How to Treat Acne, Pimples, Blackheads and Whiteheads

Acne vulgaris occurs because of the interaction of hormones and other substances on the skin's oil glands (sebaceous glands) and hair follicles. This can lead to plugged pores and outbreaks of lesions commonly called pimples or zits. Acne  usually occurs on the face, neck, back, chest and shoulders. Although we all might want clear skin, acne isn't usually  a serious health threat. But it can result in significant emotional distress, as you try to figure out how to get rid of acne.

You can spend a small fortune looking for an acne free solution. There are many on the market, from lotions such as Proactive to devices such as Zeno to topicals you find at the drugstore to prescriptions. Severe acne can lead to permanent scarring.

To understand the cause of acne, which is complex, you'll need to understand exactly how your skin is constructed. The technical term for what is affected by acne vulgaris is called a pilosebaceous unit (PSU). Found over most of the body, PSUs consist of a sebaceous gland connected to a canal, called a follicle, that contains a hair. These PSUs are found in larger amounts on our faces, upper backs and chests. The sebaceous glands create an oily substance called sebum that normally empties onto the skin surface through the opening of the follicle. The opening is called a pore. Cells called keratinocytes line the follicle.

The hair, sebum and keratinocytes that fill the narrow follicle can plug up the pore, which is an early sign that your clear skin is developing acne. The sebum is unable to reach the surface of the skin through the pore. The mixture of oil and cells allows a bacterium called Propionibacterium acnes (P. acnes), that normally live on the skin, to grow in the plugged up follicles. The body's immune system tries to get rid of the bacteria, resulting in inflammation. When the wall of the plugged follicle breaks down, it spills everything into the nearby skin - sebum, shed skin cells and bacteria - leading to pimples.

Acne vulgaris, bad enough to warrant a quest for acne remedies and acne treatments, can develop anywhere on the body, including

  • on the back (sometimes called bacne) and chest
  • on the face, including cheeks, chin, nose and forehead
  • on the neck

There are many acne products promising acne blemish control for these areas.

Difference between Blackheads and Whiteheads

People with acne vulgaris frequently have a variety of lesions. The basic acne lesion is called a comedo. It is simply an enlarged and plugged hair follicle. If the plugged follicle, or comedo, stays beneath the skin, it is called a closed comedo and produces a white bump called a whitehead. A comedo that reaches the surface of the skin and opens up is called an open comedo or blackhead because it looks black on the skin's surface. This black discoloration is due to changes in sebum as it is exposed to air. It is not due to dirt. Both whiteheads and blackheads may stay in the skin for a long time.

There are other types of acne lesions that can develop. They include the following:

  • Papules - inflamed lesions that usually appear as small, pink bumps on the skin and can be tender to the touch
  • Pustules (pimples) - papules topped by white or yellow pus-filled lesions that may be red at the base
  • Nodules - large, painful, solid lesions that are lodged deep within the skin
  • Cysts - deep, painful, pus-filled lesions that can cause scarring

Everyone can develop acne vulgaris. People of all races and ages get acne. It is most common in adolescents and young adults. It is estimated that 80 percent of people between the ages of 11 and 30 have acne outbreaks warranting treatment at some point. For most people, acne tends to go away by the time they reach their thirties; however, some people in their forties and fifties continue to have problems. This is called adult acne. Adult acne is treated like acne at any other age, but the problem is that many adults have drier skin, so they can't use some of the harsher acne lotions and acne solutions. Sometimes scars are so marked, that cosmetic surgery type treatments such as peels or dermabrasion are used to remove them.

What causes acne

We're not sure of the exact cause, but one contributing factor is an increase in hormones called androgens (male sex hormones). Another factor is heredity or genetics. Other possible causes can be:

  • drugs
  • oily cosmetics which can plug the skin follicles
  • stress
  • things in the environment like pollution and high humidity 
  • squeezing or picking at blemishes 
  • scrubbing the skin too hard

Ironically, that last one occurs when people try so hard to scrub and clean their face to get rid of acne, that they wind up making it worse.

How to get rid of acne

While there are no sure-fire ways to get rid of acne, there are many acne products that can help. Treatments can range from washing procedures and topical creams and lotions to prescription drugs, and in serious cases to other medical procedures.

Creams and lotions for acne

Creams and lotions that you put on your skin are called topical. Over-the-counter topical medicines for mild acne include:

  • Benzoyl peroxide - this destroys P. acnes, and may also reduce oil production.
  • Resorcinol - this can help break down whiteheads and blackheads
  • Salicylic acid - this helps break down whiteheads and blackheads, and can help reduce the shedding of cells that line the hair follicles.
  • Sulfur - this also helps break down whiteheads and blackheadsPrescription topical medicines that can be used to treat more serious cases of include: 
  • Antibiotics - they can help stop or slow the growth of bacteria and also reduce inflammation
  • Vitamin A derivatives (retinoids) - these can unplug existing comedones, and also allow other topical medicines to enter the follicles. Example include tretinoin (Retin-A2), adapalene (Differin), and tazarotene (Tazorac)

There is also prescription strength Benzoyl peroxide, sodium sulfacetamide/sulfur-containing products or Azelaic acid (Azelex), all of which can be used to treat acne.

Pills for acne

Sometimes you may need oral medications for acne. Some of the common antibiotics used to treat acne include:

  • Tetracycline (Achromycin V)
  • Minocycline (Dynacin, Minocin)
  • Doxycycline (Adoxa, Doryx, Monodox) 

Less commonly used antibiotics include clindamycin (Cleocin), erythromycin or sulfonamides (Bactrim).

For severe cases of acne, a doctor may prescribe isotretinoin (Accutane). This is a retinoid (vitamin A derivative). Isotretinoin is an oral drug. It is usually taken once or twice a day with food for 15 to 20 weeks. Isotretinoin reduces the size of the oil glands, and as a result, much less oil is produced. This also slows the growth of bacteria, which can help severe cases of acne. Women who take isotretinoin however must take extreme precautions about getting pregnant. Isotretinoin can cause severe birth defects.

Some types of acne in women can respond to hormonal drugs. Women with this type of acne may have other symptoms such as irregular periods or they may be very hairy (hirsutism). Hormonal drugs for acne can include:

Birth control pills - these can help suppress the androgen produced by a woman's ovaries

Low-dose corticosteroid drugs, including prednisone (Deltasone) and dexamethasone (Decadron, Hexadrol) - these can help to suppress the androgen which is produced by the adrenal glands

Antiandrogen drugs, for example spironolactone (Aldactone) - this can help to reduce the excessive oil production


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