Nearly all adolescents have occasional whiteheads, blackheads or pimples—regardless of race or ethnicity. The likelihood of developing acne is greatest during adolescence because hormone levels become elevated. Elevated hormones stimulate the sebaceous glands, glands that are attached to hair follicles, to produce greater amounts of sebum—an oily substance. An acne lesion (whitehead, blackhead or pimple) occurs when a hair follicle becomes plugged with the sebum and dead cells.
In most cases, acne begins between the ages of 10 and 13 and usually lasts for 5 to 7 years. In some adolescents, more severe acne develops, reaching a peak 3 to 5 years after the first comedones appear. Severe acne, also known as nodular acne or cystic acne, may not resolve until 30-plus years of age.
Often teens don’t reach out for help but are internally and emotionally devastated from their acne. It is important for parents to realize that teens don’t view acne “as a normal part of growing up”. Parents that recognize the impact that this has on their son’s or daughters emotional well being and take steps to help them get it under control are giving their child a precious gift. Physicians that help to clear their skin up are friends for life.
Living with acne can be emotionally devastating, especially during adolescence. To a teenager, acne can be one of the worse things that ever happened. Acne frequently makes teens feel embarrassed and lowers their self-esteem.
Social Impact of Acne
Acne has a significant impact on a person’s outlook on life. Recent studies have detected the following as common among people with acne:
- Social withdrawal
- Decreased self-esteem
- Reduced self-confidence
- Poor body image
- Feelings of depression
- Higher rate of unemployment
The effects listed above are often interrelated, with one effect leading to another and another, only to make the first effect worse. These negative psychosocial effects can have a crippling impact, discouraging patients from pursuing life’s opportunities–socially, on the job, or at school.
The myths of acne are a common cause of family conflict. As an example, it is not uncommon for the parent to blame their child’s acne on the fact that they don’t eat right or don’t wash well enough.
How acne affects people’s lives?
- 39% of teenagers with acne claimed they avoided going to school because of embarrassment
- 55% of 11- to 18-year-olds said acne prevented them from having a boyfriend or girlfriend
- 32% of adults claim acne has interfered with their ability to get a job
- 36% of adults claim acne has stopped them from making friends
The following are some quotes from patients with acne that illustrate how devastating this condition may be:
“I don’t look in mirrors…I am like a vampire–I shy away from mirrors. I comb my hair using my silhouette on the wall to show the outline of my head. I have not looked myself in the eyes in years, and is painful not to be able to do that, and that is a direct result of acne, the acne scarring.”
“It’s associated with being dirty, and I hate that, because it’s not at all like that. I inherited it from my mother, and she’s always telling me that she had the exact same thing and that it will go away. I am mad that I inherited it from her. My dad makes me feel bad because he never had bad skin when he was younger, so he doesn’t understand…. I hate that the first thing people see when they look at me is bad skin. I really. really hate that.”
“I think that if I had more self-esteem about the way I looked, I think I would have been more outgoing. I would have gone to more parties. I probably would have been more outspoken in class and would not have felt so insecure about going up and speaking in front of a group of classmates.”
“It is really humiliating to feel like I have no control over my acne. I hold my head down and I am ashamed to look at: people, embarrassed. I am 25 years old and to be acting this way is very frustrating.”
“I feel like I don’t look right no matter how hard I try to dress up and look nice–there is always that area of pimples there, and it is very unsettling. There really hasn’t been a day gone by that I don’t think about it, or look at my face…. Should I spend that much energy on it? I could be doing other things…instead of wasting 5 to 10 minutes every day looking at my face in the mirror, or playing with it, picking at my acne.”
Regardless of age, acne is a condition of the sebaceous glands. These glands are attached to hair follicles and produce an oily substance called sebum. An acne lesion forms when a hair follicle becomes plugged with sebum and dead cells. The pathogenic (disease-causing) events in the sebaceous glands are believed to be due in large degree to changes in levels of androgenic (male) hormones in the body—a circumstance usually associated with the growth and development that occurs between the ages of 12 and 21. Therefore, it is important to look for an underlying cause of acne that occurs for the first time in adulthood.
- Recurrence of acne that cleared up after adolescence
- Flare-up of acne after a period of relative quiet—for example, during pregnancy
- Occurs for the first time in a person who had never previously had acne. For these individuals, the following need to be ruled out as causes of acne:
- Medication. Some medications that can induce acne include anabolic steroids (sometimes used illegally by athletes to “bulk up”), some anti-epileptic medications, the anti-tuberculosis drugs isoniazid and rifampin, lithium and iodine-containing medications.
- Chronic physical pressure on the skin. Chafing from the straps of a backpack or tucking a violin between the jaw and chin can cause chronic pressure on the skin and may induce a condition known as acne mechanica.
- Chlorinated industrial chemicals. These may induce the occupational skin disorder known as chloracne.
- Metabolic conditions. Changes in the hormonal balance, such as those brought about by pregnancy, menstruation or hormonal abnormalities can induce acne.
It is also important to know that some lesions which appear to be acne are not acne at all. One condition that resembles acne is folliculitis, which occurs when the hair follicles become infected and inflamed. Folliculitis requires different treatment.
Adult onset acne creates a great deal of emotional turmoil. Unfortunately adult acne may be quite resistant to traditional therapies such as topical and oral medicines. Highly effective laser therapy regimens are quite welcomed by this group.