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How do Pimples develop? Doctors describe pimples as a disease of the pilosebaceous units. Found over most of the body, PSUs consist of a sebaceous gland connected to a canal, called a follicle, that contains a fine hair (see "Normal Pilosebaceous Unit" diagram). These units are most numerous on the face, upper back, and chest. The sebaceous glands make an oily substance called sebum that normally empties onto the skin surface through the opening of the follicle, commonly called a pore. Cells called keratinocytes line the follicle. The (hair, sebum, and keratinocytes) that fill the narrow follicle may produce a plug which is an early sign of pimples. The plug prevents sebum from reaching the surface of the skin through a pore. The mixture of oil and cells allows bacteria "Propionibacterium" pimpless P. pimpless that normally live on the skin to grow in the plugged follicles. These bacteria produce chemicals and enzymes and attract white blood cells that cause inflammation. (Inflammation is a characteristic reaction of tissues to disease or injury and is marked by four signs: swelling, redness, heat, and pain.) When the wall of the plugged follicle breaks down, it spills everything into the nearby skin – sebum, shed skin cells, and bacteria – leading to lesions or pimples. People with pimples frequently have a variety of lesions. The basic pimples lesion, called the comedo, is simply an enlarged and plugged hair follicle as seen in the diagram on the right. If the plugged follicle, or comedo, stays beneath the skin, it is called a closed comedo and produces a white bump called a whitehead, which is visible on the surface of the skin. Squeezing or poping these whiteheads can cause lesions and scar tissue to form! A comedo that reaches the surface of the skin and opens up is called an open comedo or blackhead because it looks black on the skin's surface. This dark or black colour is due to changes in the sebum as it is exposed to the air and is in fact not black due to dirt This solid sebum plug is both weather and water proof and is why it does not dissipate normlly by itself. It has to be either physically or chemically removed.

Other troublesome Pimple and Acne lesions can develop, including the following:

• Papules – inflamed lesions that usually appear as small, pink bumps on the skin and can be tender to touch
• Nodules – large, painful, solid lesions that are lodged deep within the skin
• Cysts – deep, painful, pus-filled lesions that can cause scarring.

What causes Pimples?

The exact cause of pimples is unknown, but doctors believe it results from several related factors. One important factor is an increase in hormones called androgens (male sex hormones). These increase in both boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy or starting or stopping birth control pills can also cause pimples.

Another factor is heredity or genetics. Researchers believe that the tendency to develop pimples can be inherited from parents. For example, studies have shown that many school-age boys with pimples have a family history of the disorder. Certain drugs, including androgens and lithium, are known to cause pimples. Greasy cosmetics may alter the cells of the follicles and make them stick together, producing a plug.

Factors that can make Pimples worse

Factors that can cause a pimple flareup include:

• Changing hormone levels in adolescent girls and adult women shortly before their menstrual period begins.
• Oil from skin products (moisturizers or cosmetics) or grease encountered in the work environment
• Pressure from tight collars, or tight sports uniforms, headbands, caps.
• Environmental irritants, such as pollution and high humidity climates.
• Squeezing or picking at skin blemishes.
• Hard scrubbing or rough treatment of the skin.
• Stress and Anxiety.

Myths about the causes of Pimples

There are many myths about what causes pimples. Chocolate and greasy foods are often blamed, but there is little evidence that foods have much effect on the development and course of pimples in most people. Another common myth is that dirty skin causes pimples; however, blackheads and other pimples lesions are not caused by dirt. Stress doesn't cause pimples, but research suggests that for people who have pimples, stress can make it worse.

Who gets Pimples?

People of all races and ages get pimples. It is most common in adolescents and young adults. An estimated 80 percent of all people between the ages of 12 and 32 have pimples outbreaks at some point. For most people, pimples tends to go away by the time they reach their thirties; however, some people in their forties and fifties continue to have this skin problem.

How are Pimples treated?

Pimples is often treated by dermatologists (doctors who specialize in skin problems). These doctors treat all kinds of pimples, particularly severe cases. Doctors who are general or family practitioners, pediatricians, or internists may treat patients with milder cases of pimples.

The goals of treatment are to heal existing lesions, stop new lesions from forming, prevent scarring, and minimize the psychological stress and embarrassment caused by this disease. Drug treatment is aimed at reducing several problems that play a part in causing pimples:

• Abnormal clumping of cells in the follicles
• Increased oil production
• Bacteria
• Inflammation.

