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Acne is the bane of many teenagers’ existence. Although it is considered a ‘normal’ part of growing up, it seems unfair that just as interest in the opposite sex is beginning and confidence is all-important, a teenager may develop acne. Indeed, the psychological effects of acne can be devastating. Despite all this, it often goes untreated even though there are effective remedies available. It must also be said, however, that many ineffective remedies are promoted, so it is important to be discerning when it comes to choosing a treatment. Neither should acne be dismissed as ‘just a stage’ a person is going through, as many people continue to have acne into their twenties, thirties, and even forties.
The exact causes of acne are not known, but much research over the last twenty years suggests that genetic and hormonal factors are major contributors. If there is a family history of moderately severe acne it is very likely that children will develop acne at puberty. The natural history of acne is that it will eventually disappear in the late twenties. About ten per cent of people, however, continue to suffer from acne in their thirties and forties and this can often be predicted by their family history.
That hormonal factors are important is evidenced by the fact that acne often begins at puberty. In women, it may also vary with the menstrual cycle. Male hormones are more potent in producing acne than female hormones, so men tend to have more severe acne than women. Women with high levels of male hormones also usually have more severe acne.
Acne develops from the increased production of sebum (oily secretion) by the sebaceous glands. These glands are under hormonal control and are deep below the surface of the skin. Under hormonal influence they produce and secrete sebum, and the more sebum that is secreted, the more severe the acne tends to be. Sebum secretion is markedly increased at puberty and has several effects on the skin:
- Sebum is a very sticky substance, similar to mozzarella cheese in texture, which blocks the oily glands. This leads to blackheads and whiteheads.
- Sebum is an irritant to the skin and therefore produces inflammation which leads to red lumps.
- Sebum is a good growth environment for certain bacteria, called propionibacterium acnes, which live in the sebaceous glands. They are attracted to sebum and they release various inflammatory products which in turn lead to pus, inflammation and cysts.

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