Acne Overview

Whether you call them blemishes, pimples, or zits, most of us experience mild acne at some point in our lives. More often a problem in the teen years, acne vulgaris, as it's known medically, starts when pores become blocked by excess oil and dead skin cells.

Acne is the most common skin condition in the United States, affecting up to 50 million Americans annually. Approximately 85 percent of people between the ages of 12 and 24 experience at least minor acne. A recent survey found that in those between 20-29 years old 50% experienced acne; in those between 30-39 years old it was 35%; in those between 40-49, 26%, and in those over 50 years old, 15%.

Those stats may sound defeating, but there's a silver lining: Because the condition is so prevalent, there are more research studies on the various types of acne and more treatment options available than ever before.

What Is it

Pimples aren't just a hallmark of puberty. Turns out, adult acne is on the rise, too, and there's a wide spectrum of ways acne appears on your skin.

So, what is acne exactly? It's a common skin condition—up to 50 million Americans have it—that occurs when hair follicles become blocked by oil and dead skin cells. The reasons you can develop acne are far-reaching but include inflammation, stress, diet, medications, bacteria on the skin, genetics and hormonal changes.

Types

There are three most common types of acne. Here's more info on each:

Cystic Acne

What it looks like: These are deep, below-the-surface bumps that have no head and, in women, are usually located along the jawline and the chin. They can be red, painful, and cause dark spots and scars once they heal.

Why it happens: This type of acne is common when you have oily skin and a combo of oil (sebum), dirt, and dead skin gets trapped within the pores. This happens often the week before your period or the week of you period— that time of the month as estrogen can cause sebum production to spike.

Blackheads/Whiteheads

What it looks like: Blackheads are black because they're open comedones (AKA bumps) on your skin and the contact with the air causes the oxidation, or darkening, of the pore's contents. Whiteheads are closed comedones, which means the impurities are under the skin and don't have contact with the air, and so the contents remain white-ish in color. Both of these are considered non-inflammatory lesions.

Why it happens: The root of both of these pimples start with "sebum plugs" in a pore or hair follicle. A blackhead is sebum plus bacteria and dead skin cells that plug the opening of the pore. When a blocked pore closes, a whitehead forms. Both tend to appear most in the T-zone since that's the area of the skin that has the most sebaceous glands.

Body Blemishes

What it looks like: Acne isn't always confined to your face; it can appear from your neck down—think "back-ne" and on places where sports bras trap sweat.

Why it happens: Even with a clear complexion, you may still struggle with body breakouts that occur due to the same culprits as on the face (dirt, oil, sweat, and dead skin).

Symptoms

You know you have acne if you're experiencing:

• Red spots or swollen skin that may be pus-filled and appear on your face, chest, neck, shoulders, neck, or back.
• Blackheads or spots that are dark in color and have an opening in the center.
• Whiteheads or white bumps that are small and don't appear to have an opening.
• Papules, which are red, tender and contain pus.
• Pustules, also known as pimples that have pus on the surface.
• Lumps, which are large and solid and can feel tender or inflamed.
• Cystic lesions, which tend to be painful pus-filled lumps under the skin.

Causes

If you're coping with acne, the most common causes are: Clogged pores, an overabundance of oil, bacteria, and inflammation.

However, there are other contributing factors that can lead to breakouts. These include stress, hormones, your menstrual cycle, the products you're using on your face and skin, diet and medications, including steroids and lithium, which can prompt acne.

The health of your skin can also be a good indicator of your overall health. To that end, you'll want to see a healthcare provider if you're also experiencing hair loss, excessive hair growth, irregular periods, and weight changes as these can indicate an endocrine disorder such as polycystic ovarian syndrome.

Diagnosis

If you're coping with acne, schedule an appointment with a board-certified dermatologist. During this skin assessment, your dermatologist will take a close look at your skin, note where your breakouts are occurring, discuss the treatments you've tried and determine what acne type you have. FYI: Acne can be classified as mild, moderate, or severe depending on the number and type of skin lesions you have.

Once your dermatologist has taken a look at your skin, you'll leave the appointment with a tailored treatment plan that's best for you. The goal is to treat your lesions, prevent scars and dark spots from developing, and alleviate any other symptoms that are bothering you.

Treatment

Your acne treatment largely depends on the type that you have. Here are some common approaches to treating acne:

Cystic Acne

What to do: Follow a consistent skincare routine to treat your skin. Wash twice a day with a cleanser containing a chemical exfoliant like glycolic acid and apply a retinoid at night. If that doesn't work, a prescription may help.

Rx route: Certain birth control pills that contain estrogen and progestin are FDA-approved for treating acne. The introduction of those hormones can lower the level of acne-causing androgens like testosterone, which spur the sebaceous gland to produce more sebum. Although it's not FDA-approved for the treatment of acne, Spironolactone—a blood pressure medication—may be prescribed off-label since it works similarly for women by blocking androgens, but without hormones. In more severe cases, Isotretinoin—the brand name is Accutane—is the gold standard and has the potential to put cystic acne into remission. (Women who are pregnant or planning to get pregnant should avoid Isotretinoin because it can cause birth defects.).

Whiteheads and Blackheads

What to do: Use a product with salicylic acid, which works to penetrate the pores and unclog them. Consider booking a facial with a professional who can do the needed extractions to help keep your complexion clear.

Body blemishes

What to do: Use an exfoliating benzoyl peroxide cleanser on your skin, especially after workouts, to get rid of blemish-causing bacteria.

Prevention

To prevent acne, try these five acne-proofing tips:

Adjust your diet. High-glycemic foods can increase levels of the hormone insulin, and may change the way estrogen is metabolized mess with your hormones. Try cutting these out and see if your skin improves. If not, let your derm know.

Stress less. A boost in cortisol (a stress hormone) can send oil glands into overdrive, so take steps to try to reduce stress in your life.

Hit the hay. Skin conditions like eczema worsen with poor sleep; acne can too. Make sure to get the seven to nine hours recommended by the National Sleep Foundation.

Less is more. If you're tempted to try everything in your medicine cabinet at once to handle the spots, don't. A pared-down routine is actually the most effective way to tackle skin that's inflamed.

Go oil-free. Look for items labeled oil-free and also "noncomedogenic," which means they won't clog your pores.

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