A pimple is a small pustule or papule. Pimples are small skin lesions or inflammations of the skin - they are sebaceous glands (oil glands) which are infected with bacteria, swell up, and then fill up with pus.

Pimples are also known as spots or zits

Pimples occur when the sebaceous glands, which are located at the base of hair follicles, become overactive. The most vulnerable parts of the body are the face, back, chest and shoulders. Pimples are palpable signs of acne, especially when a breakout occurs.

Concern is growing among experts regarding the long-term use of antibiotics for acne treatment, and its contribution to bacterial resistance. Experts from the Centre of Evidence-Based Dermatology at the University of Nottingham, England, wrote inThe Lancet (August 2011 issue) that although

pharmacies are well stocked with a wide range of acne medications, few studies have been carried out regarding their efficacy.What are the sebaceous glands?

The sebaceous glands are tiny skin glands which secrete sebum - an waxy/oily substance - to lubricate the skin and hair of mammals (humans are mammals).

In human beings they exist throughout all skin sites except the palms and soles; there is a greater abundance of sebaceous glands on the face and scalp. In our eyelids, meibomian sebaceous glands secrete a special type of sebum into tears.

Several medical conditions are linked to an abnormality in sebaceous gland function, including:

Acne (pimples).

Sebaceous cysts - closed sacs or cysts below the surface of the skin.

Hyperplasia - the sebaceous glands become enlarged, producing yellow, shiny bumps on the face.

Sebaceous adenoma - a slow-growing tumor (benign, non-cancerous) usually presenting as a pink, flesh-colored, or yellow papule or nodule.

Sebaceous gland carcinoma - an aggressive (cancerous) and uncommon skin tumor.

If a breakout occurs, doctors recommend that they be treated promptly to prevent the risk developing severe acne. There is also the

danger that untreated severe acne may result in visible scars on the skin.What are the causes of pimples?

The sebaceous glands, which produce sebum, exist inside the pores of our skin. The outer layers of our skin are being shed continuously.

Sometimes, dead skin cells are left behind and get stuck together by the sticky sebum, causing a blockage in the pore.

Pore blockage is more likely to occur during puberty (the process of physical changes by which a child's body becomes an adult body capable of reproduction). More sebum is produced by the sebaceous gland - as the pore is blocked, it accumulates behind the blockage.

This accumulated and blocked sebum has bacteria, including Propionibacterium acnes;

this slow-growing bacterium is linked to acne. Propionibacterium acnes generally exists harmlessly on our skin - however, when the conditions are right, it can reproduce more rapidly and become a problem. The bacterium feeds off the sebum and produces a substance that causes an immune response, leading to inflammation of the skin and spots.

"Good" and "bad" bacteria determine severity and frequency of pimples - researchers at the Washington University School of Medicine identified two unique strains of P. acnes among 20% of people with pimples and hardly any among those with healthy skin. They found the opposite with a different P. acnes strain.

The skin of people who are prone to acne are especially sensitive to normal blood levels of testosterone - a natural hormone found in both males and females. In such people the

testosterone can make the sebaceous glands produce too much sebum, making the clogging up of dead skin cells more likely, which in turn increases the probability of blocking the pores, etc.

You cannot catch pimples from another person; they are not infectious.

Dairy products and high glycemic index foods linked to pimples - researchers from New York University reported in the Journal of the Academy of Nutrition and Dietetics that people who eat a lot of high glycemic index foods and dairy products are more likely to have acne. They also suggested that using MNT (medicalnutrition therapy) may help in the treatment of acne.

Having pimples or acne can be hereditary.Signs and symptoms of pimples - Types of pimples

Whiteheads - also known as a closed comedo. These are very small and remain under the skin, appearing as a small, flesh-colored papules.

Blackheads - also known as an open comedo. These are clearly visible; they are black and appear on the surface of the skin. Some people mistakenly believe they are caused by dirt, because of their color, and scrub their faces vigorously - this does not help and may irritate the skin and cause other problems.

Papules - these are small, solid, rounded bumps that rise from the skin. The bumps are often pink.

