What are Acne and Pimples? How are they different?
Acne is a chronic, inflammatory skin condition that causes spots and pimples,especially on the face, shoulders, back, neck, chest, and upper arms. Some people get one or two spots once in a while, whereas some others get frequent breakouts with lots of pus-filled pimples. If the second sounds more like you, it may be acne – a chronic or long-term condition that affects many teens and adults.
Acne is a broader term, and is a more serious condition that is persistent in nature. Also known as acne vulgaris, this skin disease occurs as hair follicles are clogged with dead skin cells and oil from the skin. They manifest as blackheads or whiteheads, pimples, greasy skin, and sometimes even scarring.
Those red spots that you might see when you get out of bed and wash your face in front of the mirror are nothing but pimples! They are not really an outbreak, but a few spots that pop-up once a while, or during specific seasons. You most likely will experience some pain if you touch them, but try to keep your hands away from them as much as possible, to prevent them from spreading.
Whiteheads, blackheads, pimples, cysts, and nodules are all types of acne.
It is the most common skin condition in the United States, affecting up to 50 million Americans yearly.
It commonly occurs during puberty, when the sebaceous glands activate, but it can occur at any age. It is not dangerous, but it can leave skin scars.
The glands produce oil and are stimulated by male hormones produced by the adrenal glands in both males and females.
Acne appears on the skin as
- occluded pores (“comedones”), also known as blackheads or whiteheads,
- tender red bumps also known as pimples or zits,
- pustules (bumps containing pus), and occasionally as
- cysts (deep pimples, boils).
One can do a lot to treat acne using products available at a drugstore or cosmetic counter that do not require a prescription. However, for tougher cases of acne, one should consult a physician for treatment options.
Acne is a skin condition that occurs when your hair follicles become plugged with oil and dead skin cells. It often causes whiteheads, blackheads or pimples, and usually appears on the face, forehead, chest, upper back and shoulders. Acne is most common among teenagers, though it affects people of all ages.
Effective treatments are available, but acne can be persistent. The pimples and bumps heal slowly, and when one begins to go away, others seem to crop up.
Depending on its severity, acne can cause emotional distress and scar the skin. The earlier you start treatment, the lower your risk of such problems.
Types of acne spots
There are 6 main types of acne spots that include:
- Blackheads – open clogged pores where oil turns brown when exposed to air
- Whiteheads – closed clogged pores that are firm and won’t pop
- Papules – small red bumps that feel sore to touch
- Pustules – pus filled papules with a white tip
- Nodules – large painful lumps under the skin
- Cysts – large lumps filled with pus that look similar to boils
What Causes Acne?
Several factors contribute to the development of acne. The primary problem is change in the development of cells inside the hair follicle, leading to the formation of a plug or (comedo). The plug disrupts the normal movement of hair, skin cells, and grease (sebum), resulting in enlargement and eventually rupture of the hair follicle. A ruptured hair follicle spills its contents of oil and debris into the skin where it leads to swelling and causes redness (inflammation).
Propionibacterium acnes, a type of bacteria that normally lives in the skin hair follicles, also plays a role in acne. These bacteria produce substances that cause redness and irritation (inflammation). They also make enzymes, which dissolve the sebum from the oil glands in the skin into irritating substances. These substances also make the inflammation worse.
Certain hormones called androgens are an additional factor in causing acne. Androgens are male hormones that are present in both men and women but are present at higher levels in men. Androgens do two things: First, they enlarge the sebaceous glands in the skin. Second, they cause these glands to increase sebum (oil) production. The increased sebum production exacerbates plug formation and serves as more “food” for the bacteria. Androgens surge at puberty, which is why teens develop armpit and pubic hair and why boys develop facial hair and deeper voices. This hormonal surge also contributes to the development of acne in teens.
Estrogens, which are the female hormones, actually can help to improve acne in girls. A woman’s monthly menstrual cycle is due to changes in the estrogen levels in her body. This is why acne in a female may get better and then get worse as she goes through her monthly cycle. A doctor may recommend acne treatment with birth control pills, which contain the helpful estrogens.
Because severe acne can run in some families, there seems to be significant hereditary predisposition to serious disease.
Anatomy of the hair follicle: Hair follicles exist on virtually all skin except for the palms of the hands and soles of the feet. Inside the follicle, the hair extends up from the deep layers of the skin and comes out of a pore. Near the surface, the oil gland (sebaceous gland) enters the hair follicle where it empties sebum at a relatively constant rate. The sebum lubricates the skin and provides a protective barrier to prevent drying. Skin on the face, chest, and back has an especially large number of sebaceous glands. These are the areas where acne occurs.
