WHAT is ACNE
Acne is common and is usually treatable. You may need treatment for several months to clear spots. Inflamed acne needs to be treated early to prevent scarring. Once the spots are gone, you may need maintenance treatment for several years to keep the spots away.
What is acne and who gets it?
Acne is the common cause of spots. Most people with acne are aged between 12 and 25 but some older and younger people are affected. Boys are more commonly affected than girls. Acne usually affects the face but may also affect the back, neck and chest. The severity can range from mild to severe. About 8 in 10 teenagers develop some degree of acne. Often it is mild. However, it is estimated that about 3 in 10 teenagers have acne bad enough to need treatment to prevent scarring. Untreated acne usually lasts about 4-5 years before settling. However, it can last for many years in some cases.
What causes acne?
Understanding normal skin
Small sebaceous glands lie just under the skin surface. These glands make the oil (sebum) that keeps the skin supple and smooth. Tiny holes (pores) on the skin allow the sebum to come on to the skin surface. Hairs also grow through these pores. During the teenage years, you make much more sebum than when you were a child. This is due to the hormonal changes of puberty which stimulate the sebaceous glands. As a rule, the more sebum that you make, the more greasy your skin feels and the worse acne is likely to be. Some people make more sebum than others.
Mild-to-moderate acne - blackheads, whiteheads and small pimples
Some pores become blocked (plugged). This is due to the skin at the top of the pores becoming thicker, combined with dead skin cells that are shed into the pores. You can see the plugs that block the top of the pores as tiny spots known as blackheads and whiteheads (comedones). Note: the black of the blackheads is due to skin pigment and is not dirt as some people think. In many cases, acne does not progress beyond this mild stage.
Some sebum may collect under blocked pores. You can see this as small spots called pimples or papules. In some cases, acne does not progress beyond this mild-to-moderate stage when you can see a number of small pimples, blackheads and whiteheads.
Moderate-to-severe acne - larger spots and inflammation
Trapped sebum is ideal for a germ (bacterium) called Propionibacterium acnes to live and multiply. Small numbers of this bacterium normally live on the skin and do no harm. However, if a large number develop in the trapped sebum, the immune system may react and cause inflammation. If inflammation develops, it causes the surrounding skin to become red and the spots become larger and filled with pus (pustules). In some cases the pustules become even larger and form into small nodules and cysts.
Each inflamed spot will heal eventually. In some cases, the area of skin that was inflamed remains discoloured for several months after the inflammation has gone (post-inflammatory hyperpigmentation). This is often more noticeable in darker-skinned people. Also, a small pitted scar is commonly left on the skin where there was an inflamed spot. These small scars often do not fade fully and are a marker in older people that they once had inflamed acne spots.
Rare causes of acne
The description above is the cause of almost all cases of acne. Rarely, certain diseases in girls and women may cause acne or make acne worse. For example, polycystic ovary syndrome and conditions that cause excess male hormone to be made in the ovary or adrenal gland. These conditions cause other symptoms in addition to acne, such as thinning of scalp hair, excess growth of facial or body hair (hirsutism) and other problems. Another rare cause of acne is exposure to chemicals that occur in some workplaces (halogenated hydrocarbons).
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