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WHAT IS IT?
Most of us get a few blackheads or pimples now and then. These small bumps or blemishes on the skin are quite normal. They soon go away and are nothing to worry about. The skin problem called acne can be more troubling, though. It’s a long-lasting, sometimes severe flareup of pimples, most often on the face, chest, and back.Acne erupts when a hair follicle-the tube in which a hair grows-becomes plugged with dead skin cells and a natural oil called sebum that helps moisten and protect the skin. The follicle swells and the skin around it may become red and tender. It may also become infected with bacteria.

Acne is the most common skin problem in the United States. Anyone of any age can get it, even infants, but it’s most common in teenagers. Up to 85 percent of all teens have acne. About one adult in five gets acne now and then.

Many people believe that greasy foods or chocolates cause acne, but in fact they’re not the problem. If you have acne, you can put most of the blame on your hormones: They affect how much sebum your skin’s oil glands make. Acne tends to peak during the teen years because that’s when hormones, and oil glands, are most active.

Acne is most often harmless, though it can be annoying, and some people who have acne may feel shy or self-conscious around others. Minor bouts clear up by themselves after a week or two. Sometimes, though, severe acne leaves scars. There is no sure way to prevent acne, but you can do a lot to treat it and keep it from getting worse.
WHAT IS HAPPENING?
Your body is covered with thousands of hairs, most of them too small to see. Each hair grows up to the skin’s surface through a follicle. Each follicle has a tiny oil gland that makes sebum. Normally, sebum flows easily out of the follicles.

When a gland makes too much sebum for it all to escape, though, acne may begin. The follicle plugs up with extra sebum and dead skin cells trapped in the oil. Doctors call this plug a comedo. Something you put on your skin, such as oily makeup, can also block a follicle. In either case, when the follicle is blocked, the sebum can’t get out.

When a plug protrudes from a follicle and isn’t covered by the top layer of skin, it makes an “open comedo” or blackhead, a small spot with a dark center. The darkness of a blackhead isn’t from dirt; the oil in the plug turns dark when it’s exposed to air. When skin covers the plug so air doesn’t reach it, you may have a “closed comedo” or whitehead.

Sometimes, bacteria that always live on the skin get trapped in a blocked follicle. They may inflame it and make it fill with pus; then it swells into a pimple that can be white or red. Bacteria feed on sebum. When your body keeps making a lot of it, the follicle may even burst. The result is a painful, pus-filled cyst deep in the skin. Sometimes, if a germ such as staphylococcus infects the follicle, a large, raised boil forms in the skin.
WHAT CAUSES IT?
No one can say exactly why one person gets acne and another doesn’t, but we do know that some things increase your risk. You can’t do anything about some factors, such as your age or your gender, but there are many others you can do plenty about.

THINGS YOU CAN’T CHANGE

Age
Acne tends to peak during the teenage years. That’s because levels of many sex hormones increase quickly during puberty. These hormones make the glands in the skin produce more oil. Acne most often clears up as a person gets older.

Gender
Young men are more likely than young women to have severe acne. That’s because it’s prompted by androgens-hormones such as testosterone-which occur more in males than females.

As older adults, though, women are more likely than men to get acne. Doctors think the reason is that they have wider swings in their levels of hormones. Many women tend to get acne around menstruation, for instance: After a woman ovulates-releases an egg-her body makes more of a hormone called progesterone, which makes the skin produce more oil. Some women also get acne after childbirth because of changing hormone levels.

Oily skin
Some people have more oil in their skin than others. The extra oil makes them more likely to have acne.

Family
Teens and adults whose parents had bad acne are more likely to get acne than others whose parents didn’t. The experts are not sure why.

Occupation
People who work as short-order cooks or mechanics are more likely than others to have acne. That’s because the oil and grease they work around can block their pores. Another trigger is chlorine. People who work with products that contain chlorine-for instance, pesticides, paints, varnishes, and roofing supplies-can get a type of acne called chloracne.

