What causes acne? Acne vulgaris, the medical term for common acne; is the most common skin disease. It is so common that nearly eighty-five percent of the population will develop some form of acne at some time between the ages of twelve and twenty-five years. Although there are several theories about what causes acne, medical doctors generally agree that acne is a by-product of hormonal changes in the body. At puberty (that period of life when a child develops secondary sex characteristics), increased levels of androgens (normally referred to as the male hormone) cause the sebaceous glands to produce to much sebum. The sebaceous glands lie just beneath the skin’s surface. They produce an oily substance called sebum, the skin’s natural moisturizer. These glands and the hair follicles (the tube like structures from which hair develops) within which they are found are called sebaceous follicles. These follicles open into the skin through pores. When excess sebum combines with dead sticky skin cells a hard plug, or comedo is formed. If comedones are open to the surface, they are called blackheads. Comedones that are closed at the surface are called white heads. Plugged follicles can rupture internally, resulting in a discharge of their contents into the surrounding tissues. A comedo is the mildest type of acne. Moderate and severe inflammatory types of acne are the result of plugged follicles being invaded by the bacteria that normally lives on the skin. The role of the bacteria 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 cause inflammation that increases susceptibility to infection. A pimple forms when the damaged follicle weakens and bursts open, releasing a substance (sebum, bacteria, and skin) into the surrounding tissues. Pimples that are near the skin’s surface and are inflamed are called papules. When pimples are deeper they are called pustules. This process begins an inflammatory response that sets the stage for the development of acne. Specialists are unable to detect the exact cause of acne, but there are many risk factors that have been identified with the contribution of developing acne. Diet does not cause acne, but certain foods can cause flare-ups. However, eliminating certain foods, particularly chocolates and fats, appear to improve some cases of acne. Teenagers are more likely to develop acne, due to hormonal changes they experience. Boys tend to develop more severe acne than girls, as well as more often. Acne can also be a side effect of drugs including antibiotics, tranquilizers, oral contraceptives, and antidepressants. Hormonal changes during pregnancy and menopause can also contribute to flare-ups of acne. In addition, emotional stress seems to contribute to acne. Acne causes raised swellings, most frequently on the face, neck, shoulders, and back. Acne is not usually conspicuous, although the inflamed lesions may cause pain, tenderness, itching, or swelling. The most troubling aspects of these lesions are the negative cosmetic effects and potential for scarring. Some people, especially teenagers, become emotionally upset about their condition, and eventually have problems forming relationships. Acne has no cure, but there are several treatments. The simplest home remedy is to wash the affected areas with a mild soap and warm water at least twice a day. If the hair is oily, regular shampooing helps. Use of make-up should be limited. Oil based make-up and hairspray worsens acne. Some over-the-counter acne medications are available. These medications contain benzoyl peroxide and come in a type of cream or lotion. These medications can help infected skin however most of these medications tend to dry out the skin. Sunlight and tanning beds, while they provide temporary relief, may lead to wrinkles on the skin, skin cancers, and blotchy pigmentation. It is also recommended not to pick or squeeze pimples, since more inflammation and scarring may result. Also, the risk of infection is increased. For persistent acne, a doctor may prescribe an oral antibiotic or an antibiotic that can be applied directly to the skin. These drugs include tetracycline, enthromycin, and doxycycline. These antibiotics act to decrease inflammation and bacterial growth to prevent new comedone formation. Another drug, isotretinion, is used to treat severe cystic acne. It is usually not prescribed, however, unless all other acne treatments have failed. This drug works temporarily suppressing the production of secretions by the secretion 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 medical doctor. Acne is cot curable, although long-term control is achieved in a high percentage of patients treated with isotretinion. It can be controlled with the proper treatment, with improvement taking two or more months. Acne tends to reappear when treatment stops, but spontaneously improves over time. The intensity and duration of acne can vary among individuals. The bottom line is acne can be problematic, but with proper medication and attention to your face, it can be controlled.