Acne is a disorder of the hair follicles and sebaceous glands. With acne, the sebaceous glands are clogged. This leads to pimples and cysts.
Acne is very common. Nearly 80% of individuals in the U.S. between 11 and 30 years old will be affected by this condition at some point. Acne most often begins in puberty. During puberty, the male sex hormones (androgens) increase in both boys and girls, causing the sebaceous glands to become more active. This results in increased production of sebum. While acne is most common during puberty it can happen at any age. About 20% of males over 25 and 40% of females over 25 suffer from acne.
The sebaceous glands make oil (sebum) which normally travels via hair follicles to the skin surface. However, skin cells can plug the follicles. This blocks the oil coming from the sebaceous glands. When follicles become plugged, skin bacteria (called Propionibacterium acnes, or P. acnes) begin to grow inside the follicles, causing inflammation. Acne progresses in the following manner:
- Incomplete blockage of the hair follicle results in blackheads (a semisolid, black plug).
- Complete blockage of the hair follicle results in whiteheads (a semisolid, white plug).
- Infection and irritation cause whiteheads to form.
Acne can be superficial papules or pustules. These are pimples without abscesses. Or deep nodules or cysts. This is when the inflamed pimples push down into the skin, causing pus-filled cysts that rupture and result in larger abscesses).
What causes acne?
Rising hormone levels during puberty may cause acne. In addition, acne is often inherited or genetic. Other causes of acne may include the following:
- Hormone level changes during the menstrual cycle in women, hormone changes during pregnancy or changes when women start or stop birth control.
- Certain drugs (like corticosteroids)
- Oil and grease from the scalp, mineral or cooking oil, oil, hair spray, and certain cosmetics may worsen acne
- Bacteria inside pimples
- Tight clothes that rub or cause irritation may cause acne on the body.
- Diet with sugar possibly related to acne development. May help to switch to low-sugar diets.
- Obesity has been associated with increased acne risk.
- If a close family member had acne, other family members are at increased risk.
What are the symptoms of acne?
Acne can happen anywhere on the body. However, acne most often appears in areas where there is a high concentration of sebaceous glands, including the following:
- Upper back
- Pus-filled lesions that may be painful
- Nodules (solid, raised bumps)
Treatment of acne
Specific treatment will be decided by your child's health care provider based on:
- Your child's age, overall health, and medical history
- Severity of the acne
- Your child's tolerance for specific medicines, procedures, or therapies
- Expectations for the course of the condition
- Your opinion or preference
Topical medicines to treat acneTopical medicines are often prescribed to treat acne. Topical medicine can be in the form of a cream, gel, lotion, or solution. Examples include:
Systemic antibiotics are often prescribed to treat moderate to severe acne, and may include the following:
Isotretinoin must not be taken by women who are pregnant or who are able to become pregnant. There is a very high likelihood of birth defects happening in babies whose mothers took the medicine during pregnancy. Isotretinoin can also cause miscarriage or premature birth. Because of these effects and to minimize fetal exposure, isotretinoin is approved for marketing only under a special restricted distribution program approved by the FDA. This program is called iPLEDGE.
The goal of the iPLEDGE program is to prevent pregnancies in females taking isotretinoin and to prevent pregnant females from taking isotretinoin. Requirements of the iPLEDGE program include:
- Isotretinoin must only be prescribed by prescribers who are registered and activated with the iPLEDGE program.
- Isotretinoin must only be dispensed by a pharmacy registered and activated with iPLEDGE.
- Isotretinoin must only be dispensed to patients who are registered with and meet all the requirements of iPLEDGE
- Female patients who can get pregnant are required to use 2 methods of birth control for 1 month prior to treatment, during treatment, and for 1 month after stopping treatment.
- Pregnancy tests are required before, during, and after treatment.