Acne

The everyday pimples and pus-filled papules (small bumps) many adolescents and young adults see on their faces, chests, and backs are known medically as acne. The most frequent form of acne is acne vulgaris. Acne is highly prevalent during puberty and adolescence and may be associated with psychological effects such as reduced self-esteem or depression. Many people see improvement after puberty, but this is not always the case.

Acne crosses all racial and social boundaries. It is most common in persons aged 9–19 years and estimates are that 75–95 percent of the adolescent population is affected. However, it has been known to occur in infants and older adults as well. It is estimated that among adults over the age of 25, 40 percent of men and 54 percent of women have some degree of acne.

The high prevalence of acne vulgaris is related to the multifactorial nature of the disease. First, it is considered to have a hereditary/genetic component. Second, it is linked to hormone levels in the body, specifically androgens, which are male sex hormones found in both genders (but slightly higher in boys, accounting in part for the increased prevalence in [Page 7]boys). Changes in hormonal activity (during a wom-an's menstrual cycle, pregnancy, or stress) may also be associated with the development of acne. In new adult onset acne, a medical disease etiology should be ruled out, such polycystic ovary syndrome in women or Cushing's syndrome. More commonly though, as during puberty, the increased “sex hormone” activity in both genders leads to increased sebum production by the sebaceous glands.

In the genetically susceptible individual, however, there are changes in the keratinocytes (skin cells) lining the pore, whereby the cells become sticky and a clump of cells forms. This cell clumping leads to the development of a comedone, which is the initial step in the development of acne. Subsequently there is an accumulation of dead skin cells, bacteria and sebum in the follicle, to which the skin reacts with an inflammatory defense reaction. In an attempt to try to eliminate these contents, white blood cells are called into the area leading to the typical reaction of heat, redness, pain, and swelling.