Acne lesions: There are two major types of acne lesions: noninflammatory and inflammatory. Noninflammatory acne lesions include blackheads (open comedones) and whiteheads (closed comedones). Open and closed comedones along with papules and pustules are referred to as papulopustular acne, a form of inflammatory acne. Nodular acne is the most severe form of inflammatory acne.
Noninflammatory acne: Open comedones result from the enlargement and dilation of a plug that forms from oil and skin cells inside the hair follicle.
The hair follicle pore remains open, exposing a black plug (known as a blackhead). The dark color is not dirt inside the pore. Instead it is the oil inside the pore, which has become exposed to the outside air.
A closed comedo forms if the hair follicle pore remains closed. The plug in a closed comedo or whitehead is therefore not exposed to the outside air, and no black color develops. The closed comedo simply appears as a tiny, sometimes flesh-colored or white bump in the skin.
Inflammatory acne: Inflammatory acne lesions consist of red blemishes, pimples also called zits (papules, pustules), and larger, deeper swollen tender lesions (nodules).
Papules are closed comedones, which have become red, swollen, and inflamed.
Pustules are closed comedones, which become inflamed and begin to rupture into the skin, forming pustular heads of various sizes.
Nodules represent large, tender, swollen acne lesions, which have become intensely inflamed and rupture under the skin. If untreated, these can produce scarring.
A range of factors triggers acne, but the main cause is thought to be a rise in androgen levels.
Androgen is a type of hormone, the levels of which rise when adolescence begins. In women, it gets converted into estrogen.
Rising androgen levels cause the oil glands under the skin to grow. The enlarged gland produces more sebum. Excessive sebum can break down cellular walls in the pores, causing bacteria to grow.
- Acne signs and symptoms vary depending on the severity of your condition:
- Whiteheads (closed plugged pores)
- Blackheads (open plugged pores)
- Small red, tender bumps (papules)
- Pimples (pustules), which are papules with pus at their tips
- Large, solid, painful lumps beneath the surface of the skin (nodules)
- Painful, pus-filled lumps beneath the surface of the skin (cystic lesions)
Conventional Treatments for Acne
Most people either choose to live with acne, or out of frustration turn to medications or chemical treatments that often have side effects or simply don’t work at all. Dermatologists can prescribe medications to treat acne, including gels, lotions, cleansers and even antibiotics. The harsh chemicals used in over-the-counter and prescription acne products can cause further irritation to already-sensitive or inflamed skin, so using these is not always the best option, or safe for continued use.
According to doctors, which is the best medicine for treating acne?
Two ingredients used in many acne treatments are called benzoyl peroxide and salicylic acid. Concentrated vitamin A derivatives are also sometimes used, in addition to sulfur or zinc compounds.
Benzoyl peroxide helps kill bacteria found inside pores, which helps prevent pore clogging. This can reduce infections, redness and inflammation, but sometimes causes negative reactions like dryness, burning and peeling. Always start with a lower concentration to test your reaction, such as a lotion with 2.5 percent benzoyl peroxide.
Salicylic acid is another common active ingredient that helps remove excess cells that trap sebum and bacteria inside pores. It can also cause redness and dryness, especially on sensitive skin. Start with a product containing 0.5 percent to 3 percent salicylic acid.
Dermatologists sometimes prescribe antibiotics to help reduce the amount of bacteria getting trapped inside pores. Examples of antibiotics prescribed to treat acne include clindamycin, doxycycline, erythromycin, and tetracycline.
Once acne is resolved, how do dermatologists remove acne scars? A peel might be recommended to remove the appearance of dark spots or scars, such as a glycolic peel. Peels and other acne treatments can increase photo-sensitivity, so you’ll need to protect your skin from the sun.
- If an acne cyst becomes severely inflamed, it may rupture. This can lead to scarring.
- A specialist may treat an inflamed cyst by injecting a diluted corticosteroid.
- This can help prevent scarring, reduce inflammation, and speed up healing. The cyst will break down within a few days.
Factors that may worsen acne
These factors can trigger or aggravate acne:
- Androgens are hormones that increase in boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy and the use of oral contraceptives also can affect sebum production. And low amounts of androgens circulate in the blood of women and can worsen acne.
- Certain medications. Examples include drugs containing corticosteroids, testosterone or lithium.
- Studies indicate that certain dietary factors, including skim milk and carbohydrate-rich foods — such as bread, bagels and chips — may worsen acne. Chocolate has long been suspected of making acne worse. A small study of 14 men with acne showed that eating chocolate was related to a worsening of symptoms. Further study is needed to examine why this happens and whether people with acne would benefit from following specific dietary restrictions.
