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JAMA Patient Page
August 11, 2004


JAMA. 2004;292(6):764. doi:10.1001/jama.292.6.764

Hair follicles (the tiny pouches from which hairs grow) can become inflamed, especially on the face, chest, and back. This inflammation is called acne. Acne affects many individuals, especially in the teen years, but can last well into adulthood. Acne forms when the hair follicle produces excess oil, when the follicles are irritated (often from extra dead skin cells within the follicle), and when plugging of the pore (opening of the follicle) leads to increased bacteria in the follicle. Many treatments are available for acne and some may be used together. Dermatologists (doctors with specialized training in disorders of the skin) may offer advanced treatments to persons who have severe forms of acne or who have developed scars from their acne. The August 11, 2004, issue of JAMA includes an article about treatment of acne.

Types of acne

  • Mild acne—this includes whiteheads (closed clogged pores) and blackheads (clogged pores that are open at the skin surface).

  • Moderate or severe inflammatory acne includes whiteheads and blackheads plus papules (reddened areas that are raised above the surface of the skin) and areas of pustules (pimples—small bumps on the skin that contain pus).

  • Nodular acne—nodules are deeply embedded solid, often painful lesions. They may develop additional infection and may lead to scarring if not treated.

What can make acne worse?

  • Hormonal changes associated with puberty, menstruation, or menopause

  • Picking at or squeezing acne lesions

  • Friction, rubbing, or pressure (from tight clothing, sports gear, or harsh scrubbing of the skin)

  • Some medications (such as corticosteroids, androgenic steroids, and lithium)

Acne is not caused by dirt or by eating particular foods such as chocolate. Heredity (biological family history) may play a role in developing acne.


Routine hygiene should not be considered as treatment for acne. Appropriate treatment for acne is designed to minimize inflammation and prevent scarring. Keeping the face (or other areas affected by acne) clean is important, but harsh scrubbing should be avoided. Gentle cleansers and warm water are recommended for most effective removal of excess skin oils, bacteria, and dead skin cells. Picking at acne lesions can be harmful. Greasy cosmetic products, sprays, and other irritants should not be used because they may worsen acne.

Over-the-counter topical (applied to the skin) treatments may include products with salicylic acid, resorcinol, benzoyl peroxide, or lactic acid. Prescription medications to help acne may include stronger topical medications, antibiotics, products that contain isotretinoin (for more severe forms of acne), and oral contraceptives for women.

For more information

Inform yourself

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA's Web site at Many are available in English and Spanish.

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

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. Any other print or online reproduction is subject to AMA approval. To purchase bulk reprints, call 718/946-7424.