- Acne is the most common skin condition in the United States, affecting approximately 40 to 50 million Americans annually.1
- See your dermatologist for successful diagnosis and treatment of acne.
- Use medications and products prescribed for your acne as directed and allow enough time for them to take effect, which may be 4 to 8 weeks.
- Acne, a chronic inflammatory skin condition, is characterized by comedones (blackheads and whiteheads), pimples, and deeper lumps (cysts or nodules) that occur on the face, neck, chest, back, shoulders, and upper arms.
- Acne usually begins in puberty and affects many adolescents and young adults, but can occur at any stage of life.
- Approximately 85% of people between the ages of 12 and 24 experience at least minor acne.2
- Acne often causes significant physical and psychological problems such as permanent scarring, poor self-image, depression, and anxiety.3
- Costs associated with the treatment of acne exceed $3 billion.2
CAUSES OF ACNE
Acne is caused by many factors affecting the skin. Generally, overactive sebaceous oil glands can produce too much oil and combine with skin cells to plug pores. When the pores in the skin become plugged, the bacterium P. acnes (present on everyone’s skin) multiplies and leads to lesions on the skin.4
The following can bring on acne or worsen it:
- Emotional stress.
Some foods are known to make acne worse. Foods with a high glycemic load such as white grains (bread, rice, pasta) and sweets have been linked to acne.5 For overall good health, people should eat a healthy, balanced diet.
- Gently wash affected areas once or twice a day with mild non-drying soap. Vigorous washing and scrubbing can irritate your skin and make acne worse.
- Shampoo hair often, daily if it is oily.
- Use “noncomedogenic,” “nonacnegenic,” (does not clog pores) and oil-free cosmetics, toiletries, and sunscreens.
- Avoid astringents, which may unnecessarily dry the skin.
- To prevent scars, do not pop, squeeze, or pick at acne.
- Seek treatment early for severe acne that does not respond to over-the-counter medications to reduce the risk of scarring.
Topical therapy is a standard of care for mild acne. Some of the common topical medications include benzoyl peroxide, antibiotics, retinoids, and salicylic acid.3, 6
- Oral antibiotics are a standard of care in the management of moderate and severe acne, and acne that is resistant to topical therapy or that covers a large body surface area.3, 6
- Due to the increase of bacterial resistance, it is best not to treat less severe forms of acne with oral antibiotics, and if possible, the duration of antibiotic therapy should be limited.3
- Some antibiotic therapies for acne include tetracycline, doxycycline, minocycline, erythromycin, trimethoprim-sulfamethoxazole, trimethoprim, and azithromycin.3, 6
- Combination therapies using oral antibiotics and topical retinoids have been found effective in managing acne.2,3
- Resolution of acne takes time. There are no “overnight” or “immediate” cures.
- Some women find that oral contraceptives containing estrogen may help clear their acne if other treatments do not work. A dermatologist can help a woman determine if this is an effective treatment option.
- Oral isotretinoin is the only medication approved for severe cystic acne, the most serious form of this skin disease.
- It has been used as a course of treatment for acne for more than 25 years.3,7,8 Acne will improve in about 85% of patients after one course (4-6 months) of treatment of isotretinoin.
- Mood disorders, depression, suicidal ideation, and suicides have been reported in patients taking oral isotretinoin. However, a causal relationship has not been established.3,9,10 Many studies give evidence that treatment of acne with isotretinoin was accompanied by improvement of both depressive and anxiety symptoms, as well as improved quality of life in patients with acne.11
- Isotretinion cannot be prescribed to a pregnant female patient, and women who can become pregnant must follow strict rules to prevent pregnancy. The risk of a baby developing severe birth defects is high, even if taking the medicine for a short time.
- The Academy is committed to the safe and responsible use of isotretinoin and supports continuing education for physicians and patients to prevent fetal exposure and other potential hazards connected with the use of this medication.
- Prescribers, patients, pharmacies, drug wholesalers and manufacturers of isotretinoin in the U.S. are required to register with the iPLEDGE program. This program requires mandatory registration of all patients receiving this drug. Detailed information can be found on the iPLEDGE web site https://www.ipledgeprogram.com.
