ACNE
What is Acne?
Acne (aka acne vulgaris) is the most common skin concern in the U.S., according to the American Academy of Dermatology. It usually makes its debut in adolescence (an estimated 90% of teens suffer from acne to some degree), but acne can stubbornly stick around beyond the teenage years. Much to their chagrin, some women experience it for the first time as adults, often during pregnancy or menopause, when hormones called androgen’s boost sebum production. Men likewise as adults suffer with back breakouts or at beard areas.
Noninflammatory acne, which develops when a pore (aka a follicle) gets clogged with oil (sebum) and dead skin cells, is also known as comedonal acne. It includes:
- Blackheads: clogged pores that remain open, so the trapped oil is oxidized by air and appears black; blackheads aren’t caused by dirt, so don’t try to scrub them away—that can irritate your skin
- Whiteheads: clogged, closed pores that (left untreated) can become inflammatory acne
- Inflammatory acne develops when the bacteria that normally live on top of your skin get trapped in the pore as well and the area becomes infected, red, and swollen. Varieties of inflammatory acne include
- Papules: small, tender bumps that occur when oil, bacteria, and dead cells push deeper into the skin, causing inflammation
- Pustules: pus-filled papules, often with a yellow center
- Cysts: deep, painful, pus-filled lumps (they look similar to boils), embedded beneath the surface of the skin; cystic acne is the most severe type
- Nodules: large, solid, painful lumps that form beneath the skin’s surface
The areas with the largest, most active oil glands—the forehead, nose, and chin, commonly called the T-zone—are most likely to develop acne. But it can also develop on the neck, back, shoulders, and chest. Butt acne isn’t really acne—it’s an irritation of the hair follicles known as folliculitis.
WHAT CAUSES ACNE?
There are three main contributing factors to acne:
Clogged Pores
When a pore becomes blocked, blackheads and whiteheads form. To unplug pores and keep them from clogging again, doctors often prescribe topical medications called retinoids, or oral medication such as isotretinoin. “They’re excellent at clearing the comedones,” says Dr. Cynthia Abbott, a dermatologic surgeon in Atlanta.
Excess Oil
Sebum is a natural skin moisturizer, but the sebaceous glands can pump out too much oil. When dead skin cells clump and start to form a plug, excess oil builds up behind it.
Bacteria
The bacteria in acne normally live in the skin’s oil glands. But as the bacteria feed on excess oil, they multiply and inflame the pore. Eventually, the pore may rupture—which leads to pustules, papules, nodules, and cysts. Inflammatory acne needs medication, often topical or oral antibiotics, to calm the inflammation and clear the bacteria.
Hormones play a major role in acne. Starting around puberty, hormone levels are fluctuating, and the body is responding in many ways, including acne such as androgen’s stimulate the production of oil and cause dead skin cells to become “sticky” and be more likely to block pores.
In women, cyclical hormone fluctuations around the time of their menstrual cycles can lead to monthly acne flares, particularly painful red bumps along the jawline.
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