The body continually sheds dead skin cells as new cells are formed. In most cases, this is a gradual process that goes unnoticed. However, this process can speed up, producing excessive amounts of dead skin cells, which causes dandruff.

Dandruff is a common skin condition that causes dry white or grey flakes of dead skin to appear in the scalp or hair.

The flakes are often noticeable if they fall from your scalp on to your shoulders. Your scalp may also feel dry and itchy.

It's not contagious and doesn't usually pose a threat to health, but can be unpleasant and embarrassing.

The body continually sheds dead skin cells as new cells are formed. In most cases, this is a gradual process that goes unnoticed.

However, this process can speed up, producing excessive amounts of dead skin cells, which causes dandruff.

It's not always clear why this happens, but possible causes include seborrhoeic dermatitis (see below), a common skin condition that causes oily skin.

While not directly responsible, certain things can make your dandruff worse, such as:

If your dandruff is associated with the skin condition seborrhoeic dermatitis, you may also experience additional symptoms.

These can include scaling and itching of the skin. Areas of the body most commonly affected include:

The scaling can range from some mild pink patching to widespread thick crusts of skin.

In some cases the scales can become infected, which can lead to the patches becoming red, painful and discharging pus and fluid.

Severe cases of patching on your scalp can result in some degree of hair loss. However, if there is no scarring, the hair should regrow.

The main treatment is anti-dandruff shampoo. There are a number of different types available over the counter from most pharmacists and supermarkets.

These work in different ways, depending on the type, so if one type isn't effective you may want to try another one.

If treatment fails to clear your flaky scalp after a few weeks, or your scalp is particularly itchy, see your GP. You may need stronger prescription shampoo or a short course of a steroid lotion.

Dandruff usually responds well to treatment, but it's common for it to reoccur. Some people find they are free from symptoms for a while before having a "flare-up", where symptoms are particularly bad.

In some cases, you may need to use anti-dandruff shampoo on a regular or semi-regular basis to prevent dandruff returning.

See your GP if your symptoms show no signs of improvement after using anti-dandruff shampoo for two weeks. You may require stronger prescription treatment.

Your GP can examine your scalp to rule out skin conditions such as seborrhoeic dermatitis or psoriasis, which may also require prescription treatment.

If your GP thinks a fungal infection may be present in your scalp (for example, scalp ringworm), a skin sample may be taken and sent to a laboratory for testing.

Dandruff is a common condition. It is estimated that half of all people will be affected by dandruff at some point in their lives.

Dandruff often occurs after puberty and is most common in people in their early 20s, continuing into middle age.

It has been reported that dandruff is more common in men than women. It is thought to affect all ethnic groups equally.

Seborrhoeic dermatitis is a common, non-infectious skin condition that can cause an itchy or sore scalp, a red rash and oily white or yellow scales

Acne is a common skin condition that affects most people at some point. It causes spots to develop on the skin, usually on the face, back and chest.

The spots can range from surface blackheads and whiteheads – which are often mild – to deep, inflamed, pus-filled pustules and cysts, which can be severe and long-lasting and lead to scarring.

Keeping your skin clean is important, but will not prevent new spots developing. Wash the affected area twice a day with a mild soap or cleanser, but do not scrub the skin too hard to avoid irritating it.

If your skin is dry, use a moisturiser (emollient). Most of these are now tested so they don't cause spots (non-comedogenic).

Although acne can't be cured, it can be controlled with treatment. Several creams, lotions and gels for treating spots are available at pharmacies.

If you develop acne, it's a good idea to speak to your pharmacist for advice. Products containing a low concentration of benzoyl peroxide may be recommended, but be careful as this can bleach clothing.

If your acne is severe or appears on your chest and back, it may need to be treated with antibiotics or stronger creams that are only available on prescription.

See your GP if you cannot control your acne with over-the-counter medication or if it is causing you distress and making you feel unhappy.

Also see your GP if you develop nodules or cysts, as they will need to be treated properly to avoid scarring.

Treatments can take up to three months to work, so don't expect results overnight. Once they do start to work, the results are usually good.

Try to resist the temptation to pick or squeeze the spots as this can lead to permanent scarring.

Acne is most commonly linked to the changes in hormone levels during puberty, but can start at any age.

It affects the grease-producing glands next to the hair follicles in the skin. Certain hormones cause these glands to produce larger amounts of oil (abnormal sebum).

This abnormal sebum changes the activity of a usually harmless skin bacterium called P. acnes, which becomes more aggressive and causes inflammation and pus.

The hormones also thicken the inner lining of the hair follicle, causing blockage of the pores (opening of the hair follicles). Cleaning the skin does not help remove this blockage.

Acne is known to run in families. If both your mother and father had acne, it is likely that you will also have acne.

Hormonal changes, such as those that occur during the menstrual cycle or pregnancy, can also lead to episodes of acne in women.

There is no evidence that diet, poor hygiene or sexual activity play a role in acne.

Acne is very common in teenagers and younger adults. About 80% of people between the ages of 11 and 30 will be affected by acne.

Acne is most common between the ages of 14 and 17 in girls, and boys between 16 and 19.

Most people have acne on and off for several years before their symptoms start to improve as they get older. Acne often disappears when a person is in their mid-twenties.

In some cases, acne can continue into adult life. About 5% of women and 1% of men have acne over the age of 25.

Acne causes spots and oily skin, and sometimes skin that is hot or painful to touch.

Even mild cases of acne can cause distress. If your acne is making you feel very unhappy or you cannot control your spots with over-the-counter medication, see your GP.

