Acne - Taming That Age: Old Adolescent Affliction

by Food and Drug Administration (FDA)

Pimples. Nearly everyone has suffered through them — some more than others. They are an almost universal affliction of adolescence. Even one or two "zits" can cause much posturing and worrying in front of a mirror. A handful may cause panic. And a face full can result in permanent scarring — both of the skin and the psyche.

Describing 17-year-old acne sufferer Pimples Carson in his book The Wayward Bus, John Steinbeck wrote that the boy's face was "rivuleted and rotted and eroded with acne," and medicines sold to treat it "do no good whatsoever."

While acne today looks the same as it did in the 1930s, Steinbeck's assessment of the usefulness of acne medicine no longer holds true.

Although acne can't be cured, it can be treated successfully in the vast majority of people. Some cases, especially the mild types, can be cleared up completely. Vigorous treatment of the more severe types of acne can help prevent facial scarring.

Technically called acne vulgaris, this skin disease affects millions of Americans annually. It can vary from quite mild to extremely severe. About 80 percent of all teenagers develop acne, but the disease may also start as late as age 25 or 30, particularly in women.

What Causes Acne?

No one knows for sure exactly what causes acne, or why it usually begins in adolescence. But a number of factors, most importantly heredity, play a role. If one of your parents had acne, there's a good chance you will, too. If both had it, "the gun is pointed directly at you," says FDA dermatologist Carnot Evans, M.D.

Acne develops when the sebaceous glands and the lining of the skin duct begin to work overtime, as they do in adolescence (see accompanying diagram). The glands produce more sebum, making the skin more oily. Normally the lining of the duct sheds cells that are carried to the surface of the skin by the sebum.

When the duct is blocked, cells and sebum accumulate, forming a plug (comedo). If the plug stays below the surface of the skin, it is called a "closed" comedo or whitehead. If the plug enlarges and pops out of the duct, it is called an "open" comedo or blackhead because the tip is dark. This is not dirt and will not wash away. The discoloration is due to a buildup of melanin, the dark pigment in the skin.

Pilosebaceous units are found all over the body, but there are more on the face, upper chest, and back, which explains why acne usually occurs in these places.

There are two main types of acne: non-inflammatory and inflammatory. In non-inflammatory acne, there are usually just a few whiteheads and blackheads on the face. A relatively mild type of acne, it can be treated effectively with nonprescription medicines or, in the case of blackheads, with the prescription drug Retin-A. The majority of people with acne have this type.

With inflammatory acne, the whiteheads become inflamed, and pimples and pustules develop. In its most severe form, inflammatory acne can cause disfiguring cysts and deep, pitting scars of the face, neck, back, chest, and groin. Prescription drugs and sometimes surgery are needed to treat inflammatory acne.

Advent of Adolescence

Acne almost always starts when the body begins to mature — at about age 11 for girls and 13 for boys. Acne tends to be more severe among boys because their bodies begin increased production of male hormones called androgens that, among other things, stimulate the activity of the sebaceous gland. Girls also produce these hormones, but only one-tenth as much. The exact role hormones play in the development of acne is not known. However, studies have found that many teenage girls and women with acne have higher than normal androgen levels. These findings suggest that acne in women may be associated with increased androgen production.

Additional Triggers

In addition to puberty, a number of other factors can cause, trigger or contribute to the development of acne.

Some drugs — including certain hormones, epilepsy drugs, and anti-tuberculosis medicines — can cause acne.

Exposure to industrial oils and grease and chemicals, such as PCBs, can cause acne.

The bacteria Corynebacterium acnes can indirectly contribute to the development of acne by causing skin fats to break down into irritating chemicals.

Stress and strong emotions, such as guilt, anxiety and fear, can trigger acne in people who have a predisposition to the disease.

The onset of the menstrual period each month can trigger or worsen acne. Some 60 to 70 percent of women notice that acne gets worse the week before menstruation.

Birth control pills appear to have an effect on acne in some women. Perplexingly, they cause acne in some cases and clear it up in others.

Some oily cosmetics and shampoos can, on rare occasion, trigger acne in people who have a predisposition to it.

Dispelling the Myths

Contrary to earlier belief, there is no scientific evidence that foods such as chocolate, nuts, cola drinks, potato chips, french fries, and other fatty "junk food" cause acne or make it worse. Nonetheless, some people do notice that certain things they eat or drink do seem to trigger their acne, says FDA's Evans.

Oily skin and hair do not cause acne either. Although there is an association between the severity of acne and the amount of oil produced by the skin, not all people with oily skin have acne — and some people with dry skin do.

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.