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Acne (blackheads, whiteheads, pimples)

What is it?

Acne is derived from a genetic predisposition whose manifestations depend on the presence of sex hormones. Due to this, the lesions begin to appear at puberty, when these hormones begin to be produced by the body. The disease reaches the majority of young people of both sexes and may persist into adulthood. Acne can also begin in adulthood, which occurs more often in women.

The manifestations of the disease (blackheads and pimples) are due to increased sebaceous secretion associated with narrowing and obstruction of the opening of the pilosebaceous follicle, giving rise to open (blackheads) and closed (whiteheads) comedones.

These conditions favor the proliferation of microorganisms that cause the inflammation characteristic of pimples, and Propionibacterium acnes is the infectious agent most commonly involved.

Characteristics and symptoms

The disease manifests itself mainly on the face and trunk, body areas that are rich in sebaceous glands. Symptoms vary from person to person and, most often, are of mild intensity.

In some cases, it may become very intense, as acne conglobata (large inflammatory cystic lesions, which intercommunicate beneath the skin) and acne keloidalis (keloid scars after the disappearance of inflammation).

The clinical manifestations may be divided into four stages:

- Grade I: only non inflammatory lesions (blackheads and whiteheads).

- Grade II: comedones and small inflammatory lesions, papules and pustules.

- Grade III: comedones, small and big inflammatory lesions, that are deep in the skin, painful, reddened and inflamed, forming cystic lesions.

- Grade IV: comedones, small inflammatory lesions, large cystic lesions communicating (acne conglobata), with a lot of inflammation and disfiguring aspect.


Being a prolonged and sometimes disfiguring disease, acne should be treated from the start, to avoid its consequences, which may be scars or emotional disturbances due to the significant change in self-esteem of young people affected by it.

Treatment can be done with drugs for local use, to avoid the closure the follicles, control of bacterial growth and sebaceous glands secretion. Oral drugs may also be used, depending on the severity of the condition, usually antibiotics to control infection or in the case of female patients, hormonal therapy with anti-androgen drugs.

The removal of comedones, which can be performed by properly trained beauticians, plays an important role in preventing their transformation into inflammatory lesions.

In cases of very severe acne (like acne conglobata) or acne that is resistant to conventional treatments, it can be used isotretinoin (Accutane), medication that can permanently cure acne in about six to eight months in most cases.

Although it has no participation in the cause of the disease, the diet can influence the course of acne in some people. Foods like chocolate, animal fats, peanuts, milk and its derivatives should be avoided by patients who have acne and notice aggravation of symptoms after eating them.

The emotional disturbance caused by acne should not be underestimated. The disfigurement due to acne lesions mess with teenagers' self-esteem, who become prone to avoid social contact. When necessary, psychological support should be provided.

Treatment of acne should be supervised by a dermatologist, who is the professional skilled to indicate the ideal drug for each case. Do not use medications indicated by a friend that has a situation similar to yours. They may not be appropriate to your skin type.

Treatment's duration is usually long. It is important to know that some people get better with certain medications and others do not. So maybe your doctor needs to change your medication if the initial treatment is not being effective to control the disease.

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- Acne aestivalis
- Folliculitis

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