Also see your GP if you develop scarring, nodules or cysts. Scarring is more common with deep nodules and cysts, but can occur after spots nearer the surface.

Acne is caused when tiny holes in the skin, known as hair follicles, become blocked.

Sebaceous glands are tiny glands found near the surface of your skin. The glands are attached to hair follicles, which are small holes in your skin that an individual hair grows out of.

Sebaceous glands lubricate the hair and the skin to stop it drying out. They do this by producing an oily substance called sebum.

In acne, the glands begin to produce too much sebum. The excess sebum mixes with dead skin cells and both substances form a plug in the follicle.

If the plugged follicle is close to the surface of the skin, it will bulge outwards, creating a whitehead. Alternatively, the plugged follicle can be open to the skin, creating a blackhead.

Normally harmless bacteria that live on the skin can then contaminate and infect the plugged follicles, causing papules, pustules, nodules or cysts.

Teenage acne is thought to be triggered by increased levels of a hormone called testosterone, which occurs during puberty. The hormone plays an important role in stimulating the growth and development of the penis and testicles in boys, and maintaining muscle and bone strength in girls.

The sebaceous glands are particularly sensitive to hormones. It is thought that increased levels of testosterone cause the glands to produce much more sebum than the skin needs.

Acne can run in families. If your parents had acne, it's likely that you will also develop it.

One study has found that if both your parents had acne, you are more likely to get more severe acne at an early age. It also found that if one or both of your parents had adult acne, you are more likely to get adult acne too.

More than 80% of cases of adult acne occur in women. It is thought that many cases of adult acne are caused by the changes in hormone levels that many women have at certain times.

Despite being one of the most widespread skin conditions, acne is also one of the most poorly understood. There are many myths and misconceptions about it:

Your GP will be able to diagnosis acne by looking at your skin. This will involve examining your face, chest and back for the different types of spot, such as blackheads or sore, red nodules.

How many spots you have and how painful and inflamed they are will help determine how severe your acne is. This is important in planning your treatment.

If acne suddenly starts in adult women, it can be a sign of a hormonal imbalance, especially if is accompanied by other symptoms such as excessive body hair (hirsutism) and irregular or light periods.

The most common cause of hormonal imbalances in women is polycystic ovary syndrome (PCOS). PCOS can be diagnosed using a combination of ultrasound scans and blood tests. Read more about diagnosing PCOS.

Treatment for acne depends on how severe it is. It can take several months of treatment before acne symptoms improve.

If you just have a few blackheads, whiteheads and spots, you should be able to treat them successfully with over-the-counter gels or creams (topical treatments) that contain benzoyl peroxide.

Treatments can take up to three months to work, so don't expect results overnight.

See your GP if your acne is more widespread – for example, you have a large number of papules and pustules, or over-the-counter medication hasn't worked – as you probably need prescription medication.

If you have severe acne, such as a large number of papules and pustules on your chest and back as well as your face, or if you have painful nodules, your GP can refer you to an expert in treating skin conditions (dermatologist).

A combination of antibiotic tablets and topical treatments is usually the first treatment option for severe acne. If this doesn't work, a medication called isotretinoin may be prescribed.

Hormonal therapies or the combined oral contraceptive pill can also be effective in women who have acne. However, the progestogen-only pill or contraceptive implant can sometimes make acne worse.

Many of these treatments can take two to three months before they start to work. It's important to be patient and persist with a recommended treatment, even if there is no immediate effect.

Benzoyl peroxide works as an antiseptic to reduce the number of bacteria on the surface of the skin. It also helps to reduce the number of whiteheads and blackheads and has an anti-inflammatory effect.

Benzoyl peroxide is usually available as a cream or gel. It's used either once or twice a day. It should be applied 20 minutes after washing to all of the parts of your face affected by acne.

It should be used sparingly as too much can irritate your skin. It also makes your face more sensitive to sunlight, so avoid too much sun and ultraviolet (UV) light, or wear sun cream.

Benzoyl peroxide can have a bleaching effect, so avoid getting it on your hair or clothes.

Most people need a six-week course of treatment to clear most or all of their acne. You may be advised to continue treatment less frequently to prevent acne returning.

Topical retinoids work by removing dead skin cells from the surface of the skin (exfoliating) which helps prevent them building up within hair follicles.

Tretinoin and adapalene are topical retinoids used to treat acne. They are available in a gel or cream and are usually applied once a day before you go to bed.

Apply to all of the parts of your face affected by acne 20 minutes after washing your face.

It is important to apply topical retinoids sparingly and avoid excessive exposure to sunlight and UV.

Topical retinoids are not suitable for use during pregnancy as there is a risk that they might cause birth defects.

The most common side effects of topical retinoids are mild irritation and stinging of the skin.

A six-week course is usually required, but you may be advised to continue using the medication less frequently after this.

Topical antibiotics help kill the bacteria on the skin that can infect plugged hair follicles. They are available as a lotion or gel that is applied once or twice a day.

A six- to eight-week course is usually recommended. After this, treatment is usually stopped as there is a risk that the bacteria on your face could become resistant to the antibiotics. This could make your acne worse and cause additional infections.

Azelaic acid is often used as an alternative treatment for acne if the side effects of benzoyl peroxide or topical retinoids are particularly irritating or painful.

Azelaic acid works by getting rid of dead skin and killing bacteria. It is available as a cream or gel and is usually applied twice a day (or once a day if your skin is particularly sensitive).

The medication does not make your skin sensitive to sunlight, so you do not have to avoid exposure to the sun.

You will usually need to use azelaic acid for a month before your acne improves.

Antibiotic tablets (oral antibiotics) are usually used in combination with a topical treatment to treat more severe acne.

