Acne is a disease that affects almost 100% of the popu-
lation, from ages 8 to 80. The symptoms range from rare,
mild disease to severe, disfiguring disease, resulting in scar-
ring. The more severe the disease, the higher the incidence
of depression, even to the extent of suicidal thoughts.
The clinical presentation ranges from comedonal disease
(whiteheads and blackheads or “little bumps”), to red
papules and large cysts (“big bumps”). Scarring is associated
with cysts and “big bumps,” as well as scratching, picking,
or popping of lesions. The scarring can be extremely disfig-
uring. Adolescents with acne suffer greatly from their
disease, affecting their social and academic growth.
The cause is essentially unknown. Most authorities agree
that there is a genetic blueprint for the duration and
severity of acne, which varies greatly from patient to
patient. There is no ethnic predilection, but males are
generally more severely affected since testosterone is
an aggravating factor.
The transition into puberty causes an increase in the size
of sebaceous (oil) glands, as well as increased oil secretion.
These changes, as well as a change in the keratinization
of the hair follicle, cause occlusion, which results in
comedone (whitehead and blackhead) formation. This
occlusion allows the proliferation of Propionibacterium
Acnes bacteria. This bacteria is felt to be the cause of
larger acne lesions due to the immune system response
to the bacteria, inflammatory enzymes produced by the
bacteria, or both.
Some feel the depth of the occlusion in the hair follicle
determines the size of the resultant acne lesion, with a
deeper occlusion resulting in a larger lesion. External
factors vary from patient to patient. Stress is a universal
aggravating factor. With the exception of dairy products
in women, dietary triggers are more individual than
universal (otherwise there would be no acne as no one
would eat the offending trigger). Cosmetics generally do
not play a role; however, thick theatrical make-up, as
well as gener