Acne is a disorder that affects the skin’s oil glands and hair follicles. Plugged pores and outbreaks of lesions, commonly called pimples or zits, occur on the face, neck, back, chest, and shoulders.

Healthy Skin & Acne Factsheet

Healthy Skin Matters

What you know about your skin

Normal skin

Your skin is the organ that comes into contact with the rest of the world. It holds body fluids in, preventing dehydration (dee-hahy-DREY-shun), and keeps harmful microbes (MYE-krobs) out—without it, we would get infections. Your skin is full of nerve endings that help you feel things like heat, cold, and pain. If you couldn’t feel these things, you could get badly hurt and not even know it!

Why is healthy skin important?

Since your skin plays such an important role in protecting your body, you should keep it as healthy as you can. This will help you keep from getting sick or having damage to your bones, muscles, and internal organs.

What you might not know about your skin

Skin is actually your body’s largest organ by size. Your skin helps keep your body temperature even. If you get too hot, blood vessels near the surface of the skin, called capillaries (CAP-uh-ler-ees), enlarge to let the warm blood cool down.

Your skin also makes vitamin D (VYE-tuh-min D) when the sun shines on it. Vitamin D is important for the health of your bones and other parts of your body.

An arm with a scrape.

You can injure your skin

It’s not too hard to injure your skin. So be careful when you’re doing anything that might injure it (like using sharp tools, working in the yard, or playing a sport). Cuts, bumps, and scrapes are a normal part of life. It wouldn’t be much fun if you tried to avoid them completely. But it’s smart to wear the right protective equipment, like gloves, long sleeves, knee and elbow pads, or helmets.

Be very careful when you’re around anything hot that can burn your skin. Burns, including sunburn, can be very painful and can take a long time to heal. Burns can also get infected easily. Sometimes, burns leave bad scars and permanently damage your skin. If you’re helping out in the kitchen, make sure you use hot pads or wear oven mitts to protect your hands when you’re grabbing something hot.

What to do when your skin is injured

If you do get a cut or scratch, clean it right away with soap and warm water and put on a bandage to protect it while it heals. This keeps dirt and germs from getting into the wound and causing an infection. If you come into contact with a plant like poison ivy, wash your skin and clothing right away. If you develop a rash, ask your pharmacist about over-the-counter medicines. For severe rashes, you might need to see your doctor.

An 8-legged bug.

What to do about insect bites

Watch out for insect bites, too. Try not to scratch them, because they could get infected. Cover up your skin as much as possible when you will be in the woods, tall grass, or other areas where there may be ticks (small, 8-legged bugs). It helps to wear light-colored clothing, so you can see ticks before they have a chance to bite. Ticks can carry germs that will make you sick. If you find a tick attached to your skin, get a trusted adult to help you remove it.

Skin diseases

There are many diseases that can affect your skin. Some like vitiligo (vit-ill-EYE-go) cause the skin to lose its natural color, and some like alopecia areata (al-oh-PEE-shah ar-ee-AH-tah) can make the hair fall out. Another skin disease like epidermolysis bullosa (ep-ee-der-MOL-eh-sis bull-O-sa) can cause painful blisters. Psoriasis (suh-RYE-uh-sis) can cause itchy, scaly red patches. Go see your doctor if you think you might have a skin disease.

Acne

Most teenagers get a skin disease called acne (AK-nee). The blackheads and pimples can be embarrassing and make you feel bad about your appearance, but keep in mind that almost everyone gets them at some point. Acne isn’t usually serious, but severe cases can cause scars that will last for years.

There are many false ideas about what causes acne.

Acne is caused by bacteria (Propionibacterium acnes, often shortened to P. acnes and pronounced P. AK-nees), which live on everyone’s skin. Sometimes the follicles (FALL-lick-els) in the skin, where hair grows, become clogged with oil and dead skin cells, and the bacteria thrive. Then that spot on the skin may hurt, become swollen, red, and hot. Eventually the walls of the follicle break down and spill the oil, skin cells and bacteria into the nearby skin, and a pimple forms.