In most cases, a class of antibiotics called tetracyclines is prescribed, unless you are pregnant or breastfeeding.

Pregnant or breastfeeding women are usually advised to take an antibiotic called erythromycin, which is known to be safer to use.

It will usually take about six weeks before you notice an improvement in your acne.

Depending on how well you react to the treatment, a course of oral antibiotics can last four to six months.

Tetracyclines can make your skin sensitive to sunlight and UV light and can also make the oral contraceptive pill less effective during the first few weeks of treatment.

You will need to use an alternative method of contraception, such as condoms, during this time.

Hormonal therapies can often benefit women with acne, especially if the acne flares up around periods or is associated with hormonal conditions such as polycystic ovary syndrome.

If you don't already use it, your GP may recommend that you start taking the combined oral contraceptive pill, even if you are not sexually active. This combined pill can often help improve acne in women, but may take up to a year before the full benefits are seen.

Co-cyprindiol is a hormonal treatment that can be used for more severe acne that doesn't respond to antibiotics. It helps reduce the production of sebum.

You will probably have to use co-cyprindiol for two to six months before you notice a significant improvement in your acne.

There is a small risk that women taking co-cyprindiol may develop breast cancer in later life.

For example, out of a group of 10,000 women who have not taken co-cyprindiol, you would expect 16 of them to develop breast cancer by the time they were 35. This figure rises to 17 or 18 for women who were treated with co-cyprindiol for at least five years in their early twenties.

There is also a very small chance of co-cyprindiol causing a blood clot. The risk is estimated to be around 1 in 2,500 in any given year.

It is not thought to be safe to take co-cyprindiol if you are pregnant or breastfeeding. Women may need to have a pregnancy test before treatment can begin.

However, the drug can also cause a wide range of side effects. It is therefore only recommended for severe cases of acne that have not responded to other treatments.

Because of the risk of side effects, isotretinoin can only be prescribed by a specially trained GP or a dermatologist.

Isotretinoin is taken as a tablet. Most people take a four- to six-month course. Your acne may get worse during the first 7 to 10 days of treatment. However, this is normal and soon settles.

Because of the risk of these rarer side effects, you will need a blood test before and during treatment.

You will be asked to sign a form confirming that you understand the risk of birth defects and are willing to use contraceptives to prevent this risk, even if you are not currently sexually active.

If you think you may have become pregnant when taking isotretinoin, contact your dermatologist immediately.

There have been reports of people experiencing mood changes while taking isotretinoin. There is no evidence that these mood changes were the result of the medication.

However, as a precaution, contact your doctor immediately if you feel depressed or anxious, have feelings of aggression or suicidal thoughts.

Acne scarring can sometimes develop as a complication of acne. Any type of acne spot can lead to scarring, but it is more common when the most serious types of spots (nodules and cysts) burst and damage nearby skin.

Scarring can also occur if you pick or squeeze your spots, so it is important not to do this.

Treatments for acne scarring are regarded as a type of cosmetic surgery, which is not usually available on the NHS. However, in the past, exceptions have been made when it has been shown that acne scarring has caused serious psychological distress.

See your GP if you are considering having cosmetic surgery. They will be able to discuss your options with you and advise you about the likelihood of having the procedure carried out on the NHS.

Many private clinics offer treatment for acne scarring. Prices can vary widely (from £500 to more than £10,000) depending on the type of treatment required.

The website of the British Association of Aesthetic Plastic Surgeons provides more information about private treatment available in your area.

It is important to have realistic expectations about what cosmetic treatment can achieve. While treatment can certainly improve the appearance of your scars, it will not be able to get rid of them completely.

After treatment for acne scarring, most people notice a 50-75% improvement in their appearance.

Dermabrasion involves removing the top layer of skin, either using lasers or a specially made wire brush.

After the procedure, your skin will look red and sore for several months, but as it heals you should notice an improvement in the appearance of your scars.

Laser treatment can be used to treat mild to moderate acne scarring. There are two types of laser treatment:

Punch techniques are used to treat ice pick scars and boxcar scars. There are three types of punch technique:

Subcision is a surgical treatment that can be used to treat rolling scars. During surgery, the upper layer of the skin is removed from the underlying scar tissue. This allows blood to pool under the affected area. The blood clot helps form connective tissue, which pushes up the rolling scar so it is level with the rest of the surface of the skin.

Once subscision has been completed, additional treatment, such as laser treatment and dermabrasion, can be used to further improve the appearance of the scar.

Acne can often cause intense feelings of anxiety and stress, which can sometimes make people with the condition become socially withdrawn. This combination of factors can lead to people with acne becoming depressed.

You may be depressed if during the last month you have often felt down, depressed or hopeless and have little interest or pleasure in doing things.

If you think that you or your child may have depression, it is important to speak to your GP.

Treatments for depression include talking therapies such as cognitive behavioural therapy and a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs).

There is currently no main charity or support group for people affected by acne in England.

However, there is a range of informally run message boards and blogs about acne on the web. You may find it supportive to read about other people's experience of living with acne.

The charity Get Connected also has a website and helpline for teenagers and young people with emotional and other difficulties.

Make-up can help cover up scars and can be particularly useful for facial scars.

Camouflage make-up specially designed to cover up scars is available over the counter at pharmacies. Alternatively, ask your GP for advice

The facts behind five common skin problems and the treatments available.

Warts

Most people develop a wart at some stage in their life, usually by the age of 20.

What are they?

Warts are flesh-coloured lumps, which can be 1mm to more than 1cm across. Warts can appear anywhere, but usually affect the hands and feet. A wart on the foot is called a verruca. Genital warts appear around the genitals or anus.