Medicine side effects?

To be able to determine if isotretinoin should be stopped if side effects occur, your doctor may test your blood before you start treatment and periodically during treatment. Side effects usually go away after the medicine is stopped.

Treatments for hormonally influenced Pimples in women

In some women, pimples is caused by an excess of androgen (male) hormones. Clues that this may be the case include hirsutism (excessive growth of hair on the face or body), premenstrual pimples flares, irregular menstrual cycles, and elevated blood levels of certain androgens.

The doctor may prescribe one of several drugs to treat women with this type of pimples:

• Birth control pills – to help suppress the androgen produced by the ovaries
  
  
• Low-dose corticosteroid drugs, such as prednisone (Deltasone) or dexamethasone (Decadron, Hexadrol) – to help suppress the androgen produced by the adrenal glands
  
  
• Antiandrogen drugs such as spironolactone (Aldactone) – to reduce the excessive oil production.

Side effects of antiandrogen drugs may include irregular menstruation, tender breasts, headaches, and fatigue.

Other treatments for Pimples

Doctors may use other types of procedures in addition to drug therapy to treat patients with pimples. For example, the doctor may remove the patient's comedones during office visits. Sometimes the doctor will inject corticosteroids directly into lesions to help reduce the size and pain of inflamed cysts and nodules.

Early treatment is the best way to prevent pimples scars. Once scarring has occurred, the doctor may suggest a medical or surgical procedure to help reduce the scars. A superficial laser may be used to treat irregular scars. Dermabrasion (or microdermabrasion), which is a form of "sanding down" scars, is sometimes used. Another treatment option for deep scars caused by cystic pimples is the transfer of fat from another part of the body to the scar. A doctor may also inject a synthetic filling material under the scar to improve its appearance.

How should people with Pimples care for their skin?

Clean Skin Gently If you have pimples, you should gently wash your face with a mild cleanser, once in the morning and once in the evening, as well as after heavy exercise. Wash your face from under the jaw to the hairline and be sure to thoroughly rinse your skin.

Using strong soaps or rough scrub pads is not helpful and can actually make the problem worse. Astringents are not recommended unless the skin is very oily, and then they should be used only on oily spots.

It is also important to shampoo your hair regularly. If you have oily hair, you may want to wash it every day.

Avoid frequent handling of the skin

Avoid rubbing and touching skin lesions. Squeezing, pinching or picking blemishes can lead to the development of scars or dark blotches.

Shave carefully

Men who shave and who have pimples should test both electric and safety razors to see which is more comfortable. When using a safety razor, make sure the blade is sharp and soften your beard thoroughly with soap and water before applying shaving cream. Shave gently and only when necessary to reduce the risk of nicking blemishes.

Avoid a Sunburn or Suntan

Many of the medicines used to treat pimples can make you more prone to sunburn. A sunburn that reddens the skin or suntan that darkens the skin may make blemishes less visible and make the skin feel drier. However, these benefits are only temporary, and there are known risks of excessive sun exposure, such as more rapid skin aging and a risk of developing skin cancer.

Choose cosmetics carefully

While undergoing pimples treatment, you may need to change some of the cosmetics you use. All cosmetics, such as foundation, blush, eye shadow, moisturizers, and hair-care products should be oil free. Choose products labeled noncomedogenic (meaning they don't promote the formation of closed pores). In some people, however, even these products may make pimples worse.

For the first few weeks of treatment, applying foundation evenly may be difficult because the skin may be red or scaly, particularly with the use of topical tretinoin or benzoyl peroxide.

What research is being done on Pimples?

Medical researchers are working on new drugs to treat pimples, particularly topical antibiotics to replace some of those in current use. As with many other types of bacterial infections, doctors are finding that, over time, the bacteria that are associated with pimples are becoming resistant to treatment with certain antibiotics, though it is not clear how significant a problem this resistance represents.

Scientists are also trying to better understand the mechanisms involved in pimples so that they can develop new treatments that work on those mechanisms. For example, one group of NIAMS-supported researchers is studying the mechanisms that regulate sebum production in order to identify ways to effectively reduce its production without the side effects of current medicines. Another group is trying to understand how P. pimpless activates the immune system in order to identify possible immunologic interventions. Other areas of research involve examining the effects of isotretinoin on an area of the brain that might lead to depression and developing a laser system to treat pimples and pimples-related scars without damaging the outer layers of the skin.