While acne isn't life-threatening, it is disfiguring, can lead to permanent scarring, and is an emotional and social burden.

Acne is caused by changes in hormones, heredity and skin type. Hormones that cause physical maturation also cause sebaceous glands of the skin to produce more sebum, or oil. Male hormones have a greater effect on sebaceous glands than female hormones.

During puberty, the cells of the skin that line sebaceous follicles (the glands with a hair shaft) shed more rapidly. When the cells mix with the increased sebum, they can plug the opening of the follicle and the follicle swells with sebum.

When the skin bacteria called P. acnes multiplies in the clogged hair follicle, the skin becomes inflamed. Sometimes, inflammation spreads to surrounding skin, forming blackheads, pimples and nodules.

Teenagers with parents or a parent who had acne are more likely to get acne themselves. In addition, teens with oily skin have a greater risk of acne than teens with drier skin.

Types of acne

When the plugged follicle (called a comedo) is open, it is called a blackhead. When it's closed, it's called a whitehead.

Papules and pustules are commonly called pimples. A papule is a cellular reaction to acne, resulting in small, slightly elevated solid lesions. A pustule is a dome-shaped lesion containing pus.

A macule is the temporary red spot left by a healed acne lesion.

A nodule is a solid lesion that is inflamed, extends into deeper layers of the skin, is painful, and may cause tissue destruction resulting in scarring.

A cyst is a large pustule that is inflamed, extends into deeper layers of the skin, is painful and can result in scarring.

When patients suffer from acne, they are recommended to use a mild cleanser. An inexpensive, non-drying soap used daily is the best way to clean the face. Doctors tell them not to scrub their skin and to avoid harsh cleansers. Most "acne soaps" contain salicylic acid, which can be drying to the skin and can make inflammation worse, especially when combined with medication. Many patients discontinue medical treatment, not realizing it is the soap that is causing irritation.

Patients also give up on using medications because it generally takes at least four to six weeks for them to take effect. It is important for teenagers to understand that their skin may get worse before it gets better. Encourage your teen to "hang in there" and use medicines as prescribed. If skin becomes too dry, it is best to try a non-comedogenic moisturizer, that is, one that does not block pores. Neutrogena and Cetaphil products are quite good, but one can also look for "non-comedogenic" on the label of your preferred moisturizer. Also, one should ask his or her doctor if medication can be taken every other day.

For mild acne, topical antibiotics such as keratolytic are usually prescribed. A keratolytic is an agent that decreases the shedding of skin cells that causes comedones to form. One that is available over-the-counter is benzoyl peroxide. It is available in several strengths (2.5% to 10%), so use the lowest strength that is effective. This medicine also comes in a prescription body wash, which is great for treating larger areas such as the back or chest. Other keratolytics include adapalene and topical tretinoin. These are available by prescription in varying strengths and vehicles such as creams and gels.

If acne becomes more red or inflamed, a topical antibiotic such as clindamycin or erythromycin may be added to treatment. These agents will reduce the amount of pimples on the skin's surface and decrease inflammation. Many topical antibiotics now come formulated with benzoyl peroxide. Creams or gels with this additive can be used once a day and have been shown to decrease bacterial resistance to the antibiotic.

If acne is cystic, most doctors will recommend an oral antibiotic. The most common include doxycycline, minocycline or erythromycin. An eight-to-12-week course of treatment is recommended for maximum benefit.

Because hormonal changes continue into adulthood, that may impact acne. For example, ovarian cysts and pregnancy may cause hormone changes that lead to acne. And some women get acne when they discontinue birth control pills because those pills help keep acne under control.

Acne that appears for the first time in adulthood should be checked by a doctor. Some drugs and industrial chemicals may induce skin problems. Chronic pressure on the skin - by backpack straps or a violin tucked under the chin, for example - may induce a form of acne.

Patients suffering from severe acne should visit a dermatologist, who will most likely prescribe a course of oral isotretinoin, a more serious medication. Be advised that pregnant women should never take isotretinion.