There are many false ideas about what causes acne. Chocolate and greasy foods are often blamed, but foods probably don’t have much effect on acne in most people. Another common myth is that dirty skin causes acne. But blackheads and other acne lesions are not caused by dirt. Stress doesn’t cause acne either, but for people who have acne, stress might make it worse.

If acne really bothers you, ask your parents about going to see a doctor. If your acne is not very bad, your family doctor may be able to give you medicines that will help to improve it. Or you might want to see a doctor who treats just the skin. These doctors are known as dermatologists (dur-muh-TOL-uh-jists). Dermatologists have a number of good treatments for acne.

For more information

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: https://www.niams.nih.gov

If you need more information about available resources in your language or another language, please visit our website or contact the NIAMS Information Clearinghouse at NIAMSinfo@mail.nih.gov.

NIH Publication No. 15–7580 (S)

Acne Fact Sheet

divider line

What is acne?

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.

How does acne affect women?

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.

What are the different types of acne lesions?

What triggers acne in women?

Many things can trigger acne in women:

Does poor hygiene cause acne?

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.

Can stress cause acne?

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.

Can eating chocolate or greasy foods cause acne?

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.

How is mild acne treated?

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.

Can more serious forms of acne be treated?

Yes. Work with your doctor to find the best treatment for you.

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.

Can birth control pills help treat acne?

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.

When is surgery used for acne scarring?

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.

How can I help prevent acne and acne scars?

You can help prevent acne flare-ups and scars by taking good care of your skin:

Is rosacea the same as acne?

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.

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More information on acne

For more information about acne, call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

Acne fact sheet was reviewed by:

Diane Berson, M.D.
Weill Medical College of Cornell University

Content last updated: July 16, 2012.

Source: Office on Women's Health, HHS

Doctors don’t know what causes acne, but taking care of your skin can prevent outbreaks from becoming worse. Hormone changes during puberty, before a woman’s monthly period, or after starting or stopping birth control can cause acne outbreaks.

Acne A-Z

Points To Remember About Acne

What is acne

Acne is a disorder that affects the skin’s oil glands and hair follicles. Plugged pores and outbreaks of lesions, commonly called pimples or zits, occur on the face, neck, back, chest, and shoulders.

Acne affects the pilosebaceous units (PSUs), found over most of the body. They are most numerous on the face, upper back, and chest. PSUs consist of a sebaceous gland connected to a canal, called a follicle, which contains a fine hair. In healthy PSUs, the sebaceous glands make an oily substance called sebum that empties onto the skin surface through the opening of the follicle, called a pore. Cells called keratinocytes line the follicle.

Normal skin.

Normal Pilosebaceous Unit

When someone has acne, the hair, sebum and keratinocytes may plug up the pore, which keeps the sebum from reaching the surface of the skin. The mixture of oil and cells allows bacteria that normally live on the skin to grow in the plugged follicles and cause inflammation—swelling, redness, heat, and pain. When the wall of the plugged follicle breaks down, it spills the bacteria, skin cells and sebum into nearby skin, causing lesions or pimples.

For most people, acne tends to go away by the time they reach their thirties, but some people in their forties and fifties continue to have this skin problem.

Who Gets

People of all races and ages get acne, but 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.

Types

An anatomical illustration of a cross-section of skin showing a microcomedo, with a follicle blocked by bacteria.

Acne causes several types of lesions, or pimples.

  • A comedo (KOM-e-do): enlarged and plugged hair follicle.

  • A whitehead or closed comedo: a plugged hair follicle that stays beneath the skin and produces a white bump.

  • A blackhead or open comedo: a plugged follicle that reaches the surface of the skin and opens up. It looks black on the skin surface because the air discolors the sebum, not because it is dirty.