- Stress can make acne worse.
These factors have little effect on acne:
- Greasy foods. Eating greasy food has little to no effect on acne. Though working in a greasy area, such as a kitchen with fry vats, does because the oil can stick to the skin and block the hair follicles. This further irritates the skin or promotes acne.
- Acne isn’t caused by dirty skin. In fact, scrubbing the skin too hard or cleansing with harsh soaps or chemicals irritates the skin and can make acne worse.
- Cosmetics don’t necessarily worsen acne, especially if you use oil-free makeup that doesn’t clog pores (noncomedogenics) and remove makeup regularly. Nonoily cosmetics don’t interfere with the effectiveness of acne drugs.
Risk factors for acne include:
- People of all ages can get acne, but it’s most common in teenagers.
- Hormonal changes. Such changes are common in teenagers, women and girls, and people using certain medications, including those containing corticosteroids, androgens or lithium.
- Family history. Genetics plays a role in acne. If both parents had acne, you’re likely to develop it, too.
- Greasy or oily substances. You may develop acne where your skin comes into contact with oily lotions and creams or with grease in a work area, such as a kitchen with fry vats.
- Friction or pressure on your skin. This can be caused by items such as telephones, cellphones, helmets, tight collars and backpacks.
- Stress doesn’t cause acne, but if you have acne already, it may make it worse.
What Can I Do About Acne?
If you’re worried about acne, here are some ways to keep pimples away:
To help prevent the oil buildup that can lead to acne, wash your face once or twice a day with warm water and a mild soap or cleanser.
Don’t scrub your face. Scrubbing can actually make acne worse by irritating the skin. Wash gently, using your hands instead of a washcloth.
- If you wear makeup, moisturizer, or sunscreen, make sure they are “oil-free,” “noncomedogenic,” or “nonacnegenic.”
- When you wash your face, take the time to remove all of your makeup.
- If you use hair sprays or gels, try to keep them away from your face because they can clog pores.
- If you have long hair, keep it away from your face and wash it regularly to reduce oil.
- Baseball caps and other hats can cause pimples along the hairline. Avoid them if you think they are making your acne worse.
- Wash your face after you’ve been exercising and sweating a lot.
- Try not to touch your face.
- Don’t pick, squeeze, or pop pimples.
Many lotions and creams are sold at drugstores to help prevent acne and clear it up. You can try different ones to see which helps. Products with benzoyl peroxide (say: BEN-zoil peh-ROK-side) or salicylic (say: sal-uh-SIL-ick) acid in them are usually pretty helpful for treating acne. Benzoyl peroxide kills the bacteria that can lead to acne and it also can reduce swelling (puffiness) of pimples. Salicylic acid is another acne-fighting ingredient. It causes skin to dry out and peel, which can help get rid of pimples, too.
When you use a product for acne, be sure to follow the directions exactly. Don’t use more than you’re supposed to because this can make your skin very red and very dry. It’s also good to try just a little bit at first to be sure that you’re not allergic to the product. Don’t give up if you don’t see results the next day. Acne medicine can take weeks or months to work.
When to see a doctor
- If self-care remedies don’t clear your acne, see your primary care doctor. He or she can prescribe stronger medications. If acne persists or is severe, you may want to seek medical treatment from a doctor who specializes in the skin (dermatologist).
- For many women, acne can persist for decades, with flares common a week before menstruation. This type of acne tends to clear up without treatment in women who use contraceptives.
- In older adults, a sudden onset of severe acne may signal an underlying disease requiring medical attention.
- The Food and Drug Administration (FDA) warns that some popular nonprescription acne lotions, cleansers and other skin products can cause a serious reaction. This type of reaction is quite rare, so don’t confuse it with the redness, irritation or itchiness where you’ve applied medications or products.
Seek emergency medical help if after using a skin product you experience:
- Difficulty breathing
- Swelling of the eyes, face, lips or tongue
- Tightness of the throat
Self-help for acne
In some cases, basic self-help techniques can help manage or prevent acne:
- Only wash areas of the skin affected by acne twice a day. Too frequent washing may irritate the skin making the symptoms worse.
- Use a mild soap or cleanser and lukewarm water. Water that’s too hot or cold water can make acne worse.
- Don’t squeeze the spots or try to clean out blackheads. This can make things worse or lead to scars.
- Don’t use too much make-up or cosmetics. Non-comedogenic water-based products are designed to reduce the risk of blocking pores.
- Remove all make-up before bed.
- Use a water-based emollient that’s fragrance-free for any dry skin.
- Shower after a workout or exercise to stop sweat irritating acne.
- Regular hair washing and keeping hair off the face can also help.
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