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JAMA Patient Page
February 10, 2015


JAMA. 2015;313(6):640. doi:10.1001/jama.2015.29

Acne is the most common skin disorder in the United States.

Most people with acne are teenagers and young adults, but the condition can persist into adulthood. Adult acne is becoming more common, especially in women, for reasons that are not understood. Acne usually affects the face, chest, and upper back. Untreated acne can cause temporary skin discoloration or permanent scarring. In some people, acne can lead to low self-esteem, avoidance of social situations, and even depression.

What Causes Acne?

  • Skin cell turnover: Skin is always being renewed, shedding dead cells as new cells emerge. Sometimes this process speeds up, resulting in a buildup of dead skin cells inside hair follicles.

  • Sebum production: Glands associated with hair follicles in the skin secrete sebum, a waxy material that moisturizes the skin. The body makes more sebum when androgens (hormones) increase, which is why acne often occurs during puberty. Sebum traps dead skin cells inside the follicle, resulting in a comedo (small plug).

  • Bacterial colonization: A bacterium that lives on the skin and is usually harmless can multiply inside a comedo. The result is inflammation (redness and swelling), which leads to a rupture of the comedo under the skin. This rupture can result in larger, more painful lesions.

Other factors can contribute to acne. Genetics is believed to play a role, making some people more likely than others to develop acne. Friction (from a helmet, headband, tight clothing, or scrubbing the skin) and picking or squeezing acne lesions can cause or worsen acne. Drugs including steroids and anticonvulsants may contribute to acne. Some cosmetics and hair products make acne worse.


Acne severity depends on the type of lesions present and how much skin is affected. Most cases of acne can be successfully treated. But even with proper medication use, it may take up to 2 months to see improvement. Mild acne can often be treated with topical (applied to the skin) over-the-counter medications. For more severe acne, a doctor may prescribe stronger topical medicines, oral antibiotics, or oral contraceptives (for women). Isotretinoin is used to treat severe acne, but strict monitoring is necessary for patients taking this drug.

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Article Information

Sources: American Academy of Dermatology, National Institute of Arthritis and Musculoskeletal and Skin Diseases

Lawley LP, McCall CO, Lawley TJ. Eczema, psoriasis, cutaneous infections, acne and other common skin disorders. In: Longo DL, Fauci AS, Kasper DL, et al, eds. Harrison’s Principles of Internal Medicine. 18th ed. New York, NY: McGraw-Hill; 2012:395-404.

Topic: Skin Disorders