- Current evidence is insufficient to prove either an association or a causal relationship between isotretinoin use and inflammatory bowel disease (IBD) in the general population.12,13 While some recent studies have suggested such a relationship,14,15 further studies are required to conclusively determine if the association or causal relationship exists and/or whether IBD risk may be linked to the presence of severe acne itself.
- Laser and light-based technologies continue to be researched for their effects on mild to moderate acne.16
- Laser resurfacing, dermabrasion, chemical peels, and skin fillers provide safe and effective treatments for acne scarring. Since acne scars are unique in their appearance and often have complex characteristics, patients should consult with their dermatologist to determine an individualized treatment plan for the most successful result.
For more information on acne, visit the Acne section of Dermatology A to Z.
1. The Burden of Skin Diseases 2004, the Society for Investigative Dermatology and the American Academy of Dermatology Association.
2. Bhate K, Williams HC. Epidemiology of acne vulgaris. Br J Dermatol. 2013Mar;168(3):474-85.
3. Strauss JS, Krowchuk DP, Leyden JJ, Lucky AW, Shalita AR, Siegfried EC, Thiboutot DM, Van Voorhees AS, Beutner KA, Sieck CK, Bhushan R. Guidelines of care for acne vulgaris management. J Am Acad Dermatol. 2007 Nov;57(5):900-1.Knutsen-Larson S, Dawson AL, Dunnick CA, Dellavalle RP. Acne vulgaris: pathogenesis, treatment, and needs assessment. Dermatol Clin. 2012 Jan;30(1):99-106, viii-ix.
4. Bowe WP, Joshi SS, Shalita AR. Diet and acne. J Am Acad Dermatol. 2010 Jul;63(1):124-41.
5. Katsambas A, Papakonstantinou A. Acne: systemic treatment. Clin Dermatol. 2004 Sep-Oct;22(5):412-8.
6. Strauss JS, Leyden JJ, Lucky AW et al. Safety of a new micronized formulation of isotretinoin in patients with severe recalcitrant nodular acne: A randomized trial comparing micronized isotretinoin with standard isotretinoin. J Am Acad Dermatol 2001; 45: 196-207.
7. Peck GL, Olsen TG, Butkus D et al. Isotretinoin versus placebo in the treatment of cystic acne. A randomized double-blind study. J Am Acad Dermatol 1982; 6: 735-45.
8. Kaymak Y, Taner E, Taner Y. Comparison of depression, anxiety and life quality in acne vulgaris patients who were treated with either isotretinoin or topical agents. Int J Dermatol. 2009 Jan;48(1):41-6.
9. Hahm BJ, Min SU, Yoon MY, Shin YW, Kim JS, Jung JY, Suh DH. Changes of psychiatric parameters and their relationships by oral isotretinoin in acne patients. J Dermatol. 2009 May;36(5):255-61.
10. Wolverton SE, Harper JC. Important controversies associated with isotretinoin therapy for acne. Am J Clin Dermatol. 2013 Apr;14(2):71-6.
11. Bernstein CN, Nugent Z, Longobardi T, Blanchard JF. "Isotretinoin Is Not Associated with Inflammatory Bowel Disease: A Population-Based Case-Control Study." Am J Gastroenterol. 2009 Nov;104(11):2774-8.
12. Crockett SD, Gulati A, Sandler RS, Kappelman MD.A causal association between isotretinoin and inflammatory bowel disease has yet to be established. Am J Gastroenterol. 2009 Oct;104(10):2387-93.
13. Reddy D, Siegel CA, Sands BE, Kane S. Possible association between isotretinoin and inflammatory bowel disease. Am J Gastroenterol. 2006;101:1569–1573.
14. Crockett SD, Porter CQ, Martin CF, Sandler RS, Kappelman MD. "Isotretinoin Use and the Risk of Inflammatory Bowel Disease: A Case-Control Study." Am J Gastroenterol. 2010 Mar 30 online.
15. Hamilton FL, Car J, Lyons C, Car M, Layton A, Majeed A. Laser and other light therapies for the treatment of acne vulgaris: systematic review. Br J Dermatol. 2009 Feb 23.