What Is Acne? What Causes Pimples and How to Treat Them
"Teen Vogue" is celebrating its annual Acne Awards this week with a series of stories on all things acne. From knowing when to pop a pimple to understanding why some people get breakouts and others don’t, we’ve got you covered. Read all of the stories here.
Acne is a common experience, no matter what age you are but there’s still a lot of stigma and shame around it, which often makes people who experience acne feel deeply distraught. Luckily, we’re living in a time when body acceptance is rising and more people are opening up about their insecurities, including all things acne.
In September 2018, an article in The Guardian declared that “pimples are in” — tracing the acne positivity movement back to 2015, when British blogger Em Ford posted a YouTube video called You Look Disgusting, baring her acne covered skin alongside negative things people have said about her, the video has since received over 30 million views. Another early influencer was Kali Kushner, who still opens up about acne, scarring, and hyper-pigmentation via her Instagram account @myfacestory. She, too, has shared the comments people have made about her skin, including a police officer who once assumed her skin meant she was a “junkie”.
In the last few years, photographer Peter Devito has used his own platform (and lens) to help normalize acne — dealing with acne in his own life, the photographer wrote on Instagram that he hoped to portray it in a “more positive light/that aim to at the very least just show that having acne is normal” with a related photo project in which people with acne are photographed wearing related words such as “retouch” and “human” on their faces.
But we’re not just seeing acne on Instagram and other social media platforms, in fact it’s recently been popping up in teen movies, including 2017’s Lady Bird and 2018’s Eighth Grade, in which both leading actors appeared with acne — a conscious decision that a Vulture writer called “important”.
While all of these efforts and more have helped push the conversation about acne into the mainstream, why is there still so much shame and stigma when it comes to having it?
Here at Teen Vogue, we think it’s due to a lack of education and knowledge about what causes acne and how to properly treat it. We don’t want you to be left in the dark any longer, so we spoke to some experts about all things acne, and here’s everything we learned.
What actually is acne?
Acne is a skin condition that happens when you develop inflammation within your oil glands, and the pores become blocked. Accordingly, Joshua Zeichner, dermatologist and director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City, tells Teen Vogue that this “leads to skin-colored and red bumps on the face, as well as the chest and the back.” Acne is an inflammatory response that impacts the hair follicles — as dermatologist Dr. Howard Murad, M.D., says, “you don’t get it on your palms or fingers because there are no hair follicles there.”
Fun fact: pimples can actually start two to three weeks before they reach the skin’s surface and once they do, they are already towards the end of their life cycle, according to dermatologist Dendy Engelman, M.D. Still, the first noticeable sign of acne is a flat red bump, which Dr. Engelman says is a signal to start acting by removing any makeup or product that will potentially irritate the area even more.
So, why am I cursed with acne breakouts?
There’s actually a lot of factors that contribute to breakouts. First, some people tend to make more oil than other people due to their genetics as we are genetically programmed to make a certain amount of oil. Dr. Zeichner says, “When skin cells stick together within the follicles, they trap the oil from reaching the surface of the follicle. This allows oil levels to increase within the pore, along with overgrowth of acne causing bacteria.” All of this ultimately leads to inflammation in the skin.
Also, some people have conditions that others don’t, such as polycystic ovary syndrome, a hormonal imbalance that can result in small acne cysts. “Unfortunately, we cannot change our genes, but we can’t control the way they are expressed and use treatments to keep the skin under control,” says Dr. Zeichner.
Plus, certain foods can come into play — for example, sugary foods and iodine supplements can contribute to breakouts, particularly in people who are predisposed genetically — while picking your skin can cause further breakouts. Fun fact: washing your face or not doesn’t actually make you break out but when you touch or pick at your skin, it brings different bacteria, so to combat this you must wash your face.
Danuta Mieloch, an aesthetician and owner of Rescue Spa NYC, says lifestyle and skincare (or lack of), including living certain climates, humidity and heat can also impact your skin while another contributor is hormones. With this, someone who works out a lot and is prone to more breakouts could experience more acne whenever they sweat.
“When hormone levels rise, it can stimulate oil production and lead to acne flares,” says Dr. Zeichner. “Hormone levels rise right before women get their period and even during times of stress. It has been shown that students tend to break out and during testing periods.” So, if you’re stressed out, your skin will likely reflect this. And when you get acne, this can cause even more stress. Ugh.
What are the different kinds of acne?
There’s so many different kinds of acne and other skin irritations, it can be overwhelming to know what’s what. Dr. Murad says there are four general types of acne: whiteheads, blackheads, traditional acne, and cysts.