What causes warts?

They are caused by infection with the human papilloma virus (HPV), which can be passed on through skin-to-skin contact and sometimes through surfaces such as floors and towels. If you have a wart, you can spread it to other people through close contact. You can also spread it to other parts of your own body.

What's the treatment?

Most warts go away by themselves, but this can take up to two years. Treatments include:

over-the-counter creams and gels (not for use on genital warts) – ask your pharmacist which ones may be suitable for you
prescription chemicals to be dabbed on to the wart
cryotherapy (freezing), which should be carried out by a practitioner trained in cryotherapy
surgery and laser treatment, but these are not commonly used

There is limited evidence that duct tape placed over the wart can be effective.

These treatments may be painful and the warts may come back.

Do I need to see a doctor?

See your GP if the wart is bothering you, if you want your GP to treat it, or if treatments from the pharmacy have not worked. If you have genital warts, it's important to go to your GP or a genitourinary medicine (GUM) clinic so you can be given appropriate treatment.

Find out more about treating warts.

Impetigo

Impetigo is common in babies and children, but can affect anyone. It usually develops on the face and hands. In babies it affects the nappy area.

What is it?

Impetigo is an infection in the skin. Small blisters appear and burst, leaving yellow, moist, itchy patches that dry to a crust. The skin underneath can be red and inflamed.

What causes impetigo?

It is caused by bacteria that enter the skin through a cut, scratch or damage from an existing skin condition, such as eczema. Impetigo can be spread by direct contact and sharing towels or bedding with someone who has it.

What's the treatment?

Impetigo is likely to clear up by itself within three weeks. However, it's very contagious, so antibiotic cream or tablets should be used to get rid of it quickly.

Do I need to see a doctor?

See your GP for a diagnosis and to prescribe antibiotics. Most people are not contagious after 48 hours of treatment or once their sores have dried. It's sensible for children not to go to school or nursery until they are no longer contagious.

Find out more about treatment for impetigo.

Read Marilyn's story of her young son's impetigo.

Psoriasis

Psoriasis affects 2% of people in the UK. It usually begins between the ages of 11 and 45. Psoriasis runs in families, and one-third of people with psoriasis have a close relative with the condition. Psoriasis is not infectious.

What is it?

Psoriasis causes flaky, red patches on the skin. They can look shiny and cause itching or burning. They can be anywhere, but are more common on elbows, knees and the lower back.

What causes psoriasis?

Some of the body's antibodies attack skin cells by mistake, causing them to reproduce too quickly and build up on the skin. Certain things may make symptoms worse, including alcohol, smoking and some medicines, such as anti-inflammatories (for example, ibuprofen) and beta-blockers (used to treat heart problems). It is not passed on through close contact.

What's the treatment?

Treatments to reduce the patches depend on their severity. They include:

creams containing vitamin D or vitamin A
steroid creams
tar preparations
exposing the skin to ultraviolet (UV) light
medication taken by mouth or injection

Do I need to see a doctor?

Most people are treated by their GP, but some are referred to a dermatologist (skin specialist).

Find out more about treatment for psoriasis.

Read about Ray's experience of psoriasis.

Ringworm

Ringworm is common in children, but can affect anyone. It appears on the head, body, groin, feet, nails or beard area.

What is it?

Ringworm is not a worm, but a number of fungal infections that grow in a patch or circle on the skin. It can be a few millimetres to a few centimetres across. The patches or circles look red or silvery and can blister and ooze.

What causes ringworm?

Fungal spores enter the skin through a break, such as a scratch or a patch of eczema. Ringworm can be passed on through direct contact and sharing items such as towels, bedding or combs. It can also be passed on from the floor of shower or swimming pool areas. Pets can pass it to people.

What's the treatment?

Antifungal creams, powders or tablets, available from the pharmacy, can be effective.

Do I need to see a doctor?

See your GP if you aren't sure if it's ringworm, or if the infection has not responded to pharmacy treatment after two weeks.

Find out about the symptoms of ringworm.

Vitiligo

One in 100 people in the UK develops vitiligo. It can occur at any age, but more than half of cases begin before the age of 20. It affects men and women of any skin colour. Vitiligo is not infectious.

What is it?

Vitiligo causes pale white patches on the skin. These patches can occur anywhere, but are more noticeable on areas that are exposed to sunlight, such as the face and hands, and on dark or tanned skin. On the scalp, vitiligo can cause hair to turn white. Patches can be small or large, stay the same size, or grow. Vitiligo cannot be passed on through close contact.

What causes vitiligo?

It is caused by a lack of melanocyte cells, which colour the skin. These cells can be missing because:

the immune system isn't working properly and attacks them
the skin has come into contact with certain chemicals or has been severely sunburnt

Vitiligo is also linked to having an overactive thyroid gland (hyperthyroidism).

What's the treatment?

Treatment aims to restore skin colour and control the spread of vitiligo. Treatment can include:

steroid creams
ultraviolet A (UVA) light
disguising the patches with coloured creams, some of which are available on prescription

If vitiligo affects more than 50% of the skin, treatment may involve lightening the healthy skin using prescription creams. It's important that this treatment is carried out under the supervision of a doctor.

Creams that you can buy without a prescription that claim to lighten skin can contain harmful chemicals, so don't use them.

Find out more about the risks of skin lightening.

Do I need to see a doctor?

See your GP to confirm the diagnosis and prescribe treatment.

Atopic eczema, also known as atopic dermatitis, is the most common form of eczema. It mainly affects children, but can also affect adults.

