AcneNet This Month
September 1999

We usually associate the development of acne with adolescence, but acne can develop as early as infancy and as late as age 40, 50 or 60 years. Infantile and juvenile acne can be special cases that may require special medical attention.

In infants and very young children, acne usually appears as rash-like comedones and papules on the cheeks and chin. The acne often persists until age 18 months or even until age 5 or 6 years. It may disappear for a number of years, but reappear during adolescence. Boys are more likely than girls to have infantile or juvenile acne.

The causes of acne in infants and very young children are not entirely clear, but in some instances there may be (1) a history of acne in other family members, or (2) rarely, evidence of increased production of certain hormones. An infant or very young child with acne should be examined by the child’s pediatrician or other physician.

Infantile and juvenile acne responds to treatment much as acne responds in older persons. Therapy is required for as long as the acne persists. Any underlying conditions also must be treated by the physician.

The "oily skin" often associated with acne is usually more prominent on the face than on other parts of the body. Most people with acne also have an excessively oily scalp. Why this should be the case is explained by the distribution of sebum-producing sebaceous glands on the skin.

Sebaceous glands are found in all skin areas of the body, except for the palms of the hands and soles of the feet. They are most numerous on the scalp, forehead, cheeks and chin. Sebaceous follicles, the sebum-producing glands that cause acne when they become obstructed with abnormal numbers of cells sloughed from the pore lining, and excess sebum, may number several hundred per square centimeter on some areas of the face. On the skin of the back, there may be about 150 sebaceous follicles per square centimeter.

When sebum production is increased, the most excess sebum appears in areas where there are the most sebaceous glands.

A question that may arise is this: If sebaceous follicles become plugged up to cause acne, why is there still so much oily-looking sebum on the skin? If the follicles are obstructed, how can they excrete excess sebum onto the skin?

The answer, of course, is that only a small fraction of sebaceous follicles ever become plugged. Even in a severe case of acne with many comedones, hundreds of sebaceous follicles remain clear to exude excess sebum onto the surface of the skin. Regular, gentle cleansing with mild soap and water will usually keep the "oily look" under control (click on Acne treatments for more information on regular cleansing of the skin).

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

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

Last month’s question was:

Answer: Yes

Acne is only one of the reasons why use of steroids to "bulk up" is discouraged—and usually against the law. Steroids are extremely potent drugs that affect just about every organ in the body, often with disastrous results for the athlete’s health and well-being.

Athletes and body-builders who use steroids to "bulk up" for power events or muscle shaping are at risk for a form of acne known as drug-induced acne. The androgenic steroids used to "bulk up" can increase sebum production in the sebaceous glands. The effect can be so striking that an athlete using steroids can be seen to have an excessively oily skin. The steroid also causes a degeneration in certain skin cells. Increased sebum, and an increased number of dead skin cells, can work together to plug sebaceous follicles—the first step toward acne.

Thus, a young athlete who tries to increase his self-esteem by using steroids to ‘bulk up", may find himself with a case of steroid-induced acne.