Climate
Some people tend to get what’s known as tropical acne when the weather turns hot and humid. Travelers who aren’t used to humid weather may also get it-especially if they have oily skin or sweat a lot. Tropical acne most often clears up when the weather cools.

THINGS YOU CAN CHANGE

Washing
If you don’t keep your skin clean, you’re more likely to get acne. Soap and water won’t prevent acne, but they will keep it from getting worse.

Skin creams and makeup
Some skin creams, oils, and makeup can block the oil glands and cause acne. Watch out for products that contain cocoa butter or coconut oil.

Clothing
Tight clothing can increase your chance of acne on the part of the body it covers, by keeping your skin from shedding oil and castoff cells.

Stress
Some people get acne when they’re under lots of stress-the result of a demanding situation at home or on the job. Stress triggers the body to release a number of “fight or flight” chemicals that provide quick energy. These chemicals also seem to spur the skin’s oil glands to make more sebum.

Medications
Certain medicines can cause acne. These include birth control pills, drugs called corticosteroids that are used to treat arthritis and asthma, and some medications to prevent seizures. Like stress, they seem to prompt the oil glands to make more sebum.
WHAT YOU CAN DO FOR YOURSELF
You can’t prevent acne, but when you do have a flareup, you can do plenty to keep it under control.

Help your follicles stay open
Keep your skin clean and fairly dry by washing your face twice a day with a mild soap that contains no oil or scent. Soap doesn’t get past the surface of the skin to the follicles where acne starts, so strong, medicated soap won’t help. Don’t scrub or overwash-you could make your acne worse. If you have very oily skin, try an astringent (a drying agent).
Shampoo your hair every day. Oily hair can make acne worse.
After you exercise, wipe off sweat with a moist towel or take a shower. If it’s hot and humid and you tend to get tropical acne, do the same throughout the day.
Choose your sunscreen with care. If you have oily skin or sweat a lot, sunscreens with coconut oil or cocoa butter may make acne worse because they plug oil glands. Read the labels and look for a sunscreen that’s “non-comedogenic.” This means it shouldn’t clog your skin.
Use only water-based, oil-free makeup. Wash it off with a mild soap or makeup cleanser before you go to bed.
Try taking a long, warm bath now and then to help open your follicles.
Control bacteria
Don’t pop or squeeze pimples. When you do, you raise your risk of infection and scarring.
Don’t rest your face in your hands while reading, working, or watching TV.
Don’t cradle the phone between your shoulder and cheek. Clean the handset often with rubbing alcohol-or invest in a headset if you spend long hours on the phone.
During a bout of acne, don’t shave, or try to shave less often. Take care not to nick pimples. Rinse your blade well after each use.
Try over-the-counter medications
There are many over-the-counter (OTC) products to help fight acne. Most are sold in the cosmetics section of your drugstore as lotions, creams, gels, or cleansers. Be sure to read the label of any you plan to use so you know what’s in it and what it’s supposed to do. Look for those that contain benzoyl peroxide, alpha hydroxy acid, or salicylic acid. Some work by fighting bacteria that can infect follicles, others peel away outer layers of skin, and others may keep your oil glands from making too much sebum.

These products come in varying strengths, including stronger versions your doctor can prescribe. Test some first to see which one works best on your skin type. When trying one for the first time, try a weaker version first. If that doesn’t work, try a stronger product.
WHAT YOUR DOCTOR CAN DO FOR YOU
If your acne doesn’t go away by itself after two to three months of over-the-counter and home treatment, your doctor may prescribe stronger drugs. These include:

Antibiotics
Antibiotics that you take in pills-such as tetracycline, erythromycin, and minocycline-help prevent new pimples by killing bacteria trapped in hair follicles. Trade names include Emgel, Monodox, Sumycin, and Vibramycin. The most common oral antibiotic for acne is tetracycline.