Eczema is a condition that causes the skin to become itchy, red, dry and cracked. It is a long-term (chronic) condition in most people, although it can improve over time, especially in children.

Atopic eczema can affect any part of the body, but the most common areas to be affected are:

People with atopic eczema usually have periods when symptoms are less noticeable, as well as periods when symptoms become more severe (flare-ups).

The exact cause of atopic eczema is unknown, but it's clear it's not down to one single thing. It often occurs in people who get allergies – "atopic" means sensitivity to allergens.

It can run in families, and often develops alongside other conditions, such as asthma and hay fever.

The symptoms of atopic eczema often have certain triggers, such as soaps, detergents, stress and the weather. Sometimes food allergies can play a part, especially in young children with severe eczema.

There is currently no cure for atopic eczema, but treatment can help relieve the symptoms and many cases improve over time.

However, severe eczema often has a significant impact on daily life and may be difficult to cope with physically and mentally. There is also an increased risk of skin infections.

Many different treatments can be used to control symptoms and manage eczema, including:

About one in five children in the UK has atopic eczema. In 8 out of 10 cases, the condition develops before a child reaches the age of five. Many children develop it before their first birthday.

Atopic eczema can improve significantly, or even clear completely, in some children as they get older. About half of all cases improve a lot by the time a child reaches 11 years, and around two-thirds improve by the age of 16.

However, the condition can continue into adulthood and can sometimes develop for the first time in adults.

Acne is a disorder that causes outbreaks of skin lesions commonly called pimples. It is caused by the skin's oil glands making too much sebum, an oily substance, which leads to plugged pores. It also can be caused by the rapid production of a bacteria P. acnes.

Acne lesions occur mostly on the face, neck, back, chest, and shoulders. It is the most common skin disease. Although acne is not a serious health threat, severe acne can lead to disfiguring and permanent scarring.

Most young women and men will have at least a few pimples over the course of their lives. But acne seems to affect men and women in different ways. Young men are more likely to have a more serious form of acne. Acne in young women tends to be more random and linked to hormone changes, such as the menstrual cycle.

As women get older, acne often gets better. But some women have acne for many years. Some women even get acne for the first time at age 30 or 40.

For many women, acne can be an upsetting illness. Women may have feelings of depression, poor body image, or low self-esteem. But you don't have to wait to outgrow acne or to let it run its course. Today, almost every case of acne can be resolved. Acne also can, sometimes, be prevented. Talk with your doctor or dermatologist (a doctor who specializes in treating skin problems) about how you can help prevent acne and if treatment would help you.

It is a myth that women get acne because they don't wash enough. Too much washing or scrubbing the skin harshly can make acne worse. And washing away surface oils doesn't do much to prevent or cure acne, because it forms under the skin. The best way to clean the face is to gently wash it twice a day with a mild soap or cleanser. Be careful to remove make-up without harsh scrubbing.

Stress does not cause acne. But, acne may be a side effect of some medicines used to treat stress or depression. And in some cases, the social and emotional impact of acne lesions causes stress. Talk with your doctor if you have concerns.

While many women feel that eating chocolate or greasy foods causes acne, experts have not found a link between the diet and acne. Foods seem to have little effect on acne in most people. But, it's important to eat a healthy diet for good health.

There are many treatments for mild acne. Mild acne can consist of whiteheads, blackheads and small pustules. At home, you can wash your face twice per day with warm water and a gentle cleanser or soap. Your doctor may suggest you also try an over-the-counter lotion or cream. These medicines may make your skin dry if you use them too much. Be sure to follow the directions.

If these medicines don't work, your doctor may prescribe a cream or lotion with benzoyl peroxide, resorcinol, salicylic acid, or sulfur.

If your acne does not get better after six to eight weeks, talk with your doctor about changing your treatment.

Moderate to moderately severe acne. This type of acne consists of several whiteheads, blackheads, papules and pustules that cover from ¼ to ¾ of the face and/or other parts of the body. It can be treated with antibiotic lotions or gels, as well as retinoic acid. Retinoic acid is an altered form of vitamin A. It helps prevent whiteheads and blackheads. Your doctor may also prescribe an antibiotic pill, such as erythromycin. If you take birth control pills to prevent pregnancy, antibiotics can affect how well they work. Be sure to use a second method of birth control with the pill, such as a condom. Retinoic acid and antibiotic pills can make the skin sensitive to the sun. So, wear sunscreen and stay in the shade while using them.

Severe acne. Severe acne consists of deep cysts, redness, swelling, extreme damage to the skin and scarring. You should see a dermatologist to care for this type of acne. Scarring can be prevented with appropriate treatments. Your dermatologist can prescribe oral antibiotics and oral contraceptives. Large inflamed cysts can be treated with an injection of a drug that lessens the redness, swelling, and irritation, and promotes healing.

Your dermatologist may prescribe Accutane®, if other treatments have not worked. This is a strong medicine that can help prevent scarring and treat active disease. But, Accutane also can cause birth defects. It is important that you are not pregnant and do not plan to get pregnant while taking this medicine. You must use two methods of birth control at the same time. This is done for one month before treatment begins, during treatment, and for a full month after stopping the drug. Talk with your dermatologist about when it's safe to get pregnant. Other side effects of this drug may include dry eyes, itching, mood changes, and changes in the blood and liver. You and your dermatologist can decide whether this medicine is right for you based on the pros and cons. Use any prescribed medicine exactly as you are advised. Taking more medicine than you are supposed to take may make acne or your general health worse. Ask your doctor what to do if you miss a dose.

