What is acne?

Acne is a common skin condition, which occurs when the sebaceous glands in the skin become clogged, infected and inflamed.

Alternative name: Acne vulgaris

Acne vulgaris is a very common condition that tends to affect teenagers and young adults.

Acne occurs mainly on the face and upper body, where the skin and hair tend to be oily, and is characterised by multiple blackheads and whiteheads, papules (red bumps) and pustules (pimples). In a more severe form, cysts may form in the skin.

It starts with the onset of puberty, when both girls and boys begin to produce the male hormone testosterone. This acts on the sebaceous glands, causing oiliness of the skin.

The top layer of the skin tends to become sticky, blocking pores and causing blackheads and whiteheads.

When the pores are blocked, an overgrowth of the normal bacteria that live in the hair follicles may occur. These bacteria are called Propionibacterium acnes. As a result of the overgrowth, the person will get a red bump and then later a pustule.

In more severe cases of acne, deeper inflammation of the skin – which causes cysts and nodules – may occur.

There are many different ways of grading acne. Below is a simple, yet useful classification system:

1. Mild comedonal acne. This tends to occur in younger teenagers, and is characterised by oily skin and lots of blackheads and whiteheads.

2. Moderately severe acne or papulopustular acne. At this stage, the skin is still oily with blackheads and whiteheads, but many red papules as well as pustules are also present.

3. Severe acne or nodulocystic acne. This is when deeper inflammation, with deeper cysts and nodules, can be observed. Unfortunately, this is the most difficult type of acne to treat. If not treated properly, it may lead to permanent scarring.

Most teenagers will grow out of their acne at approximately 20 years of age, but a small percentage will continue to have acne in their adult years. This is called adult acne. It’s usually the individuals with the more severe forms of acne that get it at a younger age, and in whom acne persists well into adulthood.

Many men and women in their 40s and 50s still have acne. In men, the face tends to clear but a more severe form of acne might persist on the back. Some people call this “backne”. This type of adult acne is especially frustrating for people in their 40s and 50s, as they have to contend with both wrinkles and pimples! Fortunately, both adult and teenage acne is treatable.

Reviewed by specialist dermatologist, Dr Ian Webster, MBChB (UCT) FF DERM (SA), February 2018

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