Whiteheads are a non-inflammatory buildup on the skin’s surface while blackheads, which are also non-inflammatory, are “pores exposed to oxygen on the skin’s surface” that “when exposed to oxygen and the environment, the pore oxidizes, creating a small black dot.” Dr. Zeichner says that whiteheads can occur anywhere on the face, but are common in the t-zone, which includes the forehead, nose, chin, and area around the mouth. Blackheads also occur in the t-zone but can also occur anywhere. Acne develops in areas where there is a high concentration of oil glands, explaining why it commonly occurs on the face, the middle of the chest, and the back.
Then there’s more traditional acne — think your typical red bumps. Additionally, there are papules, which are red bumps that occur when there are blocked pores, and pustules, which are red bumps with white pus at the surface. Hormonal breakouts come ago, particularly around times of stress, says Dr. Murad while men tend to have more serious breakouts than women because women have more estrogen (men have less), which helps acne breakouts subside.
“Acne on the chest is called folliculitis and is caused from clogged pores with oil, dead skin cells and other debris,” dermatologist Dr. Engelman, tells Teen Vogue. Once clogged, this results in inflamed hair follicles usually caused by bacterial or fungal infections and appears as small red bumps. “Breakouts can also occur from dermatitis, the result of irritation from clothing friction, exacerbated by sweating. Body acne tends not to show up as frequently as blackheads, but instead can be whiteheads, pimples and cysts.” “Bacne” (back acne) along with chest acne develops because these areas of the body have a high concentration of oil glands, which when blocked, can lead to clogged pores.
Danuta says that after working out or sweating it is important to remove clothing such as sports bras as soon as possible.” The sooner you can shower and cleanse the skin the less likely breakouts are to occur.” Dirty clothes can clog pores and cause breakouts.
Cysts are painful and deep, inflamed nodules similar to “balloons under the skin” which are filled with oil, and do not have a connection to the surface — meaning they are not pickable, according to Dr. Zeichner. Cysts, like all other forms of acne, happen when pores are blocked. However, “when bacterial overgrowth and inflammation goes deeper into the skin, a cyst develops,” says dermatologist Sejal Shah, M.D.
Dr. Engelman says that when you have a hormonal imbalance or are experiencing periods of stress, your body can overstimulate the sebaceous oil glands, making you produce more oil that gets stuck in your pores, thus trapping bacteria. When pores are clogged with oil, dead skin cells, and bacteria, the pores can rupture under the skin, causing the inflammation to spill out into the surrounding tissue and the body forms a cyst around it to stop the inflammation from spreading.
Why do some people get acne as teens and others get it as adults?
Dr. Zeichner says, “We likely develop acne because of sensitivity to hormones, leading to stimulation of your oil glands.” While teens typically develop acne because of hormonal changes during puberty, “Acne is an increasing problem,” says Dr. Zeichner. “We don’t totally understand why it develops, but likely has to do with hormonal changes, stress, and diet.”
Adult acne and teenage acne are both caused by a combination of things including hormonal imbalance, stress, dietary, environmental factors, and genetics, says Dr. Engelman. The only difference is where they appear. According to Dr Engelman, een acne usually appears on the T-zone area, if not all over, whereas adult acne presents on the chin and jawline.
However, no matter what age you deal with acne, it can be frustrating and your experience is totally valid. So, as Dr. Engelman says, “The best thing you can do is to continue doing what you’ve always done; don’t aggravate it and visit a dermatologist for treatment.
If you have acne does it mean you are “dirty”?
It is a myth that having acne means you are dirty! If you have acne it doesn’t make you any less than, however it can definitely impact your emotions or make you feel insecure. “Regardless of whether there is physical discomfort, many patients suffer from psychological distress,” says Dr. Zeichner. Acne can not only alter the state of your skin, but can also impair your self-esteem, cause depression, poor performance in school, and even prevent people from forming close relationships with other people. Due to this, Dr. Murad says it’s important to honor yourself (particularly in your teenage years) and give yourself positive encouragement.
Another thing to keep in mind is that acne impacts everyone differently. “There are some people who barely wash their face that never break out. There are other people who are diligent at cleansing, but still break out anyway,” says Dr. Zeichner. It’s important to keep in mind that acne is a medical condition that can be treated. “It is not a right of passage that you need to suffer through.” However, if your acne is not properly treated, it can leave behind significant, lifelong scars, which is why we must treat it the right way, and do so as early as possible.
How do you avoid acne scarring?
Whenever I have acne I can’t help but want to pop my pimples or pick my skin. It’s a really bad habit and Dr. Murad says this can lead to serious scarring. So, to prevent scarring from happening you need to treat your acne as soon as it starts. “Don’t wait to see if it will clear on its own. Visit a dermatologist and begin a consistent skin regime,” he says. I’ll be sure to keep this in mind next time I have the urge to pick my skin.
Credits:
Photographer: Anairam
Stylist: Michelle Li
Make-up: Courtney Perkins
Hair: Lizzie Arneson
Manicurist: Dawn Sterling
Originally Appeared on Teen Vogue