Some large cysts do not respond to medication and may need to be drained or removed. Your dermatologist is the only person who should drain or remove these. You should never try to drain or remove your acne by squeezing or picking. This can lead to infection, worsen your acne, and cause scarring.

Overall, if you don't see a change in your skin in six to eight weeks, talk with your doctor about your treatment plan.

For women who break out mainly around their menstrual cycle, some birth control pills can help. Research shows that these pills can clear acne by slowing down overactive oil glands in the skin. Sometimes, birth control pills are used along with a drug called spironolactone to treat acne in adult females. This medication lowers levels of the hormone androgen in the body. Androgen stimulates the skin's oil glands. Side effects of this drug include irregular menstruation, breast tenderness, headache and fatigue. Spironolactone is not appropriate therapy for all patients.

If you have scarring, your dermatologist may suggest surgery to help heal acne lesions and remove scarring. A laser can reshape scar tissue and reduce redness. Dermabrasion is a type of surgery that can remove surface scars and reduce the depth of deep scars. Another option is to transfer fat from one part of the body to the face. In some cases, a single treatment can help scarring. But for lasting results, several are often needed. There are also topical treatments for acne scarring.

Photodynamic therapy is a new acne treatment. It begins with light microdermabrasion. This is used to remove dead skin cells on the face's surface. Then, an acid is put on the skin for 30 to 60 minutes. After this period, the acid is taken off. Lastly, the skin is treated with a laser. This treatment is still being researched, but seems to give positive long-term results.

Rosacea (ro-ZAY-she-ah) is a common skin problem often called "adult acne." Faired skinned and menopausal women are more likely to have rosacea. Rosacea also seems to run in families. It causes redness in the center parts of the face and pimples. Blood vessels under the skin of the face may enlarge and show through the skin as small red lines. The skin may be swollen and feel warm.

Women with rosacea don't have the same lesions as seen with common acne. They may have flushing of the face, when they are hot, drink alcohol or hot drinks, or eat spicy foods. This flushing causes the face to appear red. In the most severe form, this redness does not go away. The eyes may become swollen and nodules in the skin may be painful.

You can help keep rosacea under control by keeping a record of things that cause it to flare up. Try to avoid or limit these triggers as much as you can. Antibiotic lotions or gels can also help. Sometimes, you may need to take antibiotic pills. Your dermatologist may treat you with laser surgery. If you think you have rosacea, talk with your doctor about these treatments.

This publication contains general information about acne. It describes what acne is and how it develops, the causes of acne, and the treatment options for various forms of acne. Information is also provided on caring for the skin. If you have further questions after reading this publication, you may wish to discuss them with your doctor.

Acne is a disorder resulting from the action of hormones and other substances on the skin’s oil glands (sebaceous glands) and hair follicles. These factors lead to plugged pores and outbreaks of lesions commonly called pimples or zits. Acne lesions usually occur on the face, neck, back, chest, and shoulders. Although acne is usually not a serious health threat, it can be a source of significant emotional distress. Severe acne can lead to permanent scarring.

Doctors describe acne as a disease of the pilosebaceous units (PSUs). Found over most of the body, pilosebaceous units consist of a sebaceous gland connected to a canal, called a follicle, that contains a fine hair (see illustration “Normal Pilosebaceous Unit”). These units are most numerous on the face, upper back, and chest. The sebaceous glands make an oily substance called sebum that normally empties onto the skin surface through the opening of the follicle, commonly called a pore. Cells called keratinocytes line the follicle.

The hair, sebum, and keratinocytes that fill the narrow follicle may produce a plug, which is an early sign of acne. The plug prevents sebum from reaching the surface of the skin through a pore. The mixture of oil and cells allows bacteria Propionibacterium acnes (P. acnes) that normally live on the skin to grow in the plugged follicles. These bacteria produce chemicals and enzymes and attract white blood cells that cause inflammation. (Inflammation is a characteristic reaction of tissues to disease or injury and is marked by four signs: swelling, redness, heat, and pain.) When the wall of the plugged follicle breaks down, it spills everything into the nearby skin—sebum, shed skin cells, and bacteria—leading to lesions or pimples.

People with acne frequently have a variety of lesions, some of which are shown in the illustrations below. The basic acne lesion, called the comedo (KOM-e-do), is simply an enlarged and plugged hair follicle. If the comedo stays beneath the skin, it is called a closed comedo and produces a white bump called a whitehead. A comedo that reaches the surface of the skin and opens up is called an open comedo or blackhead because it looks black on the skin’s surface. This black discoloration is due to changes in sebum as it is exposed to air. It is not due to dirt. Both whiteheads and blackheads may stay in the skin for a long time.

The exact cause of acne is unknown, but doctors believe it results from several related factors. One important factor is an increase in hormones called androgens (male sex hormones). These increase in both boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy or starting or stopping birth control pills can also cause acne.

Another factor is heredity or genetics. Researchers believe that the tendency to develop acne can be inherited from parents. For example, studies have shown that many school-age boys with acne have a family history of the disorder. Certain drugs, including androgens and lithium, are known to cause acne. Greasy cosmetics may alter the cells of the follicles and make them stick together, producing a plug.

There are many myths about what causes acne. Chocolate and greasy foods are often blamed, but there is little evidence that foods have much effect on the development and course of acne in most people. Another common myth is that dirty skin causes acne; however, blackheads and other acne lesions are not caused by dirt. Stress doesn’t cause acne, but research suggests that for people who have acne, stress can make it worse.

