes severe later, according to the AAP. And it can take weeks or months to see improvement from acne treatments.

But more important, early treatment can make a lifelong difference, both physically and emotionally. Acne can cause depression, anxiety and low self-esteem, especially for teenagers. Acne can also cause physical scarring.

Luckily, almost every case of acne can be controlled and even some scarring can be treated. Ask your doctor to get you started on a treatment plan soon.

reviewed 6/24/2019

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