Pustules - these are pimples full of pus. They are clearly visible on the surface of the skin. The base is red and the pus is on the top.

Nodules - these are morphologically similar (similar structure) to papules, but larger. They can be painful and are embedded deep in the skin.

Cysts - these are clearly visible on the surface of the skin. They are filled with pus and are usually painful. Cysts commonly cause scars.

How common are pimples (acne)?

Acne is the most common skin disease for adolescents. According to the British Medical Journal (Clinical Evidence, Authors: Sarah Purdy, David DeBerker):

More than 80% of teenagers get acne at some point.

A community sample of 14 to 16 year-olds in the United Kingdom revealed that acne affected 50% of them.

A sample study of adolescents in New Zealand found acne was present in 91% of boys and 79% of girls.

A sample study of adolescents in Portugal found that the average prevalence of acne (in both sexes) was 82%.

30% of teenagers with acne required medical treatment because of its severity.

General practitioners (GPs, primary care physicians) in the UK reported that 3.1% of 13 to 25 year-old patients visited them complaining of acne.

The incidence of acne is similar in both adult males and females.

Doctors report that acne appears to peak at 17 years of age.

Acne incidence (presence, occurrence) in adults is increasing, doctors report. We don't know why.

What are the treatments for pimples? How can I treat my pimples?

Last updated: 26 September 2014

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Pimples (acne, zits, spots) affect the skin of the majority of teenagers and a significant number of adults. Some individuals are lucky and have occasional breakouts while others may experience ongoing (chronic) problems. The

presence of pimples on the skin, especially the face, may cause anxiety and embarrassment.Treating pimples promptly can also help overcome its emotional and psychological effects. Although pimples are not in themselves bad for overall health, living with them, especially if they are persistent and become a long-term problem can be as devastating emotionally as living with a chronic disease.Studies have shown that people with regular breakouts of pimples are more likely to develop depression.Experts say that acne should be treated promptly, especially if the individual is prone to getting pimples.Contents of this article:

1. Self-help treatments 2. A virus that eats bacteria 3. Over-the-counter treatment 4. Prescription medication

5. What makes pimples worse? You will also see introductions at the end of some sections to any recent developments that have been covered by MNT's news stories. Also look out for links to information about related conditions.

Fast facts on pimplesHere are some key points about pimples. More detail and supporting information is in the main article. Pimples are developed by the majority of

teenagers and a significant number of adults.

Pimples can cause anxiety and embarrassment, particularly when situated on the face.

Prompt treatment of pimples often helps with overcoming their emotional and psychological effects.

People with regular breakouts of pimples are more likely to experience depression.

The risk of developing pimples is increased by a diet high in dairy products and high glycemic index foods.

To reduce the risk of pimples, it is recommended that people wash their faces about twice each day - not more often.

Popping (bursting) pimples can make the skin infection worse.

Over-the-counter (OTC) pimple treatments often contain active ingredients such as benzoyl peroxide, salicylic acid and sulfur.

Prescription medication for pimples includes topical treatment, antibiotics and laser and light therapy.

Breakouts of pimples can be made worse by the stress and anxiety, makeup and greasy hair.

Self-help treatments

Diet

Researchers from New York University reported in the Journal of the Academy of Nutrition and Dietetics that a diet high in dairy products and high glycemic index foods increases the risk of developing pimples. The scientists also suggest that using medical nutrition therapy may help reduce the number and severity of acne outbreaks.

There is a risk you may push the infection further down, causing more serious blockage and worse swelling and redness if you try to

burst the pimple.

Washing your face

Wash your face about twice each day - not more often. Make sure you have a mild soap. Use warm water. Wash gently; do not scrub

the skin. Experts advise the use of an OTC lotion which contains benzoyl peroxide.

Do not pop (burst) the pimple

There is a risk you may push the infection further down, causing more serious blockage and worse swelling and redness. Popping pimples also increases the risk of scarring.

If you need to get rid of it

If you have an important event, such as a public-speaking engagement or wedding and it is important to get rid of a sightly pimple, get a specialist to treat it for you.