  • Papules: inflamed lesions that usually appear as small, pink bumps on the skin and can be tender to the touch.

  • Pustules or pimples: papules topped by white or yellow pus-filled lesions that may be red at the base.

  • Nodules: large, painful solid lesions that are lodged deep within the skin.

  • Cysts: deep, painful, pus-filled lesions that can cause scarring.

An anatomical illustration showing a cross-section of skin with an open comedo or blackhead.

Causes

Doctors don’t know exactly what causes acne, but it probably results from several related factors. One is an increase in hormones called androgens, or 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.

Researchers believe that you may be more likely to get acne if your parents had acne. Certain drugs, including androgens and lithium, can also cause acne. Greasy makeup may alter the cells of the follicles and make them stick together, causing pores to get clogged.

There are many myths about what causes acne. The following do not cause acne:

  • Foods you eat, such as chocolate and greasy foods.

  • Dirty skin.

  • Stress, but if you already have acne, stress can make it worse.

Treatment

Treatment helps heal existing lesions, stop new lesions from forming, and prevent scarring. Medicines can reduce several problems that play a part in causing acne, including abnormal clumping of cells in the follicles, increased oil production, bacteria, and inflammation. A doctor may recommend over-the-counter or prescription medicines to take in a pill or apply to the skin.

Some over-the-counter topical medicines, which are applied to the skin, include:

  • Benzoyl peroxide, which kills bacteria and may also reduce oil production.

  • Resorcinol, which can help break down blackheads and whiteheads.

  • Salicylic acid, which helps break down blackheads and whiteheads and also helps reduce the shedding of cells lining the hair follicles.

  • Sulfur, which helps break down blackheads and whiteheads.

Topical medicines come in many forms, including gels, lotions, creams, soaps, and pads. In some people, topical medicines may cause side effects such as skin irritation, burning, or redness, which often get better or go away with continued use. If you have severe or prolonged side effects, you should report them to your doctor.

Several types of prescription medicines include:

  • Antibiotics, which help slow or stop the growth of bacteria and reduce inflammation.

  • Vitamin A derivatives, or retinoids, which unplug existing comedones, allowing other medicines, such as antibiotics, to enter the follicles. Some may also help decrease the formation of comedones.

  • Other medicines may destroy bacteria, reduce oil production or reduce inflammation.

Who Treats

Diagnosing and treating acne may involve you and several types of health professionals, including:

  • General or family physicians.

  • Dermatologists, who specialize in treating skin problems.

  • Internists, who specialize in the diagnosis and medical treatment of adults.

  • Pediatricians, who diagnose and treat children.

Living With

If you have acne, you may want to follow some of these recommendations for taking care of your skin.

  • Clean your skin gently. Use a mild cleanser in the morning, in the evening and after heavy exercise. Do not use strong soaps or rough scrub pads. Only use astringents if the skin is very oily, and then only on oily spots.

  • Shampoo your hair regularly. If you have oily hair, you may want to wash it every day.

  • Avoid rubbing and touching skin lesions. Squeezing or picking blemishes can cause scars or dark blotches to develop.

  • Shave carefully. Make sure the blade is sharp, and soften the hair with soap and water before applying shaving cream. Shave gently and only when necessary to reduce the risk of nicking blemishes.

  • Avoid sunburn and suntan. Many of the medicines used to treat acne can make you more prone to sunburn.

  • Choose cosmetics carefully. All cosmetics and hair-care products should be oil free. Choose products labeled noncomedogenic, which means they don’t clog pores. In some people, however, even these products may make acne worse.

Some things can make acne worse. These include:

  • Changing hormone levels in teen girls and adult women two to seven days before their menstrual periods start.

  • Oil from skin products (moisturizers or cosmetics) or grease in the work environment (such as a kitchen with fry vats).

  • Pressure from sports helmets, tight clothes or backpacks.

  • Environmental irritants, such as pollution and high humidity.

  • Squeezing or picking at blemishes.

