Acne: What Causes It and How Can it Be Treated?

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Acne plagues about 85 percent of teens in each generation, according to the American Academy of Dermatology.

While this generation perhaps has more creams, pills and alternative treatments available to them than any other before, doctors say the causes of acne are unknown.

Blackheads, whiteheads, red bumps and cysts all count as acne to dermatologists. By this definition, an estimated 40 million to 50 million Americans have acne, according to the American Academy of Dermatology.

Related: The scientific reason people love pimple-popping videos

Teens might suffer the most, but anyone can develop acne.

"If you have it, you're not alone," said Dr. Mathew Avram, director of the Massachusetts General Hospital Dermatology Laser and Cosmetic Center in Boston.

Most doctors think acne arises from the overproduction of natural oils in the skin, dead skin cells, inflammation and the buildup of bacteria, Avram said.

But the American Academy of Dermatology calls the exact cause of acne "a mystery."

How does acne form?

All pimples start in a pore, which is an opening in the skin around a hair follicle. Sweat glands at the bottom of the pores normally produce oil, but for reasons still largely unclear to doctors, sometimes too much oil is produced. If there is an excess of dead skin on the surface, the pore clogs, causing a blackhead or whitehead.

Bacteria found on everyone's skin called P. acnes may flourish in the excess oil, causing the skin to become inflamed and creating a pimple, according to the Mayo Clinic.

Why do some people get acne?

"There's the myth that chocolate causes acne, which I say is completely wrong," said Dr. Margaret Parsons, a fellow of American Academy of Dermatology. "For me, the stress that's making you craving the chocolate is probably causing the acne."

Parsons said studies have failed to show a link between food and acne. Instead, research shows stress, hormones and genetics can all increase the risk for acne.

Because the causes of acne are so unclear, doctors tend to prescribe treatments based on the severity of the acne.

New acne treatments

In the last five years, more doctors are turning to light to get rid of pimples.

"You paint on this solution ALA, or aminolevulinic acid and it gets absorbed in the skin where the pimples are," said Dr. Monica Halem, a dermatologist and clinical assistant professor at the New York-Presbyterian Hospital in New York City.

"If you shine a blue light on it, it causes a reaction, and it destroys the bacteria. It's pretty popular. I use it [in the office]," Halem said.

Light therapy, also called photodynamic therapy, calls for two to three sessions a week and as the acne clears up, some patients may have to go in for a monthly maintenance. Some may never come back at all.

Halem said she uses photodynamic therapy, but reserves it for patients who did not have success with the more common creams and pills.

Standard acne treatments

For mild to moderate acne, most doctors recommend trying home remedies or over-the-counter medications before seeing a family doctor or dermatologist.

Some studies have shown that over-the-counter gels containing 5 percent tea tree oil may be an effective treatment option for mild to moderate acne, according to the Mayo Clinic.

But the first line of treatment is washing your face with lukewarm water and a mild cleanser twice a day.

Too much scrubbing or using harsh cleansers will only irritate the skin, and could make the problem worse, according to the Mayo Clinic.

Parsons said she urges her patients to avoid picking their acne, as it only increases inflammation. And avoiding greasy moisturizers and sunscreens can also prevent breakouts. Products labeled "non-comedogenic" have been proven less likely to cause breakouts, according to the National Institutes of Health.

"There's a lot of good over-the-counter products out there," said Dr. Christina Kim, an assistant clinical professor at the David Geffen School of Medicine at the University of California at Los Angeles.

However, severe acne that goes untreated can scar the skin, Kim said.

Acne advice for kids and adults

"If you have scars from acne, that is the time to go see a professional," Kim said.

Dermatologists and family doctors can prescribe acne treatments that work by reducing oil production, speeding up skin cell turnover, fighting bacteria and reducing inflammation, according to the Mayo Clinic.

Mild acne that doesn't improve with home treatments can be treated with topical creams or antibiotics, Avram said.

If standard treatments fail, some patients with severe acne might try a drug called Accutane. While effective, Avram said the drug carries risks of birth defects and other side effects. Patients on the drug must submit blood tests, pregnancy tests and frequently visit the doctor.

But Avram said the most important things for patients with acne to remember is that treatment takes time, and their skin might get worse before it gets better.

"Most treatments won't work for 6-8 weeks," Avram said. But keep trying even if the first treatment doesn't work, he said.

"There's a lot of options available out there," Avram said.

Pass it on: While acne's causes remain somewhat mysterious, available treatments may reduce acne's severity for most people.

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Lauren Cox
Live Science Contributor
Lauren Cox is a contributing writer for Live Science. She writes health and technology features, covers emerging science and specializes in news of the weird. Her work has previously appeared online at ABC News, Technology Review and Popular Mechanics. Lauren loves molecules, literature, black coffee, big dogs and climbing up mountains in her spare time. She earned a bachelor of arts degree from Smith College and a master of science degree in science journalism from Boston University.