Acne
From Breakouts To Clear Skin
Acne is a prevalent skin condition characterized by outbreaks of bumps known as pimples or zits, typically appearing on the face, neck, back, chest, and shoulders.
Emotional distress and other psychological factors may play a role in triggering acne outbreaks or exacerbating existing skin conditions. Severe cases can lead to permanent scarring.
Who Gets Acne?
Acne can affect anyone regardless of age. In teenagers, acne is prevalent due to increased hormone levels (androgens), especially during puberty which stimulates active sebaceous glands more frequently. It is also common among adults, particularly women. Genetic predisposition can increase the likelihood of acne, particularly if parents also experience it.
Types of Acne
Mild Acne
Mild acne is acne with minimal or no inflammation of the skin, plus no signs of acne scars.
Mild acne involves superficial blackheads and whiteheads without inflammation or scarring. It is often managed at home with daily washing and over-the-counter treatments like benzoyl peroxide or salicylic acid. Improvement usually takes 6-8 weeks. If these methods don't work, stronger prescription treatments, such as topical antibiotics or retinoids, may be needed. Oral medications are not typically recommended initially. Consulting a doctor is important to choose the right treatment and allow time for it to be effective. Consistency with treatment is key for managing and preventing new acne.
Moderate Acne
Moderate acne consists of a denser collection of comedones, and red, inflamed, pus-filled lesions (pustules).
Moderate to moderately-severe acne features a higher density of whiteheads and blackheads, along with red, inflamed areas and pus-filled pustules. This condition is often caused by Propionibacterium acnes (P. acnes) bacteria infecting clogged pores, leading to inflammation. Effective treatment typically involves prescription medications or procedures. It's crucial to start treatment early to prevent permanent scarring and to be patient, as medications may take 6 to 8 weeks to show results while preventing new lesions.
Severe Acne
Severe acne is deep, widespread, red, inflamed acne lesions that are painful and likely to scar if left untreated.
Severe acne can be controlled with prescription acne medications and/or specific procedures.
Propionibacterium acnes (P. acnes), a bacteria which normally live on the skin's surface, can infect sebum within clogged pores, leading to inflammation in moderate to severe acne. In severe cases, the infected pores (sebaceous glands) can burst, releasing sebum, bacteria, and irritating substances into deeper skin layers. This causes increased inflammation and the formation of these painful nodules or cysts.
There are different types of severe acne.
Types of severe acne
(with overlapping qualities)
- Nodulocystic acne (cystic acne) - Large, deep, painful lesions filled with thick, yellow pus. Can occur alone or in clusters, potentially merging & causing extensive inflammation and skin damage.
- Gram-negative folliculitis - Caused by gram-negative bacteria infecting hair follicles. Seen in individuals who have undergone prolonged antibiotic treatment.
- Acne conglobata - Deep abscesses, severe inflammation, & widespread blackheads. Commonly affects the neck, shoulders, chest, back, & buttocks, leading to pus-filled lesions and thick scarring. (Most prevalent in males aged 18-30).
- Acne fulminans - Rapid onset of highly destructive acne. May be accompanied by fever & aching joints.
Severe acne requires aggressive treatment and often requires multiple sessions over time (due to likelihood of recurrence).
Truncal Acne (Chest + Back)
Truncal acne is when outbreaks occur on the back,
neck, chest, and arms—"Acne of the body".
Truncal acne is caused by the same that leads to acne on the face. Because the back, chest, arms, and buttocks are covered with sebaceous glands (which secrete sebum to protect and moisturize the skin), these areas are as susceptible to acne as the face is. This is especially true during puberty, when sebaceous glands produce more sebum due to the hormonal changes of adolescence.
Triggers can be different from facial acne. For example, clothing that covers the body is more likely to trap sweat, oils, and other substances that can clog pores, creating an ideal condition for breakouts, especially after exercise or working in a warm environment, such as a kitchen.
The treatment of this type of acne is also different. The thicker skin of the body makes truncal acne slower to respond to treatments.
(Over 1/2 of patients we see for facial acne issues, also have acne in other places on the body.)
It's important to know that if left untreated, this type of acne may result in scars called follicular macular atrophy.
Talk to your doctor about what is best for you to do at home to prevent future truncal acne outbreaks, as every person's aftercare different and unique.
Teenage Acne
Acne afflicts nearly every teenager at some point during their adolescence.
Acne is most common in teenagers and is a normal part of adolescence no matter your gender, race, or ethnicity. During puberty, elevated hormone levels stimulate higher sebum production than usual, increasing the chance of acne flares.
In adolescence, boys are more prone to acne due to increased sebum production. However, in adulthood, women often experience more acne because of hormonal changes associated with menstruation, pregnancy, and menopause.
Individuals with a family history of acne are at a higher risk of developing it in general.
Sports & acne mechanica
Acne mechanica is a type of acne triggered by consistent physical factors like heat, sweat, friction, pressure, or irritation on the skin.
Teens who play sports, wear backpacks, or play a musical instrument in contact with their face or neck regularly may acquire this form of acne.
Common triggers
- Helmets & helmet straps especially those worn by football & hockey players, & motorcycle riders
- Shoulder pads & straps worn by football players
- Tight hats or headbands worn for long periods of time
- Tight fitted clothing, particularly jeans, underwear (bras), or uniforms made from synthetic fabric
- Musical instruments, such as the violin, tucked against the neck for long periods of time
- Backpack straps
Adult Acne
Adult acne is acne appearing after the age of 25 can occur in people well into their 30s, 40s, or beyond.
Adult acne is a common experience. There are two types of adult acne:
- Persistent Acne - Acne that continues into adulthood or recurs frequently after adolescence. This type of acne is characterized by long-lasting or recurring breakouts in adults, often involving areas like the face, back, and shoulders. It can be influenced by factors such as hormonal imbalances, stress, and certain medications or skincare products.
- Late-onset Acne - Acne that first appears in adults, typically after age 25. Unlike teenage acne (which begins during adolescence), this type can start in a person’s 30s, 40s, or even later. Triggers can be hormonal changes, stress, medication, or underlying health conditions. It may present similarly to adolescent acne, with breakouts on the face, back, or shoulders, and may sometimes be more persistent or challenging to treat.
Causes of acne in adults
- Hormonal activity
- Medications you're taking
- Family history
- Cosmetics using
- Another health issue
Treatment options are based upon
- Type of acne (comedonal, inflammatory)
- Location of acne on your body
- Your skin type (dry, oily, combination)
- Severity (mild, moderate, severe)
- Your gender* (some treatments optimal for one gender and not another)
- Responses to past treatments
*Some oral medications are prescribed to control underlying hormonal triggers of acne among women.
