In people who have acne, dead skin cells mix with sebum (oil) produced by the skin and plug up hair follicles in the skin. Bacteria that grow in the plugged hair follicles cause more skin irritation. Acne commonly starts in the early teen years, when the oil glands in the body start making more sebum.
When the hair follicle becomes plugged with oil and skin cells, a “whitehead” occurs. If the follicle is plugged near the surface of the skin and air touches the plug, it turns black and is called a "blackhead." A blackhead isn't caused by dirt.
If the wall of a plugged hair follicle breaks, the area swells and turns into a red bump. If the hair follicle wall breaks near the skin surface, the bump usually becomes a pimple. If the wall breaks deep in the skin, acne nodules or cysts can form. This is called "cystic acne."
Both boys and girls get acne. But it may be worse in boys because they have more skin oils. For many people, acne symptoms fade by the age of 25, but they can continue well into the adult years.
Family history also plays a role. If your mother and father had bad acne, you may have it, too.
Your immune system plays a role too. Some people are extra sensitive to the bacteria that get trapped in their hair follicles.
Many treatments are available for acne, including over-the-counter and prescription medicines.
Benzoyl peroxide and salicylic acid are the most common and most effective over-the-counter medicines for acne. These medicines kill bacteria, dry up the oil and make your skin peel off. They are available in many forms, such as gels, lotions, creams, soaps or pads. Keep in mind that it can take up to 8 weeks before you notice an improvement in the appearance of your skin. If an over-the-counter acne product doesn't seem to help after 2 months, talk to your doctor.
In some people, over-the-counter acne medications may cause side effects such as skin irritation, burning or redness. Tell your doctor if you have side effects that are severe or that don't go away over time.
If over-the-counter medicines are not effective, your doctor may prescribe a retinoid cream or gel. Retinoids, such as tretinoin and adapalene, are usually applied to the skin once a day. Be sure not to get them near your eyes, mouth and the area under your nose.
If you use a retinoid, you must avoid the sun or use a strong sunscreen because this medicine increases your risk of getting a sunburn. Women who are pregnant or may become pregnant should not use a retinoid called tazarotene because it can cause birth defects.
If your acne is severe, your doctor may prescribe an antibiotic to treat it. Antibiotics such as minocycline, doxycycline and tetracycline reduce bacteria and inflammation, and can be used in combination with other treatments for acne, such as benzoyl peroxide. Antibiotics can be taken by mouth or used on the skin as a lotion, cream or gel.
Isotretinoin is a medicine used to treat very bad acne. It is usually used for acne that did not get better after treatment with other medicines. It is important for you to take isotretinoin the right way. You should also know about the side effects of isotretinoin. Talk to your doctor if you have any questions about this medicine or if you have side effects when you take it.
Before taking isotretinoin, tell your doctor if you or anyone in your family has diabetes, asthma, liver disease, heart disease or depression. You should also tell your doctor if you are allergic to any medicines, especially parabens (chemicals used in cosmetics, moisturizers and isotretinoin). Be sure to tell your doctor if you are taking any other medicines, even over-the-counter medicines.
Isotretinoin has been prescribed just for you. Don't share it with other people and keep it away from children. You should take isotretinoin with food. You don't have to keep the medicine in the refrigerator, but keep it out of sunlight. Don't keep it in a place that is very warm.
You may not give blood while you are taking this medicine or for at least 1 month after you stop taking it. You should also not have cosmetic procedures done to smooth your skin (such as waxing) while you are taking isotretinoin and for at least 6 months after you stop.
Isotretinoin is like vitamin A, so while you are taking isotretinoin, you should not take vitamin A pills or multivitamins that contain vitamin A. You also should not take any antibiotics without talking to your doctor first.
The dosage of isotretinoin is different for each person. During your treatment, your doctor may change your dosage. Be sure to take isotretinoin just the way your doctor tells you. If you miss one dose, don't take extra the next time. You will probably take isotretinoin for 15 to 20 weeks.
Your acne may get worse when you first start using isotretinoin. This usually just lasts for a little while. If this happens to you, your doctor may have you use other medicines along with the isotretinoin in this stage.
Your doctor needs to check on you often. Be sure you keep all of your appointments with your doctor. He or she may check your cholesterol levels and your liver.
During treatment, you may have some of the following side effects. These side effects usually go away when you stop taking isotretinoin:
A few people have even more serious side effects. If these problems aren't treated, they could last even after you stop taking isotretinoin. If you have any of the side effects listed below, stop taking isotretinoin and check with your doctor right away:
Your skin might keep getting better even after you stop taking isotretinoin. Most of the side effects go away in a few days or weeks after you stop taking isotretinoin. If your side effects last for more than a few weeks after you stop taking this medicine, talk to your doctor.
Your acne may not get better the first time you use isotretinoin for 15 to 20 weeks. If you need to take isotretinoin again, you can start taking it 8 to 10 weeks after your first treatment is over. Do not give blood for at least 1 month after you stop taking isotretinoin.
You must not take isotretinoin if you are pregnant or if there is any chance you might get pregnant while taking this medicine!
Isotretinoin causes severe birth defects, including malformation of the head and face, mental retardation and severe internal defects of the brain, heart, glands and nervous system. It can also cause miscarriage, premature birth or death of the fetus.
In order to prevent pregnancy, you must use 2 forms of birth control at the same time for at least 1 month before you start taking isotretinoin and during the entire time you are taking this medicine. Keep using 2 forms of birth control for 1 month after you stop taking isotretinoin.
Your doctor will make sure you are not pregnant before you start taking isotretinoin. He or she will check again every month while you are taking it. You will be asked to read and sign a consent form to show that you understand the dangers of birth defects and agree to use 2 forms of birth control. If your period is late, stop taking isotretinoin and call your doctor right away.
Acne, especially cystic acne, can cause scars in some people. You can help reduce scarring by not squeezing or picking at blemishes. Also, avoid scrubbing your skin. If you do get scars, treatments to help reduce scarring are available.
Written by familydoctor.org editorial staff