Acne Information Overview

An estimated 10 percent of adults from age 25 to 44—some 17 million Americans—are plagued by acne. But among adult women, the figure is more like 20 to 40 percent. In fact, adult women are the fastest-growing group of people consulting dermatologists for acne—and many of them had far fewer pimples as teens.

Acne Overview

An estimated 85 percent of Americans from 12 to 25 suffer the heartbreak of acne, and some 60 percent treat them with over-the-counter remedies. Pimples peak around during the mid- to late-teens, but many people, especially women, continue to suffer them throughout adulthood.

Your face is the place most acne develops, but pimples can also appear on your chest and back, which also contain oil-producing (sebaceous) glands, according to Nicholas Lowe, M.D., a clinical professor of dermatology at UCLA.

Acne is caused by disruptions of your skin’s normal shedding and lubrication processes. Pimples begin in hair follicles that are connected to oil-producing (sebaceous) glands. The oil your skin produces (sebum) helps keep your skin from drying out. Normally, it flows out of your hair follicles through your pores. Sebum also carrys with it dead skin cells that you constantly shed from the linings of your hair follicles.

But during puberty, male sex hormones (androgens), which are produced by both sexes, enlarge your sebaceous glands, boost your sebum production, make your follicle walls less flexible, and encourage shed skin cells to clump together. Mix these changes together with certain bacteria that normally live in your follicles, and plugs (comedones) can form that block your pores.

Because men produce more androgens than women, acne tends to affect more adolescent boys than girls. Most acne sufferers have normal androgen levels. They’re just extra-sensitive to the androgens they produce.

Once a plug forms, it may be pushed to the skin surface and protrude slightly. That’s a “blackhead.” Contrary to advertising claims, dirty skin does not cause blackheads. The dark color comes from skin pigment that gets mixed into the plug before it reaches your skin surface. Usually, blackheads do not become full-fledged pimples.

If a plug doesn’t reach your skin surface, but continues to grow in a follicle, it can rupture the follicle wall. The mixture of oil, dead cells, and bacteria spills into your surrounding tissue causing a minor infection. In response, your infection-fighting white blood cells rush to the area, and the result of their battle with the bacteria is a white-headed acne pimple.

Acne pimples appear in three forms: “pustules,” classic whiteheads; “papules,” red bumps deeper down that don’t become whiteheads; and “nodules” or “cysts,” welts that can cause scarring. Dermatologists classify acne as mild (comedonal), moderate (papulopustular), and severe (cystic). Mild acne means a mix of blackheads and whiteheads. Moderate acne involves black- and whiteheads with up to 15 papules, and skin redness. In severe acne, you have the moderate form, with nodules or cysts.