People of all races and ages get acne. It is most common in adolescents and young adults. An estimated 80 percent of all people between the ages of 11 and 30 have acne outbreaks at some point. For most people, acne tends to go away by the time they reach their thirties; however, some people in their forties and fifties continue to have this skin problem.

Acne is often treated by dermatologists, who are doctors who specialize in skin problems. These doctors treat all kinds of acne, particularly severe cases. Doctors who are general or family practitioners, pediatricians, or internists may treat patients with milder cases of acne.

The goals of treatment are to heal existing lesions, stop new lesions from forming, prevent scarring, and minimize the psychological stress and embarrassment caused by this disease. Drug treatment is aimed at reducing several problems that play a part in causing acne:

All medicines can have side effects. Some side effects may be more severe than others. You should review the package insert that comes with your medicine and ask your health care provider or pharmacist if you have any questions about the possible side effects.

Depending on the extent of the problem, the doctor may recommend one of several over-the-counter (OTC) medicines and/or prescription medicines. Some of these medicines may be topical (applied to the skin), and others may be oral (taken by mouth). The doctor may suggest using more than one topical medicine or combining oral and topical medicines.

Doctors usually recommend an OTC or prescription topical medicine for people with mild signs of acne. Topical medicine is applied directly to the acne lesions or to the entire area of affected skin.

There are several OTC topical medicines used for mild acne. Each works a little differently. Following are the most common ones:

Topical OTC medicines are available in many forms, such as gels, lotions, creams, soaps, or pads. In some people, OTC acne medicines may cause side effects such as skin irritation, burning, or redness, which often get better or go away with continued use of the medicine. If you experience severe or prolonged side effects, you should report them to your doctor.

OTC topical medicines are somewhat effective in treating acne when used regularly; however, it may take up to 8 weeks before you see noticeable improvement.

People with moderate-to-severe inflammatory acne may be treated with prescription topical or oral medicines, alone or in combination.

Several types of prescription topical medicines are used to treat acne. They include:

Like OTC topical medicines, prescription topical medicines come as creams, lotions, solutions, gels, or pads. Your doctor will consider your skin type when prescribing a product. Creams and lotions provide moisture and tend to be good choices for people with sensitive skin. If you have very oily skin or live in a hot, humid climate, you may prefer an alcohol-based gel or solution, which tends to dry the skin. Your doctor will tell you how to apply the medicine and how often to use it.

For some people, prescription topical medicines cause minor side effects including stinging, burning, redness, peeling, scaling, or discoloration of the skin. With some medicines, these side effects usually decrease or go away after the medicine is used for a period of time. If side effects are severe or don’t go away, notify your doctor.

For patients with moderate-to-severe acne, doctors often prescribe oral antibiotics. Oral antibiotics are thought to help control acne by curbing the growth of bacteria and reducing inflammation. Prescription oral and topical medicines may be combined. Common antibiotics used to treat acne are tetracycline, minocycline, and doxycycline.

Other oral medicines less commonly used are clindamycin, erythromycin, or sulfonamides. Some people taking these antibiotics have side effects, such as an upset stomach, dizziness or lightheadedness, changes in skin color, and increased tendency to sunburn. Because tetracyclines may affect tooth and bone formation in fetuses and young children, these drugs are not given to pregnant women or children under age 14. There is some concern, although it has not been proven, that tetracycline and minocycline may decrease the effectiveness of birth control pills. Therefore, a backup or another form of birth control may be needed. Prolonged treatment with oral antibiotics may be necessary to achieve the desired results.

People with nodules or cysts should be treated by a dermatologist. For patients with severe inflammatory acne that does not improve with medicines such as those described above, a doctor may prescribe isotretinoin, a retinoid (vitamin A derivative). Isotretinoin is an oral drug that is usually taken once or twice a day with food for 15 to 20 weeks. It markedly reduces the size of the oil glands so that much less oil is produced. As a result, the growth of bacteria is decreased.

Isotretinoin is a very effective medicine that can help prevent scarring. After 15 to 20 weeks of treatment with isotretinoin, acne completely or almost completely goes away in most patients. In those patients where acne recurs after a course of isotretinoin, the doctor may institute another course of the same treatment or prescribe other medicines.

Isotretinoin can cause birth defects in the developing fetus of a pregnant woman. It is important that women of childbearing age are not pregnant and do not get pregnant while taking this medicine. Women must use two separate effective forms of birth control at the same time for 1 month before treatment begins, during the entire course of treatment, and for 1 full month after stopping the drug. You should ask your doctor when it is safe to get pregnant after you have stopped taking isotretinoin.

Some people with acne become depressed by the changes in the appearance of their skin. Changes in mood may be intensified during treatment or soon after completing a course of medicines like isotretinoin. There have been a number of reported suicides and suicide attempts in people taking isotretinoin; however, the connection between isotretinoin and suicide or depression is not known. Nevertheless, if you or someone you know feels unusually sad or has other symptoms of depression, such as loss of appetite, loss of interest in once-loved activities, or trouble concentrating, it’s important to consult your doctor.

Talk to your doctor or pharmacist about the side effects of isotretinoin. You can also visit the Food and Drug Administration (FDA) website. To determine if isotretinoin should be stopped if side effects occur, your doctor may test your blood before you start treatment and periodically during treatment. Side effects usually go away after the medicine is stopped.

In some women, acne is caused by an excess of androgen (male) hormones. Clues that this may be the case include hirsutism (excessive growth of hair on the face or body), premenstrual acne flares, irregular menstrual cycles, and elevated blood levels of certain androgens.

The doctor may prescribe one of several drugs to treat women with this type of acne:

Doctors may use other types of procedures in addition to drug therapy to treat patients with acne. For example, the doctor may remove the patient’s comedones during office visits. Sometimes the doctor will inject corticosteroids directly into lesions to help reduce the size and pain of inflamed cysts and nodules.

