Acne affects 40 to 50 million Americans (at some point in their lives) and can range from mild (blackheads and whiteheads) to moderate (pimples) to severe (cysts).
The science: “Quite simply, acne is a clogged pore,” explains New York City dermatologist Francesca Fusco, M.D. Each pore is a tiny opening on the surface of the skin that leads to a hair follicle as well as a sebaceous gland. When too much sebum, an oily substance that keeps moisture in the skin, is produced, the pore can get blocked with dead skin cells and bacteria to form a blackhead or whitehead (also called a comedone). If this comedone ruptures, oil and bacteria spread to the surrounding area and cause an inflammation, also known as a pimple.
Causes: Hormonal changes can send oil glands into overdrive. Genes play a role, but for the three out of four teenagers who develop acne, this usually has to do with puberty. Adult acne, which generally affects women in their 30s, 40s and 50s, is mostly caused by hormonal fluctuations related to menstrual cycle, pregnancy, birth control pills (especially when you stop taking them) or menopause. In some cases, it can be a sign of polycystic ovary disease.
Stress, smoking and diet can cause acne regardless of age or gender. Beauty products that contain oils like synthetic lanolin or petrolatum, greasy hair products like pomade and certain medications including Lithium and cortisteroids are common triggers as well. Also, the combination of bacteria, oil and friction from wearing headbands, helmets with chin straps or cradling your phone can cause contact acne.
Different kinds of acne:
Blackheads and whiteheads: A blackhead is a partially blocked pore, where trapped dead skin cells, sebum and bacteria have seeped to the surface. (The dark color is not caused by dirt, but the melanin in your skin reacting with the oxygen in the air). A whitehead is caused by the same factors but is a completely blocked pore with a closed surface.
Papules and pustules: Papules are inflamed red bumps with no visible fluid (i.e. they can’t be popped). Pustules—tender, pus-filled bumps—are plain old pimples.
Nodules and cysts: Both are large, hard bumps that have become infected below the surface of the skin. The difference is that cysts are filled with pus and nodules are not. Both types can be quite painful and last for months. Since nodules and cysts can cause scarring even if you don’t pick at them, a dermatologist should always treat this type of acne.
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