Acne is the result of overactive oil glands at the base of hair follicles, which are a cause of hormonal changes during adolescence. Oily skin can be hereditary, which increases the sensitivity of the skin to hormonal changes. Skin cells can "plug" skin pores causing "whiteheads" and, with pigment, "Blackheads". A "pimple" is an oil gland that is infected with bacteria, resulting in an inflamed area with pus formation.

Alternative Names of Acne are: Pimples

Complications of Acne

Acne scarring: Acne scarring can sometimes develop as a complication of acne when the most serious types of spots - nodules and cysts - rupture (burst) damaging nearby skin. Scarring can also occur if you pick or squeeze your spots, so it is important to avoid doing this.

There are three main types of acne scars:

• Ice-pick scars: small, deep holes in the surface of your skin that look like the skin has been punctured with a sharp object.
• Rolling scars: caused by bands of scar tissue that form under the skin giving the surface of the skin a rolling and uneven appearance.
• Boxcar scars: round or oval depressions, or craters, in the skin.

Causes of Acne

To better understand the causes of acne, it is useful to learn more about the sebaceous glands, which play a key role in the condition's development.

The triggers of acne

Teenagers

Cases of teenage acne are thought to be triggered by increased levels of a hormone called testosterone that occurs during puberty. The hormone plays an important role in stimulating the growth and the development of the penis and testicles in boys, and maintaining muscle and bone strength in girls. The sebaceous glands are particularly sensitive to hormones, so it is thought that the increased testosterone causes the glands to produce much more sebum than the skin actually needs.

Adults

In cases of adult acne, over 80% of cases occur in women. It is thought that many cases of adult acne are a result of the changes in hormone levels that many women will experience at certain points during their life. Possible triggers for adult acne include:

• Periods: some women experience a flare-up of acne just before their period is due.
• Pregnancy: many women experience symptoms of acne during pregnancy; usually during the first trimester (first three months).
• Polycystic ovary syndrome: this poorly understood, but common condition can cause acne, weight gain and the formation of small cysts inside the ovary.
• Side effects of medication: in some people, certain types of medication can cause acne, e.g. steroid medication and lithium (which is often used to treat depression and bipolar disorder).

Signs & Symptoms of Acne

If you are suffering from acne, you probably do not need me to tell you about the symptoms, but for those who are reading this for other reasons, here is a summary of the physical symptoms:

• Blackheads (open comedo) and Whiteheads (below the skin surface)
• Nodules - large and firm lumps below the skin
• Pustules - yellowish lumps on the skin surface, pus filled
• Pimples - red spots with no pus - a symptom of non-inflammatory acne
• Cysts - a sac, pus filled under the skin tissue of about 5mm in diameter - very painful
• Dry, pink and itchy skin
• Scarring

Diagnosis of Acne
Acne is classified as mild, moderate or severe. The severities are described below:

• Mild acne: where you mostly have blackheads and whiteheads that are usually confined to your face.
• Moderate acne: where you have a combination of whiteheads, blackheads, papules and pustules that may extend to your shoulders and back.
• Severe acne: as well as the papules and pustules, you also have nodules and cysts and the spread of the acne may be extensive.

Treatments of Acne

Your recommended treatment plan will depend on whether your acne is mild, moderate or severe.

Mild acne is treated using gels or creams (topical treatments) such as:

• benzoyl peroxide,
• topical retinoids,
  topical antibiotics, or
• azelaic acid.

Moderate acne is usually treated using a combination of the medications that are mentioned above. In some cases, antibiotic tablets (oral antibiotics) may also be used. If you have severe acne, you will usually be referred to a dermatologist (an expert in treating skin conditions).

Prevention of Acne

Acne is not infectious and it is not caused by poor hygiene. However, a build-up of sebum (an oily substance that stops hair and skin drying out) and dead cells on the skin surface may increase the risk of blocked follicles and allow bacteria to multiply. You can help prevent this by washing your face with a gentle cleansing product. If you are wearing any make-up, make sure you wash it off before you go to bed. There is no evidence that wearing make-up causes spots but the less you touch your skin, the fewer bacteria will be spread on your skin. To prevent the spread of bacteria, wash your hands before touching your face (for example to apply make-up). A good balanced diet is, however, important in keeping you healthy.

When to seek Medical Advice

Although acne is rarely a serious medical condition, when outbreaks are severe it can cause emotional distress especially when the acne problem extends into young adulthood. If not treated properly, permanent scarring of the skin may result. This is the time when professional medical advice is needed and prudent.