What causes acne?
Most people who get acne start having it in their early teens. This is when the oil glands in the body start making more sebum (oil). Some people also have too many "sticky" skin cells. In people with acne, these cells mix with the oil and plug up the hair follicles in the skin.
These plugs trap bacteria (germs) in the follicles, which can cause the follicles to swell. Tender red bumps are the result. In acne, what start as small red bumps can turn into pimples and even cysts.
Things that can make acne worse
- Oil-based makeup, suntan oil, hair gels and sprays, and oils from machinerys or cooking
- Stress and strong feelings like guilt, fear, and being nervous
- Periods in women
- Squeezing or picking at pimples
- Scrubbing the skin hard
Things that don't cause acne
- The role diet plays in causing acne is still controversial although a few studies have shown benefits of omega-3 fatty acids and bad effects of high sugar containing foods
Who gets acne?
Anyone can get acne. But it may be worse in young men because they have more skin oils. Other things also affect how bad your acne gets.
Heredity (your genes) plays a role. If your mother and father had bad acne, you may too. Your immune system also plays a role. Some people are more likely to get the bacteria trapped in the hair follicles. This can cause very bad acne. Foods don't seem to be related to acne, but if you feel that some foods make your acne worse, you may want to avoid those foods.
What kinds of changes are there?
A whitehead results when the follicle is plugged with sebum and skin cells. If this plug reaches the surface of the skin and the air touches it, it turns black and is called a blackhead. A blackhead is not caused by dirt. If the wall of the plugged follicle breaks, the area swells and turns into a red bump. If the follicle wall breaks near the skin surface, the bump usually becomes a pimple. If the wall breaks deeper under the skin, acne nodules or cysts can form. This is called cystic acne. It is the type most likely to lead to scars.
How can acne be treated?
Acne can be treated in different ways. The main thing to remember is that it will take about two months of any treatment before your skin starts to look better.
Benzoyl peroxide (in different strengths) clears up acne for many people. You can get benzoyl peroxide without a prescription. It comes in a cream, lotion, gel, soap or in pads. You spread it over the whole area where you have acne (not just dabbing it onto each blemish). Your doctor may tell you to use it once a day at first and then work you up to two times a day. If you start using benzoyl peroxide, begin with a lower strength. Use it once a day at bedtime. Before using it, gently wash the skin with soap and water. If benzoyl peroxide doesn't seem to help after two months or is very irritating to your skin, get advice from your doctor. Benzoyl peroxides can bleach your clothes, so be careful.
Antibiotics can be very good for acne. They can be taken by mouth, or used in a lotion, cream, or gel on the skin. Again, be sure to apply the lotion, cream or gel over the whole area where you have acne. Often doctors start with these but if they don't work, you may have to take the antibiotic as a pill over months.
Tretinoin (some examples are Retin-A, Stieva-A) can be a very good treatment for acne. It is often rubbed onto the skin once a day. Be sure not to get it near the eyes, mouth and area under the nose. It may seem at first that tretinoin is making your acne worse. Give it several weeks to start working. If you use tretinoin, you must avoid the sun or use a strong sunscreen. Tretinoin increases your risk of getting a very bad sunburn. Some come with sunscreen added to them. Pills are used to treat severe acne. Many creams/gels contain a combination of acne treatments such as vitamin A and an antibiotic.
Isotretinoin (Accutane) may be needed to treat severe acne. It is best in treating cystic acne and to prevent scars. It is taken once a day by mouth for 15 to 20 weeks. Isotretinoin can cause serious side effects. It causes serious birth defects and miscarriages. It should never be taken during pregnancy or even one month before pregnancy. All women must use birth control while you take isotretinoin, as well as one month before and one month after you start taking it.
Talk to your doctor and follow directions carefully if he or she prescribes isotretinoin for you.
Will I have scars?
You can help reduce scarring by not squeezing or picking at blemishes. Also avoid scrubbing your skin hard. Gentle washing is better.
What can be done about the scars?
Scars can be treated. Treatment is often delayed until after your acne is under control. A number of treatments exist. Talk to your family doctor about the options.
This health education material was developed and adapted by The College of Family Physicians of Canada from online materials developed by The American Academy of Family Physicians, with permission. It is regularly reviewed and updated by family physician members of the CFPC Patient Education Committee, who refer to the current evidence-based medical literature. Support for this program has been provided by a grant to the CFPC Research and Education Foundation by Scotiabank.
These pages may be reproduced for not-for-profit educational purposes only.
Child & Adolescent Health Care
, Patient Education