Acne Acne is a condition of the skin that ranges in appearance from small raised bumps to pimples and large cysts. Acne is so common that 80 percent of the population will have some form of it at some time in their lives. Causes Although there are several theories about what causes acne, authorities generally believe that acne is a by-product of hormonal changes during puberty. Production of hormones (particularly the male hormone testosterone) increases and stimulates the sebaceous glands in the skin to produce sebum (an oily secretion). Most excess oil produced by these glands leaves the skin through the hair follicles. Sometimes, oil clogs these tubes and creates comedones (blocked hair follicles). Comedones are what form the initial lumps in acne. If comedones are open to the surface of the skin, they are called blackheads. They contain sebum from the sebaceous glands, bacteria, and any skin tissue that accumulates near the surface. Comedones that are closed at the surface are called whiteheads. Plugged follicles can rupture internally, resulting in a discharge of their contents into the surrounding tissues. This process begins an inflammatory response that sets the stage for acne. The role of bacteria in acne is unclear. Bacteria may act by causing chemical reactions in the sebaceous fluid, leading to the release of very irritating compounds called fatty acids. These in turn may cause inflammation that increases susceptibility to infection. Authorities disagree about the role of diet in acne. Dietary change alone does not cure acne, nor does acne stem from an allergic reaction to a specific food. However, some cases of acne appear to improve after eliminating certain foods, particularly chocolates and fats. Symptoms Acne causes raised swellings, most frequently on the face, neck, back, chest, and shoulders. In severe cases, there may be pus-filled sacs that break open and discharge fluid. Soreness, pain, and itching may accompany the bumps. These symptoms could be acne, or they could indicate other skin reactions to such substances as cosmetics or medications. Since puberty plays a role in the onset of acne, the condition usually appears during the teenage years. However, it can extend to age 25 and over, particularly in women. Although acne is not life-threatening, it can be a problem. If untreated, acne lesions can leave permanent scars. Treatment Acne has no prevention or cure, but there are several treatments. The simplest home remedy is to wash the affected areas thoroughly at least twice a day with warm water and mild soap. Washing gently will not dry or irritate sensitive skin. Use of makeup should be limited. In addition, skin may heal with exposure to the sun. However, sunlamps and ultraviolet lamps should be used only under a doctor's supervision. Do not pick or squeeze pimples, since more inflammation and scarring may result. Also, the risk of infection is increased. Some over-the-counter acne medications, particularly lotions or creams containing benzoyl peroxide, can help troubled skin. However, most of these preparations tend to dry the skin if the manufacturer's directions are not followed carefully. For persistent acne, a doctor may prescribe an antibiotic preparation that can be applied to the surface of the skin or an oral antibiotic, such as tetracycline or erythromycin. These antibiotics act to suppress bacterial growth, which may be a factor in worsening acne. Another drug, tretinoin (vitamin A acid), has reduced acne in more than 50 percent of the people who have tried it. This drug can be taken independently or in combination with an antibiotic, and it must be used under a doctor's supervision. A newer drug, isotretinoin, is related to tretinoin and is used to treat severe cystic acne. It is usually not prescribed, however, unless all other acne treatments have failed. This drug works by temporarily suppressing the production of secretions by the sebaceous glands. It is important to note that this drug can have very serious side effects and should never be used without the knowledge and supervision of an experienced doctor. In addition, isotretinoin should not be used by any woman who is, who thinks she may be, or who intends to become pregnant. Use of this drug in any amount for even short periods during pregnancy is associated with an extremely high risk of fetal abnormalities and spontaneous abortion.