Acne 101: Acne Causes

Episode #121 / Nov 11, 2009
We can all recognize acne: white heads, black heads and cysts. But do you know what causes acne? Or what treats acne? Or why acne treatments work? Dr. Schultz answers all of these questions in Acne 101.
Adam Goldstein on November 19, 2009 at 9:35pm

First of all, I would just thank you for responding to all of my posts. I love this website.

I have 2 questions pertaining to this subject. As you now know, i have been complaining about dry skin post-accutane.

First question, I still get some whiteheads from time to time now. Does this mean that my oil glands are still active? Because i thought i might just still be getting these whiteheads post-accutane because I apply so many thick moisturizers and oils to my skin to combat the dryness.

Second question, what is the difference between a pus pimple and a whitehead.? As you explained, the pus pimples are inflamed and the whiteheads are not inflamed. The reason I ask is because i'm curious to know that if my pimple eventually forms a head, but started off as a little painful bump under the skin, is that inflamed or not inflamed. I still get these very seldom but used to get them a lot before accutane. So just to say that again incase i made that confusing. Are pimples that start out as bumps, slightly painful, under the skin and take a little while to come to the surface, are these inflamed?

Thank you Dr. Schultz once again!

Neal Schultz, M.D. on November 20, 2009 at 5:33pm

@Adam: Thank you for your kind words about DermTV! Your questions show that you clearly have a very good understanding of the physiology of your skin. Below I will answer both:

Regarding question #1 - While post Accutane everyone's oil glands still function a little, I think your whitehead issue is strictly external occlusion from the "many thick moisturizers and oils" you have used in pursuit of fighting your skin's dryness. While glycolics are my treatment of choice for the condition you describe, because of your dry and sensitive skin, I would instead recommend gentle extrusion by either a professional facialist or dermatologist.

Regarding question #2 - A "pus pimple" contains pus which is yellowish. Given a few days it forms a crust and then heals leaving a red/pink flat mark for days to weeks. Pus is composed of white blood cells (and debris) which are one of the mediators of inflammation in the body, hence these are "inflammatory" lesions. On the other hand, a "whitehead" is a tiny collection of sebum/oil (from your oil gland or from skincare products) sometimes mixed with a few dead skin cells (from the lining of the follicle). There's no pus and no white cells and hence considered a non inflammatory pimple. Also, whiteheads tend to be very stable and usually just hang around until they gets popped or picked. So, the evolving painful pimples you are describing are most likely regular inflammatory acne lesions. On an interesting note, they are also an unwelcome confirmation that even post Accutane, oil glands retain some sebum synthesis ability.

magaly on November 21, 2009 at 5:28am

I'm sixteen so obviously I'm dealing with acne. However when I break out its normally one to two huge inflammatory pimples that sometimes take months to go away! Right at this moment Ive be been dealing with a pimple right on the tip of my nose and im already on topical acne medication and plan to see the dermatologist soon. However, I really want to know a way to get rid of these pimples in a safe way with out scarring. And this one on my nose is popped but its still very inflammed and seems to have blood underneath the surface but also a scab has already formed. I need help urgently!

Neal Schultz, M.D. on December 10, 2009 at 6:27pm

@magaly: Pimples on the nose are the toughest to deal with because the top and tip of the nose scar so easily (because there is no fat underneath). There are really only two options for healing:

(1) Get the body to take away the pus that is causing the pimple. To do this, make a warm compresses (washcloth soaked in warm but not hot water) and apply it to the pimple area for three-to-four minutes four times per day. In addition, topical meds like over-the-counter cortisone and products containing salicylic acid and sulfur or resourcinol can help. It usually takes two-to-five days.

(2) Physically remove the pus that is causing the pimple. On the nose in particular, physical removal must be done by a dermatologist because of the risk of scarring if too large of an opening in the skin is made when draining the pimple.

If it takes a long time for occasional pimples to go away, preventing them might be a better way to go (i.e., option #1).

Your first sentence "I'm sixteen so obviously I'm dealing with acne" is refreshingly calm and realistic. Good luck!

AGesss on April 10, 2010 at 5:29am

Does Tea tree oil work for pimples?

Neal Schultz, M.D. on June 1, 2010 at 1:04am

@AGesss: Tea tree oil has antibacterial properties and therefore is helpful for acne. Unfortunately at higher, more effective doses it can have an unpleasant odor.

Jennifer on June 27, 2010 at 11:43pm

Hello Dr. Schultz!
I will try to make this short, but have a long history with acne so bear with me! I am 18 years old, and have dealt with acne since I was 11. I had cystic acne and was prescribed accutane when I was 14, But it dried my skin out so horribly that it cracked. I honestly feel as though I have tried everything. although my acne is no longer severe, it is still a huge annoyance to me, and really effects my self esteem, I am on tri-cyclen lo now, and also take prozac for the depression the acne has caused. I have been on oral antibiotics, prescribed creams, I've tried proactiv, I recently ordered a skincare regimen for $300 that made my acne worse. I am really really fed up, I don't know what else to do. Are there any new treatments for acne? or should I try laser? Sorry for so many questions.. Thank you for your time!

Neal Schultz, M.D. on July 15, 2010 at 7:05pm

@Jennifer: The two options I would consider at this point are laser treatments(as you mentioned) or intense topical treatments involving weekly visits to a dermatologist who does superficial glycolic exfoliation treatments and extracts clogs and pus pimples (since it sounds like while your acne is persistent, it's not as cystic as before your accutane). To find a dermatologist specializing in acne visit The American Academy of Dermatology.