Early treatment is the best way to prevent acne scars. Once scarring has occurred, the doctor may suggest a medical or surgical procedure to help reduce the scars. A superficial laser may be used to treat irregular scars. Dermabrasion (or microdermabrasion), which is a form of “sanding down” scars, is sometimes used. Another treatment option for deep scars caused by cystic acne is the transfer of fat from another part of the body to the scar. A doctor may also inject a synthetic filling material under the scar to improve its appearance.

If you have acne, you should gently wash your face with a mild cleanser, once in the morning and once in the evening, as well as after heavy exercise. Wash your face from under the jaw to the hairline and be sure to thoroughly rinse your skin.

Ask your doctor or another health professional for advice on the best type of cleanser to use.

Using strong soaps or rough scrub pads is not helpful and can actually make the problem worse. Astringents are not recommended unless the skin is very oily, and then they should be used only on oily spots.

It is also important to shampoo your hair regularly. If you have oily hair, you may want to wash it every day.

Avoid rubbing and touching skin lesions. Squeezing, pinching or picking blemishes can lead to the development of scars or dark blotches.

Test both electric and safety razors to see which is more comfortable. When using a safety razor, make sure the blade is sharp and soften the hair thoroughly with soap and water before applying shaving cream. Shave gently and only when necessary to reduce the risk of nicking blemishes.

Many of the medicines used to treat acne can make you more prone to sunburn. A sunburn that reddens the skin or suntan that darkens the skin may make blemishes less visible and make the skin feel drier. However, these benefits are only temporary, and there are known risks of excessive sun exposure, such as more rapid skin aging and a risk of developing skin cancer.

While undergoing acne treatment, you may need to change some of the cosmetics you use. All cosmetics and hair-care products should be oil free. Choose products labeled noncomedogenic (meaning they don’t promote the formation of closed pores). In some people, however, even these products may make acne worse.

For the first few weeks of treatment, applying foundation evenly may be difficult because the skin may be red or scaly, particularly with the use of topical tretinoin or benzoyl peroxide.

Medical researchers are working on new drugs to treat acne, particularly topical antibiotics to replace some of those in current use. As with many other types of bacterial infections, doctors are finding that, over time, the bacteria that are associated with acne are becoming resistant to treatment with certain antibiotics, though it is not clear how significant a problem this resistance represents.

Scientists are also trying to better understand the mechanisms involved in acne so that they can develop new treatments that work on those mechanisms. For example, one group of NIAMS-supported researchers is studying the mechanisms that regulate the development of the sebaceous glands. Another group is trying to understand how P. acnes activates the immune system in order to identify possible immunologic interventions. Other areas of research involve examining the effects of isotretinoin (a potent drug for acne) on the sebaceous glands. Moreover, a new drug called isoprenylcysteine is currently being evaluated for the treatment of P. acnes-induced inflammation and overproduction of sebum.

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Information Clearinghouse
National Institutes of Health

1 AMS Circle
Bethesda, MD 20892-3675
Phone: 301-495-4484
Toll Free: 877-22-NIAMS (877-226-4267)
TTY: 301-565-2966
Fax: 301-718-6366
Email: NIAMSinfo@mail.nih.gov
Website: http://www.niams.nih.gov

Frequetnly Asked Questions About Acne and Pimples
Fast Facts: An Easy-to-Read Series of Publications for the Public

Acne is a disease that affects the skin’s oil glands. The small holes in your skin (pores) connect to oil glands under the skin. These glands make an oily substance called sebum. The pores connect to the glands by a canal called a follicle. Inside the follicles, oil carries dead skin cells to the surface of the skin. A thin hair also grows through the follicle and out to the skin. When the follicle of a skin gland clogs up, a pimple grows.

Most pimples are found on the face, neck, back, chest, and shoulders. Acne is not a serious health threat, but it can cause scars.

Sometimes, the hair, sebum, and skin cells clump together into a plug. The bacteria in the plug cause swelling. Then when the plug starts to break down, a pimple grows.

Acne is the most common skin disease. People of all races and ages get acne. But it is most common in teenagers and young adults. An estimated 80 percent of all people between the ages of 11 and 30 have acne outbreaks at some point. Some people in their forties and fifties still get acne.

Acne is treated by doctors who work with skin problems (dermatologists). Treatment tries to:

Early treatment is the best way to prevent scars. Your doctor may suggest over-the-counter (OTC) or prescription drugs. Some acne medicines are put right on the skin. Other medicines are pills that you swallow. The doctor may tell you to use more than one medicine.

There are many myths about what causes acne. Dirty skin and stress do not cause acne. Also, chocolate and greasy foods do not cause acne in most people.

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Information Clearinghouse
National Institutes of Health

1 AMS Circle
Bethesda, MD 20892-3675
Phone: 301-495-4484
Toll Free: 877-22-NIAMS (877-226-4267)
TTY: 301-565-2966
Fax: 301-718-6366
Email: NIAMSinfo@mail.nih.gov
Website: http://www.niams.nih.gov

The information in this fact sheet was summarized in easy-to-read format from information in a more detailed NIAMS publication. To order the Acne Q&A full-text version, please contact NIAMS using the contact information above. To view the complete text or to order online, visit http://niams.nih.gov.

This publication contains information about medications used to treat the health condition discussed here. When this publication was developed, we included the most up-to-date (accurate) information available. Occasionally, new information on medication is released.

For updates and for any questions about any medications you are taking, please contact