  • Scrubbing your skin too hard.

  • Stress.

Research Progress

Medical researchers are looking for new drugs to treat acne. Doctors are finding that, over time, the bacteria associated with acne are becoming resistant to certain antibiotics, though it is not clear how significant a problem this resistance represents. Some researchers are trying to identify probiotics to treat acne-affected skin. 

Scientists are also trying to better understand the mechanisms involved in acne so 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 acne-causing bacteria activate the immune system in order to identify possible immunologic interventions. 

Researchers are also studying the skin microbial community to understand its association with acne.

Source: NIAMS, NIH

  1. True or False: Your skin is the largest organ of your body.
  2. True or False: Skin makes vitamin C when the sun shines on it.
  3. True or False: You should put a bandage on a cut or scrape on your skin.
  4. True or False: Insect bites might be itchy, but they won’t cause any real problems.
  5. True or False: Vitiligo is a skin disease that causes the skin to lose its natural color.
  6. True or False: You might have to see the doctor if you have a severe case of acne.
  7. True or False: You should use the hottest water possible when washing your hands or bathing.
  8. True or False: Too much sun can damage your skin.
  9. True or False: Physical activity only helps your muscles.
  10. Multiple Choice: Acne is caused by:
  • chocolate and greasy foods
  • bacteria that live on the skin
  • dirty skin

  1. True. The skin is the largest organ of the human body. It keeps out infections, regulates your body temperature, and protects all your inner organs.

  2. False. Skin makes vitamin D when the sun shines on it.

  3. True. Bandages keep out dirt and germs and help the skin to heal. Don’t forget to wash the injury with soap and warm water before putting the bandage on.

  4. False. Insect bites can get infected, and bites from certain ticks can carry germs that will make you sick.

  5. True. Vitiligo causes the skin to lose pigment, the substance that gives skin its color.

  6. True. A severe case of acne can make you feel really bad about your appearance, and it may leave scars that will last for years. See your doctor if your acne really bothers you.

  7. False. Hot water can dry out your skin or even cause serious burns. Use water that is comfortably warm to wash your hands or to shower or bathe.

  8. True. Getting too much sun, even if you tan easily, can make your skin look old years too soon and can increase your risk of skin cancer later in life. Use a sunscreen with a sun protection factor (SPF) of 30 or 45 on your skin if you will be out in the sun.

  9. False. Physical activity is good for the skin too! It increases the flow of blood to the surface of your skin and brings oxygen and nutrients to your whole body. Sweating helps to flush out impurities from your skin.

  10. B, bacteria that live on the skin.

 Acne Facts Sheet -From Women's Health 

Content:

  • What is acne?
  • How does acne affect women?
  • What are the different types of acne lesions?
  • What triggers acne in women?
  • Does poor hygiene cause acne?
  • Can stress cause acne?
  • Can eating chocolate or greasy foods cause acne?
  • How is mild acne treated?
  • Can more serious forms of acne be treated?
  • Can birth control pills help treat acne?
  • When is surgery used for acne scarring?
  • How can I help prevent acne and acne scars?
  • Is rosacea the same as acne?
  • More information on acne

What is acne?

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.

How does acne affect women?

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.

What are the different types of acne lesions?

  • Comedo (whiteheads or blackheads) or papules. The comedo is the basic acne lesion, which is a plugged pore. If the plugged pore stays under the skin, it's called a closed comedo and forms a white bump or whitehead. Blackheads are comedos that open up and appear blackish on the surface of the skin. This black color is not due to dirt, but because the air reacts with the excess oil.

  • Pustules or pimples. Pustules or pimples are acne lesions that contain pus and are red at the base.

  • Nodules. These are more serious acne lesions. They lodge deeper in the skin, are painful, and can cause scarring.

  • Cysts. Like nodules, these lesions are deep within in the skin, are painful, and are filled with pus, and can cause scarring.

What triggers acne in women?

