AcneNet This Month
September 2000

Tip of the Month

When acne is mentioned, we usually think of blackheads, papules and other acne lesions on the face. That is where acne is most visible. It also is where acne occurs in more than 90% of people with acne.

Facial acne is, in some people, accompanied by acne at other sites on the body. Occasionally, there may be acne on the body but little or no acne on the face.

The most common sites for non-facial acne are the back, chest and upper arms. Usually, more severe acne on the back and chest is accompanied by more severe facial acne. When acne is severe on the back, it tends to spread toward lower areas on the back and buttocks. When acne is severe on the chest, the upper areas of the breasts may be affected.

Acne vulgaris at non-facial sites is due to the same causes as facial acne. In some cases, non-facial acne may be caused or worsened by continuous pressure or friction from items such as backpacks and shoulder straps. Treatment of non-facial acne is generally the same as for facial acne.

The appearance of facial acne can be as individual as the appearance of faces. Just as there is no face that is exactly like another face, there is no case of facial acne vulgaris that precisely mimics another case.

With this qualification, Fact of the Month will attempt to address a request frequently made by visitors the the AcneNet website. Site visitors frequently ask for photos that illustrate points made in the text. Especially requested are photos that illustrate the types of acne. "You are always talking about comedones, papules, pustules and cysts, but without pictures I’m not sure what you mean," one site visitor stated in his response to our Tell us about yourself questionnaire.

In response to these requests, we offer photos of acne of different types and severity.

First, acne vulgaris with comedones:

Next, acne vulgaris with papules and pustules:

Finally, more severe than acne with comedones, papules and pustules, is acne vulgaris with cysts:

(Photos used with permission of the American Academy of Dermatology National Library of Teaching Slides, and the Sulzberger Institute for Dermatologic Education)

Each month we pose a question that is answered the following month. This month’s question:

Pus-filled acne lesions (pustules) are very unsightly, and it is tempting to squeeze them. Can pustules be squeezed to get rid of them?

We’ll have the answer, and a discussion of the answer, on AcneNet next month.

Answer to last month’s Question of the Month

Last month’s question was:

A 15-year-old male has blackheads, whiteheads and oily skin—in other words, a mild case of acne vulgaris. He is embarrassed and feels socially isolated because of his appearance. His father tells him that acne no worse than this is "normal" in a teen-ager, and if left alone will disappear in a few years. Is the father correct?

Answer: Only time will tell if the father is correct about the duration of his son’s acne, but the father shows insensitivity to the boy’s need for emotional support and understanding.

In numerous studies, the incidence of acne in adolescents has been found to be from 40% to 100%. In a U.S. public health survey, 80% of the population had acne by age 18 years. The higher figure is probably more correct because some studies considered only clearly visible acne while other also considered "sandpaper acne" not yet clearly visible. Beginning in early to mid-teens, acne usually increased gradually in severity, reaching a peak 3 to 5 years after onset. Some acne went on to greater severity—nodular or cystic acne—by late teens to early 20s. However, in these studies, most acne regressed and eventually disappeared in the late teens to early 30s. There has been no good way to predict which case of acne will persist or increase in severity, and which will regress and disappear.

The father who told his son to "leave it alone and it will eventually go away" was likely citing "folk tales" rather than scientific data. While the boy’s acne might very well regress and disappear in time, this can’t be predicted and it also is possible the acne may increase in severity and cause scarring. Equally important, the boy needs emotional support with his feeling of social isolation—something not provided by an off-hand citation of a folk tale.

Parents of teen-agers with acne not only need to know the facts about acne, they also need to understand how a condition often dismissed as a "kid’s disease" can devastate the emotional life of a teen at a time of emotional instability. While a parent may be tempted to shrug off a teen’s concern—or even make light of it—to a teen-ager acne may be the worst thing that ever happened in his or her life.