What is acne?

Acne is a skin problem that shows up as blackheads, whiteheads, and pimples. It most often affects the face, neck, and upper body. Acne occurs when oil and dead skin cells clog the skin's pores.

Acne usually starts during the teen years and often lasts into adulthood. Gentle cleansing every day controls most mild acne. If home treatment does not work, your doctor may prescribe creams, antibiotics, or a stronger medicine called isotretinoin. Sometimes birth control pills help teenage girls who have monthly acne flare-ups.

You’re most likely to get acne as a teen or young adult. That’s when you produce more testosterone. That causes oil glands to make more oil. The extra oil mixes with dead skin and bacteria. This clogs pores and causes swelling, redness, and pimples. Acne usually gets better in the adult years.

Symptoms of acne include whiteheads, blackheads, and pimples and cystic lesions. These can occur on the face, neck, shoulders, back, or chest. Mild acne usually causes only whiteheads and blackheads. Severe acne can produce hundreds of pimples that cover large areas of skin.

Acne treatment depends on whether you have a mild, moderate, or severe type of acne. Sometimes a doctor will combine treatments to get the best results and to avoid developing drug-resistant bacteria. Treatment could include lotions or gels you put on blemishes or sometimes on entire areas of skin, such as the chest or back (topical medicines). You might also take medicines by mouth (oral medicines).

Most treatments for acne take time. It often takes 6 to 8 weeks for acne to improve after you start treatment. Some treatments may cause acne to get worse before it gets better.

Certain medicines, such as low-dose birth control pills or spironolactone, may help control acne for some women.

Mild acne

If you have just a few pimples to treat, you can get an acne cream without a prescription. Look for one that has adapalene, benzoyl peroxide, or salicylic acid. These work best when they're used just the way the label says.

Treatment for mild acne (whiteheads, blackheads, or pimples) may include:

• Gentle cleansing with warm water and a mild soap.
  • Avoid skin products that clog your pores. Look for products that say "noncomedogenic" on the label.
  • Try not to scrub or pick at your pimples. This can make them worse and can cause scars.
• Using a retinoid you put on your skin, such adapalene or tretinoin.
• Applying benzoyl peroxide alone or benzoyl peroxide with a topical antibiotic.
• Applying azelaic acid or salicylic acid.

If these treatments don't work, you may want to see your doctor. You may be given a prescription for stronger lotions or creams. You may try an antibiotic lotion. Or you may try a lotion with medicine that helps to unplug your pores.

Moderate-to-severe acne

Sometimes acne needs treatment with stronger medicines or a combination of therapies. Deeper blemishes, such as nodules and cysts, are more likely to leave scars. So your doctor may give you oral antibiotics sooner to start the healing process. This kind of acne may need a combination of several therapies. Treatment for moderate-to-severe acne may include:

• Applying benzoyl peroxide.
• Draining of large pimples and cysts by a doctor.
• Applying prescription antibiotic gels, creams, or lotions.
• Applying prescription retinoids.
• Applying azelaic acid.
• Taking prescription oral antibiotics.
• Taking prescription oral retinoids (such as isotretinoin).

Photodynamic therapy (PDT) and other light and laser-based therapies are being used to treat acne. These include the use of blue light, red light, intense pulsed light (IPL), and infrared or pulsed dye lasers. Sometimes these treatments are used along with medicines. But they may also help people who can't be treated with medicines.

Acne scars

There are many procedures to remove acne scars, such as laser resurfacing, chemical peels, and dermal fillers. Some scars shrink and fade with time. But if your scars bother you, talk to your doctor. You may be referred to a dermatologist or a plastic surgeon.

Isotretinoin (such as Amnesteem, Claravis, or Zenatane) is a powerful medicine that's usually prescribed for severe acne that can't be cleared up with other medicines. It's typically taken for 4 to 5 months. If acne returns after treatment, you may be able to take another round of medicine.

This medicine unclogs skin pores, shrinks oil glands, and decreases bacteria and inflammation. It can reduce the scarring caused by acne. It may also help if acne is causing distress. There's a link between acne and depression and other mental health concerns.

But isotretinoin can cause side effects. And it has serious risks, especially during pregnancy.

What are the serious risks during pregnancy?

Taking isotretinoin even for a short time during pregnancy can cause severe birth defects or miscarriage.

Before anyone can start treatment with isotretinoin, they have to enroll in a program called iPLEDGE. Your doctor can explain this program to you. Among other things, it may require you to:

• Use two forms of birth control before, during, and after your treatment.
• Take pregnancy tests before, during, and after treatment if you're able to get pregnant.
• Have monthly doctor visits while you're taking this medicine. These may be in-person or virtual care (telehealth) visits.

What are some possible side effects?

Other side effects include dry skin, nose, mouth, eyes, and lips. Some people also feel more tired than usual, sunburn more easily, have problems with night vision, or lose more hair than usual.

These side effects can usually be treated with over-the-counter products like moisturizers, sunscreen, and artificial tears. If you have dry eyes while taking this medicine, you may have to wear glasses instead of contact lenses.