Many things can trigger acne in women:

  • Hormone changes during puberty. During puberty, girls have an increase in male sex hormones called androgens. This increase causes the glands to get larger and make more sebum.

  • Hormone changes as an adult. The menstrual cycle is one of the most common acne triggers. Acne lesions tend to form a few days before the cycle begins and go away after the cycle is completed. Other hormone changes, such as pregnancy and menopause, improve acne in some women. But some women have worse acne during these times. Stopping use of birth control pills can play a role as well.

  • Medicines. Certain medicines, such as those used to treat epilepsy and types of depression.

  • Make-up.

  • Pressure or friction on the skin. Friction caused by bike helmets or backpacks can make acne worse.

  • Family history. If other people in your family have acne, there is a greater chance you will have it.

Does poor hygiene cause acne?

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.

Can stress cause acne?

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.

Can eating chocolate or greasy foods cause acne?

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.

How is mild acne treated?

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.

  • Benzoyl peroxide works to reduce oil made by the glands.

  • Resorcinol, salicylic acid, and sulfur help breakdown whiteheads and blackheads.

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

Can more serious forms of acne be treated?

Yes. Work with your doctor to find the best treatment for you.

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.

Can birth control pills help treat acne?

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.

When is surgery used for acne scarring?

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.

How can I help prevent acne and acne scars?

You can help prevent acne flare-ups and scars by taking good care of your skin:

  • Clean your skin gently with a mild soap or cleanser twice a day — once in the morning and once at night. You should also gently clean the skin after heavy exercise. Avoid strong soaps and rough scrub pads. Harsh scrubbing of the skin may make acne worse. Wash your entire face from under the jaw to the hairline and rinse thoroughly. Remove make-up gently with a mild soap and water. Ask your doctor before using an astringent.

  • Wash your hair on a regular basis. If your hair is oily, you may want to wash it more often.

  • Do not squeeze or pick at acne lesions. This can cause acne scars.

  • Avoid getting sunburned. Many medicines used to treat acne can make you more prone to sunburn. Many people think that the sun helps acne, because the redness from sunburn may make acne lesions less visible. But, too much sun can also increase your risk of skin cancer and early aging of the skin. When you're going to be outside, use sunscreen of at least SPF 15. Also, try to stay in the shade as much as you can.

  • Choose make-up and hair care products that are "non-comedogenic" or "non-acnegenic." These products have been made in a way that they don't cause acne. You may also want to use products that are oil-free.

  • Avoid things that rub the skin as much as you can, such as backpacks and sports equipment.

  • Talk with your doctor about what treatment methods can help your acne. Take your medicines as prescribed. Be sure to tell your doctor if you think medicines you take for other health problems make your acne worse.

Is rosacea the same as acne?

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.

More information on acne

  • DermWeb
    Phone: 604-875-4747

  • National Institute of Arthritis and Musculoskeletal and Skin Diseases
    Information Clearinghouse, NIAMS, NIH, HHS
    Phone: 301-495-4484, 301-565-2966 (TDD: 877-226-4267)

  • American Academy of Dermatology
    Phone: 847-330-0230, 202-842-3555, 866-503-SKIN (7546)

Acne fact sheet was reviewed by:

Diane Berson, M.D.
Weill Medical College of Cornell University

Source: Office on Women's Health, HHS

 Frequently Asked Questions About Acne and Pimples

Fast Facts: An Easy-to-Read Series of Publications for the Public

What Is Acne?

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.

  • How Does Acne Develop?

  • Who Gets Acne?

  • What Causes Acne?

  • How Is Acne Treated?

  • How Should People With Acne Care for Their Skin?

  • What Things Can Make Acne Worse?

  • What Are Some Myths About the Causes of Acne?

  • What Research Is Being Done on Acne?

How Does Acne Develop?

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.

There are many types of pimples. The most common types are:

  • Whiteheads. These are pimples that stay under the surface of the skin.

