Acne is a condition of the skin that shows up as different types
of bumps. These bumps can be blackheads, whiteheads, pimples,
and cysts. It usually shows up on the face, neck, shoulders, upper
back, and chest. The hair follicles, or pores, in your skin contain
sebaceous glands (also called oil glands). These glands make sebum,
which is oil that lubricates your hair and skin.
Hormones stimulate the sebaceous glands to make
more sebum, and the glands may become overactive. Pores become
clogged if there is too much sebum and too many dead skin cells.
Bacteria can then get trapped inside the pores and multiply, causing
swelling and redness - the start of acne.
People with acne frequently have a variety of lesions.
The basic acne lesion, called the comedo (KOM-e-do), is simply
an enlarged and plugged hair follicle. There are two main types:
1. If the plugged follicle, or comedo, stays beneath the skin,
it is called a closed comedo and produces a white bump called
2. A comedo that reaches the surface of the skin and opens up
is called a blackhead because it looks black on the skin's surface.
This black discoloration is not due to dirt. Both whiteheads and
blackheads may stay in the skin for a long time.
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 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.
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.
Hormonal acne is most often influenced by androgens
in the body. Androgens are hormones that stimulate the sebaceous
glands and hair follicles in the skin. When the sebaceous glands
are over-stimulated by androgens, for example around the time
of menstruation, women, both young and old, tend to have acne
flare-ups. Stress can also affect the levels of androgens, resulting
in further breakouts. These adult-onset acne flares occur most
often on the lower face, chin and jawline of adult women.
Most women with acne have normal serum levels of androgens. However,
some women with acne also have facial hirsutism, excess facial
hair, or male pattern alopecia, hair loss and/or thinning on the
scalp. Women with these symptoms may have increased androgen production,
and a hormonal work-up that includes an evaluation for adrenal,
ovarian or pituitary abnormalities may be indicated.
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 foods like french fries or pizza,
even chocolate, seem to have little 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. Finally, stress does not cause acne although
it can make existing acne worse because stress increases sebum
production. Acne isn't really helped by the sun. Although a suntan
can temporarily make acne look less severe, it won't help it go
away permanently. And too much sun isn't a good idea, anyway,
because it can cause wrinkles and skin cancer later in life. So
don't soak up those rays - either under the sun or from a tanning
bed - in an effort to help your skin.