Acne develops when skin cells do not shed properly — they stick together and plug up the pores. An acne breakout starts in the skin’s pores. It takes about two to three weeks before a blemish shows up on the skin’s surface. This blockage encourages an oil called sebum and a bacteria called proplonlbacterium (P. acnes) to build up in the skin pores, leading to inflammation. The oil is produced by the sebaceous glands.

Deep within each pore is a sebaceous gland that works to produce sebum, an oil that keeps skin soft and moist. As the skin renews itself, old skin cells die and are shed off. Under the best circumstances this happens evenly and gradually, making way for fresh new skin. But some people shed skin unevenly and as a result, dead cells mix with sebum and clump together to form a sticky plug. This plug traps oil and bacteria inside the pore - the beginning of a blemish. During puberty, hormones accelerate oil-producing sebaceous glands into hyperdrive, putting teen skin at particular risk for acne.

In adolescents, acne breakouts are related to the natural release of androgen hormones, which occur during puberty. Acne can also be caused by the use of harmful, body-building steroid drugs. Humidity and perspiration can also contribute to breakouts. Contrary to earlier belief, acne is not affected by diet or poor hygiene. In fact, over-washing can make an acne flare-up harder to control.

Even though teenagers tend to call any form of a breakout a “zit,” acne has more than one symptom. A build-up of P. acnes can cause:

• Blackheads and whiteheads, also known as comedones. Comedones are enlarged pores filled with sebum. Blackheads are comedones that have opened onto the skin surface. Whiteheads are comedones that are closed on the surface.


• Pimples, also known as pustules; these inflamed follicles occur when the P. acnes bacteria in the follicle attracts infection-fighting cells. The follicle may rupture, spilling its contents into the surrounding skin, causing further inflammation.


• Nodules and cysts, which are more severe forms of acne that go deeper into the skin, forming firm, deep bumps and swellings; similar to pimples, they result from increased sebum production, which leads to bacterial growth, irritation and redness. When left untreated, or when “picked at,” acne lesions can lead to permanent scarring.

In the U.S. alone, more than $1.4 billon is spent on acne medications and treatments each year. In many instances, the money spent yields less than satisfactory results and causes bothersome or dangerous side effects. Most prescription medications, such as antibiotics, require at least three months of continuous treatment before any improvement can be expected. Often, a second, third or fourth cycle of therapy is needed.

Over-The-Counter Products

There are numerous non-prescription acne cleansers, astringents, moisturizers and pimple creams available at local drug stores. Some help unplug whiteheads and blackheads while others help encourage the skin to shed. It’s important to use all products as directed. Many experts recommend giving over-the-counter products no more than six to eight weeks to work. If there is no improvement in acne during that time period, a dermatologist may be seen to explore other treatment options. Many over-the-counter products are available in stronger “prescription only” formulas.

Prescription Gels, Creams and Lotions

Topical Antibiotics: These “prescription only” products help fight acne by killing the bacteria that infect the pores. Sometimes acne may become resistant to the antibiotics, rendering them useless. Side effects can include dry, red skin and an increase in sun sensitivity. Commonly prescribed topical antibiotics include Cleocin T and Azelex.

Oral Antibiotics: These systemic medications affect the entire body and therefore can cause serious side effects. Some antibiotics, such as tetracycline, need to be taken on an empty stomach. Side effects can include nausea and dizziness.

Vitamin A Derivatives: These retinoid medications prevent skin cells from clumping together and encourage shedding. Usually applied once a day, these medications can increase sensitivity to the sun, so it’s important that patients use sunscreen. Other side effects can include dryness, redness and irritation. Common Vitamin A derivatives include Retin-A, Differin and Tazorac. One particular retinoid, Accutane, has been shown to cause more serious side effects, including psychological disorders and, in rare cases, birth defects. Sexually active women who take this medication must use contraception during treatment and have monthly lab work performed.

Birth Control Pills: These are prescribed for women who have flare-ups that occur at the same time each month during the menstrual cycle. The pills help control the hormones that prompt oil production in the skin. Women should consult their physician to determine which birth control pills are most appropriate.

First and foremost, don’t hesitate to see a dermatologist about your acne. In the meantime, here are some basic skincare tips and advice that can help prevent or ease problems with breakouts:

• Don’t overwash or use harsh scrubs. Acne is not caused by dirt. Two gentle washings a day is sufficient. Anything more can leave healthy skin dry and irritated, triggering the glands to produce even more oil. The result being even more pimples.
• Don’t use alcohol-based products. Alcohol strips the top layer of the skin and many astringents contain alcohol which can cause dryness and irritation. Again, this can prompt excess oil production and more blemishes.
• Beware of sweat. Working out heats up the body, and perspiration makes the skin an even more attractive environment for acne bacteria to grow. Take a shower as soon as possible after vigorous physical activity.
• Don’t squeeze or pick. It’s important to adopt a strict “hands off” policy when it comes to acne. Trying to pop pimples on your own can drive acne bacteria deeper into the skin. Picking can lead to more inflammation and permanent scarring.
• Don’t let acne define you. Remember that who you are goes beyond the condition of your skin. Smart teens acknowledge the problem, take whatever action they can to deal with it, and then get on with what really matters.