  • Blackheads. These pimples rise to the skin’s surface and look black. The black color is not from dirt.

  • Papules. These are small pink bumps that can be tender.

  • Pustules. These pimples are red at the bottom and have pus on top.

  • Nodules. These are large, painful, solid pimples that are deep in the skin.

  • Cysts. These deep, painful, pus-filled pimples can cause scars.

Who Gets Acne?

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.

What Causes Acne?

The cause of acne is unknown. Doctors think certain factors might cause it:

  • The hormone increase in teenage years (this can cause the oil glands to plug up more often)

  • Hormone changes during pregnancy

  • Starting or stopping birth control pills

  • Heredity (if your parents had acne, you might get it, too)

  • Some types of medicine

  • Greasy makeup.

How Is Acne Treated?

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

  • Heal pimples

  • Stop new pimples from forming

  • Prevent scarring

  • Help reduce the embarrassment of having acne.

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.

How Should People With Acne Care for Their Skin?

Here are some ways to care for skin if you have acne:

  • Clean skin gently. Use a mild cleanser in the morning, evening, and after heavy workouts. Scrubbing the skin does not stop acne. It can even make the problem worse.

  • Try not to touch your skin. People who squeeze, pinch, or pick their pimples can get scars or dark spots on their skin.

  • Shave carefully. If you shave, you can try both electric and safety razors to see which works best. With safety razors, use a sharp blade. Also, it helps to soften your beard with soap and water before putting on shaving cream. Shave lightly and only when you have to.

  • Stay out of the sun. Many acne medicines can make people more likely to sunburn. Being in the sun a lot can also make skin wrinkle and raise the risk of skin cancer.

  • Choose makeup carefully. All makeup should be oil free. Look for the word “noncomedogenic” on the label. This means that the makeup will not clog up your pores. But some people still get acne even if they use these products.

  • Shampoo your hair regularly. If your hair is oily, you may want to shampoo daily.

What Things Can Make Acne Worse?

Some things can make acne worse:

  • Changing hormone levels in teenage girls and adult women 2 to 7 days before their period starts

  • Pressure from bike helmets, backpacks, or tight collars

  • Pollution and high humidity

  • Squeezing or picking at pimples

  • Hard scrubbing of the skin.

What Are Some Myths About the Causes of Acne?

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.

What Research Is Being Done on Acne?

Scientists are looking at new ways to treat acne. Current research includes:

  • Working on new drugs to treat acne, including new topical antibiotics

  • Looking at ways to prevent plugs

  • Looking at ways to stop the hormone testosterone from causing acne

  • Understanding more about bacteria on the skin.

For More Information on Acne and Other Related Conditions:

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.

For Your Information

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

U.S. Food and Drug Administration

Toll Free: 888-INFO-FDA (888-463-6332)
Website: http://www.fda.gov

Source: NIAMS, NIH
Healthy Skin Matters

Healthy Skin Matters

What you know about your skin

Normal skin
Your skin is the organ that comes into contact with the rest of the world. It holds body fluids in, preventing dehydration (dee-hahy-DREY-shun), and keeps harmful microbes (MYE-krobs) out—without it, we would get infections. Your skin is full of nerve endings that help you feel things like heat, cold, and pain. If you couldn’t feel these things, you could get badly hurt and not even know it!

Why is healthy skin important?

Since your skin plays such an important role in protecting your body, you should keep it as healthy as you can. This will help you keep from getting sick or having damage to your bones, muscles, and internal organs.

What you might not know about your skin

Skin is actually your body’s largest organ by size. Your skin helps keep your body temperature even. If you get too hot, blood vessels near the surface of the skin, called capillaries (CAP-uh-ler-ees), enlarge to let the warm blood cool down.

Your skin also makes vitamin D (VYE-tuh-min D) when the sun shines on it. Vitamin D is important for the health of your bones and other parts of your body.

An arm with a scrape.

