A common skin condition starting after puberty, which may persist for many years. It involves plugged pores (blackheads and whiteheads), pimples and deeper nodules on the face, neck, trunk and even the upper arms. It arises from pilosebaceous glands (relating to hair follicles and associated SEBACEOUS GLANDS). SEBUM production is increased and bacterial proliferation causes inflammation with PAPULE and PUSTULE formation. Plugs of sebum and epidermal cells form blackheads (comedones); the colour is not due to dirt but to dried oil and shed skin cells in the hair-follicle openings.
Twice-daily washing with a salicylic-acid cleanser, such as azaleic acid, can help remove the pore-blocking debris, as can daily shampooing and using oil-free cosmetics. Blackheads can be hidden with a flesh-tinted acne lotion containing benzoyl peroxide or sulphur. There is a risk in squeezing blackheads, however tempting, and it is best to ask an expert how to do this properly. Other treatments include DERMABRASION and certain antibiotic lotions although long-term use is likely to lead to bacterial resistance developing. Tretinoin and adapilene may be prescribed for use on the skin but are not permitted in pregnancy and may cause problems such as hypersensitivity to sunlight, so medical advice is essential. In resistant cases, long-term suppressive oral therapy with an antibiotic such as TETRACYCLINES or with ERYTHROMYCIN may be recommended. In females whose acne is due to POLYCYSTIC OVARY SYNDROME, a combined oestrogen-antiandrogen ‘pill’ is an alternative. Severe resistant acne can often be cleared by a 16- to 24-week course of oral isotretinoin, but this drug is teratogenic (see TERATOGENESIS) and can cause many side-effects including depression, so its use requires specialist supervision.