Acne is often something we relate to changing hormones during our teen years. While it is true that acne is most common between the ages of twelve and twenty-four, many are surprised to find out that adults can struggle with acne as well. Acne is a chronic condition characterized by spots and pimples on your face and body. These spots occur when your pores retain oil and dead skin cells resulting in clogged pores and inflammation. Whiteheads, blackheads, pimples, and cysts are all types of acne. If you struggle with consistent breakouts, you are not alone. Acne is the most common skin condition in the United States, affecting nearly fifty million people each year. Unlike some other skin conditions, acne is not dangerous. However, inappropriate treatment can lead to scarring. The best acne treatment depends on how severe your breakouts are, how persistent they are, and your risk factors for acne.
What Causes Acne?
While the cause of acne is simple, the reasons that some patients are prone to acne while others have clear skin rest on four main factors:
Four Causes of Acne
The number one reason people get acne is family history. While there is no specific “acne gene,” genetics does play a role in a few factors that can impact your chances of developing acne. These factors include immunity (how well you can fend off acne-causing bacteria), hormonal conditions, and family history. One study showed that those with a first-degree relative with adult acne were more likely to develop it themselves.
Ever wonder why teenagers are more likely to have acne? The answer is the increase in hormones during puberty. During puberty, hormones called androgens (present in both males and females) increase the size of the oil glands in the skin. Androgens are the male sex hormones that also include testosterone. As a result of this increased hormone production, the glands start producing more oil, which can clog the pores.
There is a link between emotional state and acne. Patients who are anxious or exposed to a lot of stress tend to experience more acne than usual. When you are under stress, wounds (including acne) are slower to heal. This means the pimples you may already have remain on your skin longer and are likely to be more severe. Increased stress could also mean acne appears more visible as it takes longer for each pimple to heal. While stress may not directly “cause” acne, it can exacerbate previous outbreaks.
Women are much more likely to develop acne due to hormonal changes related to their menstrual cycle. In fact, nearly sixty-five percent of women report worsening acne during their menstrual cycle. Just before your cycle, levels of progesterone and estrogen drop. This often triggers your sebaceous glands (the glands that produce oil) to produce more sebum to help keep your skin from becoming too dry, which can result in clogged pores and acne flare-ups. Hormone changes can also increase skin inflammation and the production of acne-causing bacteria. Many women are prescribed birth control pills to help regulate hormones and control acne.
The common myths about acne, such as an unhealthy diet and cleanliness, are not linked to acne outbreaks, but many indicate one (or more) of the above causes.
Acne is easily diagnosed by its appearance, and the severity can vary significantly. Acne falls into three main types:
Mild: Skin-Colored Comedones (Whiteheads and Blackheads)
Whiteheads and blackheads are considered non-inflammatory acne. Non-inflammatory blemishes generally do not cause swelling in the surrounding area and are not painful. Blackheads (open comedones) occur when the pore is clogged by oil and dead skin cells. The top of the pore remains open despite being clogged, resulting in the “black” color seen on the skin. Whiteheads (closed comedones) also form due to clogging; however, the top of the pore closes and appears as a small bump on the skin’s surface. Whiteheads can be more challenging to treat than blackheads as the pore is closed and resulting in difficulty removing oil and dirt.
Moderate: Inflamed, Red Papules
Pimples that are red and swollen are known as inflammatory acne. While oil and dead skin also play a role in this type of acne, bacteria also clog pores resulting in an infection below the skin’s surface. Papules occur when severe inflammation causes the walls surrounding your pores to break down. When this happens, your pores become red and hard and very sensitive to touch. Also, the skin around the pores appears pink due to inflammation. Moderate acne is generally what most people picture when they think of an acne “breakout.”
Severe: Deep Cystic Nodules. Potential To Scar
Nodules occur when already clogged, and swollen pores continue to grow. Unlike papules, nodules are deep under the skin, making them harder to see. Cysts develop when enlarged pores are clogged by dead skin cells, oils, and bacteria. The sacs are challenging to treat as they occur deep within the skin, even further below the surface than nodules. In fact, they are the largest form of acne and produce large, red bumps that are painful to the touch. These abnormal pockets of fluid are the most likely type of acne to result in scarring. In fact, cysts typically result from a severe infection within the pore requiring prescription medication to treat. While both men and women may have acne, women may have an additional hormonal component that can be controlled with oral contraception. This treatment alone or combined with spironolactone, which blocks the skin’s hormone receptors, is particularly effective in treating cystic acne in women.
During a consultation, Megan MacCarthy PA-C and Colleen VanEgeren PA-C, our dermatology specialists with a combined 34 years of experience, will determine the severity of your acne and match an appropriate treatment plan.