You can injure your skin

It’s not too hard to injure your skin. So be careful when you’re doing anything that might injure it (like using sharp tools, working in the yard, or playing a sport). Cuts, bumps, and scrapes are a normal part of life. It wouldn’t be much fun if you tried to avoid them completely. But it’s smart to wear the right protective equipment, like gloves, long sleeves, knee and elbow pads, or helmets.

Be very careful when you’re around anything hot that can burn your skin. Burns, including sunburn, can be very painful and can take a long time to heal. Burns can also get infected easily. Sometimes, burns leave bad scars and permanently damage your skin. If you’re helping out in the kitchen, make sure you use hot pads or wear oven mitts to protect your hands when you’re grabbing something hot.

What to do when your skin is injured

If you do get a cut or scratch, clean it right away with soap and warm water and put on a bandage to protect it while it heals. This keeps dirt and germs from getting into the wound and causing an infection. If you come into contact with a plant like poison ivy, wash your skin and clothing right away. If you develop a rash, ask your pharmacist about over-the-counter medicines. For severe rashes, you might need to see your doctor.

What to do about insect bitesAn 8-legged bug.

Watch out for insect bites, too. Try not to scratch them, because they could get infected. Cover up your skin as much as possible when you will be in the woods, tall grass, or other areas where there may be ticks (small, 8-legged bugs). It helps to wear light-colored clothing, so you can see ticks before they have a chance to bite. Ticks can carry germs that will make you sick. If you find a tick attached to your skin, get a trusted adult to help you remove it.

Skin diseases

There are many diseases that can affect your skin. Some like vitiligo (vit-ill-EYE-go) cause the skin to lose its natural color, and some like alopecia areata (al-oh-PEE-shah ar-ee-AH-tah) can make the hair fall out. Another skin disease like epidermolysis bullosa (ep-ee-der-MOL-eh-sis bull-O-sa) can cause painful blisters. Psoriasis (suh-RYE-uh-sis) can cause itchy, scaly red patches. Go see your doctor if you think you might have a skin disease.

Acne

Most teenagers get a skin disease called acne (AK-nee). The blackheads and pimples can be embarrassing and make you feel bad about your appearance, but keep in mind that almost everyone gets them at some point. Acne isn’t usually serious, but severe cases can cause scars that will last for years.

There are many false ideas about what causes acne.

Acne is caused by bacteria (Propionibacterium acnes, often shortened to P. acnes and pronounced P. AK-nees), which live on everyone’s skin. Sometimes the follicles (FALL-lick-els) in the skin, where hair grows, become clogged with oil and dead skin cells, and the bacteria thrive. Then that spot on the skin may hurt, become swollen, red, and hot. Eventually the walls of the follicle break down and spill the oil, skin cells and bacteria into the nearby skin, and a pimple forms.

There are many false ideas about what causes acne. Chocolate and greasy foods are often blamed, but foods probably don’t have much effect on acne in most people. Another common myth is that dirty skin causes acne. But blackheads and other acne lesions are not caused by dirt. Stress doesn’t cause acne either, but for people who have acne, stress might make it worse.

If acne really bothers you, ask your parents about going to see a doctor. If your acne is not very bad, your family doctor may be able to give you medicines that will help to improve it. Or you might want to see a doctor who treats just the skin. These doctors are known as dermatologists (dur-muh-TOL-uh-jists). Dermatologists have a number of good treatments for acne.

For more information

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: https://www.niams.nih.gov

If you need more information about available resources in your language or another language, please visit our website or contact the NIAMS Information Clearinghouse at NIAMSinfo@mail.nih.gov.

NIH Publication No. 15–7580 (S)

Source: NIAMS, NIH

Acne: Overview

Questions and Answers about Acne

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.

What Is Acne?

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.

Illustrations

  • Normal Pilosebaceous Unit
  • Types of Lesions

How Does Acne Develop?

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.

Normal Pilosebaceous Unit

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.