This medicine may also cause headaches, muscle pain, or changes in your liver or blood. You'll have blood tests to see how it's affecting your liver and to check your cholesterol and triglyceride levels.

There may be a link between this medicine and depression or other serious mood problems. Your doctor will want to know if you have mood changes.

Some reports suggest that isotretinoin may increase the risk of inflammatory bowel disease. But experts don't have enough information to know if this is true.

How can you decide if you should take this medicine?

You may want to take isotretinoin if:

• You have acne that doesn't get better after several months of treatment with other medicines.
• You have acne that's causing scarring.
• Acne causes you to have anxiety, low self-esteem, or depression.

You may not want to take this medicine if:

• You can control your acne with other medicines or treatments.
• There is any chance that you could get pregnant.
• You want to avoid the side effects.

Your doctor can help you weigh the pros and cons of this medicine so you can decide what's right for you.

When you see a doctor about acne, you'll have a physical exam. Your doctor will ask you questions about your past and current health. Women may be asked questions about their menstrual cycles. Most often, you won't have any special tests to diagnose acne.

Medicines can help manage how severe acne outbreaks are and how often they occur. Medicines work in different ways to improve acne by:

• Unplugging skin pores and stopping them from getting plugged with oil.
• Killing bacteria.
• Reducing the amount of skin oil.
• Reducing the effects of hormones in producing acne (for some women).

Your treatment will depend on the type of acne you have. (Do you have pimples, whiteheads, blackheads, or cystic lesions?)

• Creams and lotions (topical medicines) may work best for acne that consists only of red bumps on the skin with no open sores. These often have fewer and less serious side effects than pills. But for severe acne, they may not work as well as pills.
• Oral antibiotics (pills) or isotretinoin may work better if you have open sores with bacteria or inflammation.

Often the best treatment is a combination of topical medicines and pills. Sometimes a product contains two topical medicines, such as clindamycin/benzoyl peroxide.

After acne is under control, you'll often need ongoing treatment to keep it from returning. Your doctor may suggest treatments other than antibiotics for long-term use. This avoids the risk of drug resistance.

Medicine choices

Medicines used to treat acne include:

• Benzoyl peroxide.
• Salicylic acid.
• Alpha hydroxy acid.
• Topical and oral antibiotics.
• Topical retinoid medicines.
• Azelaic acid.
• Isotretinoin.
• Low-dose birth control pills that contain estrogen.
• Spironolactone.

• Have your child gently wash their face 1 or 2 times a day with warm (not hot) water and a mild soap or cleanser and rinse well.
• Have your child use an over-the-counter lotion or gel that contains benzoyl peroxide. Start with a small amount of 2.5% benzoyl peroxide and increase the strength as needed. Benzoyl peroxide works well for acne, but your child may need to use it for up to 2 months before the acne starts to improve.
• Have your child apply acne cream, lotion, or gel to all the places your child gets pimples, blackheads, or whiteheads, not just where they are now. Follow the instructions carefully. If your child's skin gets too dry and scaly or red and sore, reduce the amount. For the best results, make sure your child applies the medicines as directed and does not miss doses.
• Do not let your child squeeze or pick pimples and blackheads. This can cause infection and scarring.
• Be sure your child uses only oil-free makeup, sunscreen, and other skin care products that will not clog pores.

The tendency to develop acne runs in families.

The risk of getting acne is highest during the teen and young adult years. These are the years when hormones such as testosterone are increasing. Many women have acne flare-ups in the days just before their menstrual periods.

Acne can be made worse if you:

• Use skin and hair care products that have irritating substances.
• Wash your face too often or too hard, or use harsh soaps or very hot water.
• Have a lot of stress.
• Touch your face a lot.
• Sweat a lot.

Acne, or acne vulgaris, is a skin problem that starts when oil and dead skin cells clog up your pores. Some people call it blackheads, blemishes, whiteheads, pimples, or zits. When you have just a few red spots, or pimples, you have a mild form of acne. Severe acne can mean hundreds of pimples that can cover the face, neck, chest, and back. Or it can be bigger, solid, red lumps that are painful (cysts).

Acne is very common among teens. It usually gets better after the teen years. Some women who never had acne growing up will have it as an adult, often right before their menstrual periods.

Acne starts when skin glands start making more oil. The oil and dead skin cells can clog the pores of the skin. This traps bacteria inside the pores causing swelling, redness, and pus.

For most people, acne starts during the teen years. This is because hormone changes make the skin oilier after puberty starts.

Acne can run in families. If one of your parents had severe acne, you are more likely to have it. Certain medicines, such as corticosteroids or lithium, can also cause acne to form.

Sometimes newborns have acne because their mothers pass hormones to them just before they are born. Acne can also appear when the stress of birth causes the baby's body to release hormones on its own. Young children and older adults also may get acne.

A few conditions, such as polycystic ovary syndrome and Cushing's syndrome, can lead to outbreaks of acne.