Side effects of any antibiotic can include diarrhea, upset stomach, and yeast infections. (Antibiotics kill all sorts of bacteria, including those that control the growth of things such as yeast that live in every body.) You’ll also need to be careful in the sun if you’re taking one of these drugs, since they can make your skin burn more easily. Antibiotic gels such as Clindomycin (trade name: Cleocin T) have fewer side effects than oral antibiotics.

Your doctor may prescribe an oral antibiotic as well as benzoyl peroxide that you apply to your skin. Research suggests the combination works better than either drug alone.

Retinoic acid
Retinoic acid, also called tretinoin (trade name: Retin-A), is made from vitamin A. It’s a prescription drug sold as a cream or gel. It goes directly on the skin. It’s best known as a treatment for wrinkles, but it also works for acne. Retin-A can take up to 12 weeks to improve acne.

Pro
Helps keep plugs from forming in follicles by preventing dead skin cells from clumping together.
Works best against blackheads and whiteheads.
Con
May cause redness and peeling, and your acne may seem worse at first.
Greatly raises your risk of getting a bad sunburn, so if you use it, stay out of the sun or use a strong sunscreen.
Isotretinoin
Isotretinoin (trade name: Accutane) is also derived from vitamin A, but you swallow it in capsules. Doctors think Accutane works by shrinking oil glands so they make less oil. It’s often used for severe acne after other treatments have failed to help. You should not take it with other acne drugs or vitamin A pills. You take Accutane for four to five months.

Pro
Keeps working for months-even years-after treatment stops.
Con
Costly.
Has some serious side effects. These include higher cholesterol levels-which raise your risk of heart disease-liver problems, dry mouth, chapped lips, fatigue, headache, and muscle aches. Accutane causes birth defects, so it should never be used if you are pregnant, or if there is a chance you’ll become pregnant while taking it or within a month after you stop.
Azelex
Azelex or azelaic acid (an acid found in wheat). This prescription cream kills bacteria and keeps pores from clogging. It has been approved for acne treatment in the United States, after many years of use in Europe. Azelex works best on mild acne, but may be used along with antibiotics to treat severe cases. You put it on your face, back, and chest twice a day; your acne should improve within four weeks.

Pro
Studies show that it may have fewer side effects than Retin-A.
Con
It may burn or sting your skin. It can also cause skin to peel, or to be become dry, itchy, and red.
Hormone therapy
If you’re a woman and your acne seems to come from changing hormone levels-for instance, if it’s worse around your period-your doctor may advise hormone treatments to reduce your level of male hormones. These include the doses of estrogen and progestin found in regular birth control pills. One pill often prescribed for acne is Ortho Tri-Cyclen.

Pro
Control of hormone levels may take care of the basic cause of acne.
Con
You may not know for six months or more if the treatments are working.
Side effects of birth control pills may include headaches, tender or swollen breasts, and mood changes, including depression. Women who take the Pill have a slightly higher risk of breast and cervical cancers than women who don’t. Women who take the Pill and also smoke have a much higher risk than other women of heart attack and stroke.
Scar removal
If you have scars from acne, your doctor can do a lot to reduce or get rid of them:

Skin peels: Removing the top layer of damaged skin with a rotating wire brush or stainless steel wheels is called dermabrasion. It works by replacing the old scars with new ones that are less visible. This technique can improve your skin’s texture, but it may remove some pigment, leaving splotches. Another method burns a thin layer of skin with chemicals. The burned skin then peels away. Chemical peels are most often used to treat skin that’s badly wrinkled or sun-damaged. Peels can also help smooth out acne scars.
Injections: Your doctor can fill acne scars with injections of collagen, a natural fibrous protein. Collagen injections don’t last, so they may need to be redone as often as every six months. Also, some people are allergic to the protein. To find out if you are, your doctor can give you a skin test before starting the treatment.
Cryosurgery: This technique freezes and then removes puffy acne scars known as keloids.