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What is acne?

Acne is characterized by blackheads, whiteheads, red inflamed bumps called papules and pustules, and in severe cases, deep-seated nodules and cysts. Acne is caused by increased sebum or oil production, clogged hair follicles, altered bacteria and hormones. The T zone is the area between the forehead, nose and chin where acne frequently occurs. However, the back, neck, chest, shoulders, upper arms and buttocks can be affected by acne.

Acne (acne vulgaris)

Acne vulgaris is a common skin problem that presents with blackheads, whiteheads, inflamed, and cystic lesions. It frequently results in scarring and can lead to significant social and emotional distress for sufferers. Acne on the face affects more than 90% of people at some time in their lives, acne on the chest affects about 60% of people, and acne on the back affects approximately 15% of people. It commonly begins in adolescence and often resolves in the mid-twenties. This is also the time when peer pressure, self-image, self-esteem and confidence are being tested. However, acne can also persist into or begin in adulthood, primarily in women.

Studies show that acne and acne scarring can lead to low self-esteem, anxiety, depression and thoughts of suicide. These aspects can negatively impact functioning in daily activities, school, and work. Treatments are available that improve acne and subsequently, increase self-esteem, and reduce social and emotional distress.

Who is at risk for acne?

Acne affects men and women of all races and ethnicities. 85% of acne sufferers are teens and young adults. Pre-adolescents can develop acne when there is an increase in hormones that trigger oil production and acne. Adult acne primarily affects women in their thirties and older. 

What causes acne?

Acne commonly begins around puberty when androgen hormones increase. This stimulates enlargement of sebaceous glands and increased oil production. Excess oil with increased skin cell turnover (dead skin cells) block the sebaceous gland duct and hair follicle. The result is whiteheads and blackheads. Further, bacteria normally resides on skin. When certain bacteria become trapped in the hair follicle, it can cause inflammation and infection and lead to pustules, papules, nodules and cysts.

Genetics and hormones contribute to the formation of acne. Other factors associated with acne include:

  • Insulin resistance
  • Hormone imbalance such as in Polycystic Ovarian Syndrome (PCOS)


Treatment is aimed at unclogging pores, reducing acne-causing bacteria, decreasing inflammation and sebum production. Combination therapy consists of topical or oral antibiotics, anti-inflammatory agents, anti-hormonal agents and retinoids. Chemical peels with glycolic acid and salicylic acid are good options to exfoliate and reduce oil in acne-prone skin. Women with hormonal acne or PCOS may receive oral contraceptives or other oral therapy to combat the hormonal component of acne. In the most severe cases, isotretinoin (Accutane) is very effective to treat nodular and cystic acne. Phototherapy using non-invasive light helps kill acne-causing bacteria and clear acne.

Nodular and cystic acne commonly cause scarring. Professional medical treatments can help to prevent or reduce scarring. Acne that is inadequately treated can cause permanent scarring of the skin and have a significant impact on self-esteem.

The most important action you can take is to start treatment early to prevent side effects and scarring. Early treatment can prevent mild acne from becoming severe and prevent red or dark spots called post -inflammatory hyperpigmentation. Early treatment can control acne, prevent future breakouts, and prevent scarring. If scarring is already established, there are treatments available to minimize and reverse the effects. During your consultation Dr. Rachel White will discuss your concerns and the best treatments for your specific condition, severity, and lifestyle.

Dr. Rachel White is a board certified dermatologist in Buckingham, Pennsylvania. She will tailor treatments to meet your needs. She may suggest a combination of therapies that may include topical and oral medications, chemical peels, skincare products, microneedling and laser therapy.

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