Types of Lesions

 

Types of Lesions

Other troublesome acne lesions can develop, including the following:

  • Papules. Inflamed lesions that usually appear as small, pink bumps on the skin and can be tender to the touch.

  • Pustules (pimples). Papules topped by white or yellow pus-filled lesions that may be red at the base.

  • Nodules. Large, painful, solid lesions that are lodged deep within the skin.

  • Cysts. Deep, painful, pus-filled lesions that can cause scarring.

What Causes Acne?

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.

Factors That Can Make Acne Worse

Factors that can cause an acne flare include:

  • changing hormone levels in adolescent girls and adult women 2 to 7 days before their menstrual period starts

  • oil from skin products (moisturizers or cosmetics) or grease encountered in the work environment (for example, a kitchen with fry vats)

  • pressure from sports helmets or equipment, backpacks, tight collars, or tight sports uniforms

  • environmental irritants, such as pollution and high humidity

  • squeezing or picking at blemishes

  • hard scrubbing of the skin

  • stress.

Myths About the Causes of Acne

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.

Who Gets Acne?

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.

How Is Acne Treated?

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:

  • abnormal clumping of cells in the follicles

  • increased oil production

  • bacteria

  • inflammation.

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.

Treatment for Blackheads, Whiteheads, and Mild Inflammatory Acne

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:

  • Benzoyl peroxide. Kills P. acnes, and may also reduce oil production

  • Resorcinol. Can help break down blackheads and whiteheads

  • Salicylic acid. Helps break down blackheads and whiteheads. Also helps cut down the shedding of cells lining the hair follicles

  • Sulfur. Helps break down blackheads and whiteheads.

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.

Treatment for Moderate-to-Severe Inflammatory Acne

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

Prescription Topical Medicines

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

  • Antibiotics. Help stop or slow the growth of bacteria and reduce inflammation

  • Vitamin A derivatives (retinoids). Unplug existing comedones (plural of comedo), allowing other topical medicines, such as antibiotics, to enter the follicles. Some may also help decrease the formation of comedones. These drugs contain an altered form of vitamin A.

  • Others. May destroy P. acnes and reduce oil production or help stop or slow the growth of bacteria and reduce inflammation.

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.

Prescription Oral Medicines

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.

Treatment for Severe Nodular or Cystic Acne

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.

Advantages of Isotretinoin

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.

Disadvantages of Isotretinoin

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.

Treatments for Hormonally Influenced Acne in Women

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:

  • Birth control pills. To help suppress the androgen produced by the ovaries

  • Low-dose corticosteroid drugs, such as prednisone or dexamethasone. To help suppress the androgen produced by the adrenal glands

  • Antiandrogen drugs such as spironolactone. To reduce the excessive oil production.

Other Treatments for 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.

How Should People With Acne Care for Their Skin?

Clean Skin Gently

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 Frequent Handling of the Skin

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

Shave Carefully

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.

Avoid a Sunburn or Suntan

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.

Choose Cosmetics Carefully

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.

What Research Is Being Conducted on Acne?

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.

More information on research is available from the following websites:

  • NIH Clinical Research Trials and You was designed to help people learn more about clinical trials, why they matter, and how to participate. Visitors to the website will find information about the basics of participating in a clinical trial, first-hand stories from actual clinical trial volunteers, explanations from researchers, and links to how to search for a trial or enroll in a research-matching program.

  • ClinicalTrials.gov offers up-to-date information for locating federally and privately supported clinical trials for a wide range of diseases and conditions.

  • NIH RePORTER is an electronic tool that allows users to search a repository of both intramural and extramural NIH-funded research projects from the past 25 years and access publications (since 1985) and patents resulting from NIH funding.

  • PubMed is a free service of the U.S. National Library of Medicine that lets you search millions of journal citations and abstracts in the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, and preclinical sciences.

Where Can People Find More Information About Acne?

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

Source: NIAMS, NIH