Touching your face

Even though this may require some willpower, try to refrain from touching your face with your hands. If you are using a telephone, do not let receiver touch the skin of your face - it may have skin residue or sebum on it. Before

touching your face make sure you always wash your hands with soap.

Hand hygiene

Keep your hands and nails as clean as you can by washing them regularly with soap. Keep your nails short.

Glasses (spectacles)

Glasses collect sebum and skin residue; clean them regularly.

Loose clothing

If the pimples are on parts of your body covered by clothing, such as your back, shoulders or chest, wear loose clothing. Whenever possible, avoid wearing headbands, caps and scarves - if you have to wear them, wash them regularly. In short - allow your skin to breathe.

Makeup

Make sure you have taken all your makeup off when you go to sleep. Only use makeup that is nonceomedogenic or nonacnegenic - you should be able to read this on the label.

Hair

Sebum and skin collects in hair. Keep your hair clean. Try to keep your hair away from your face.

Sun exposure

Overexposure to sunlight may sometimes result in the production of more sebum. Some medications used by people with acne may make your skin more prone to sunburn.

Shaving your face

Be careful when you shave. Either use safety razors (make sure blade is sharp) or an electric

shaver. Before shaving, soften the skin with warm, soapy water before applying the shaving cream - the skin is softer straight after a warm shower.

A virus that eats bacteria

A study published in American Society for Microbiology explained that Propionibacterium acnes phages , a harmless family of viruses that live on human skin, destroy the bacterium called Propionibacterium acnes that grows in our pores and commonly activates acne.Lead researcher, Dr. Robert Modlin, from the David Geffen School of Medicine at UCLA, said:

"Acne affects millions of people, yet we have few treatments that are both safe and effective. Harnessing a virus that naturally preys on the bacteria that causes pimples could offer a promising new tool against the physical and emotional scars of severe acne."

Propionibacterium acnes can irritate the immune system, causing pimples to form. Most treatments attempt to decrease the number of Propionibacterium acnes on the skin. Dr. Modlin and team believe thatPropionibacterium acnes phages could be used to seek out and destroy the acne-causing bacterium.

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Over-the-counter treatment

The majority of OTC products for pimples or acne contain the following active ingredients:

Resorcinol

Resorcinol helps break down blackheads and whiteheads. It is a crystalline phenol (carbolic acid, C6H5OH) and comes from various resins. This active ingredient is also used for the treatment of dandruff, eczema andpsoriasis.

Benzoyl Peroxide

(C6H5CO) 2O2 - this active ingredient attacks and kills bacteria and slows down the glands' production of oil. Benzoyl works as a peeling agent, accelerating skin turnover and clearing pores, which in turn reduces the bacterial count in the affected area.

Salicylic Acid

C6H4 (OH)COOH - helps break down blackheads and whiteheads, also slows down the

shedding of cells which line the follicles of the oil glands, effective in treating inflammation and swelling. Salicylic acid is a white crystalline substance which is also used as a fungicide, or in making aspirin or dyes or perfumes. It causes the epidermis to shed skin more easily, prevents pores from becoming blocked while at the same time allowing space for new cells to grow. Many dandruff shampoos contain salicylic acid.

Sulfur

A chemical element which is denoted with the symbol S. It helps breakdown blackheads and whiteheads. Sulfur, in its native form, is a yellow crystalline solid. Sulfur has been used for centuries for treating acne, psoriasis and eczema. Scientists are not sure how sulfur works to help skin diseases. We do know that elemental sulfur does oxidize slowly to

sulfurous acid which is a mild reducing and antibacterial agent.

Retin-A

Retin-A helps unplug blocked pores. Retin-A contains Tretinoin, an acid form of vitamin A, also known as all-trans retinoic acid (ATRA). Tretinoin is also used for the treatment of acute promyelocytic leukemia. Retin-A has been used widely to combat aging of the skin, it also acts as a chemical peel. It was the first retinoid developed for acne use by applying it on the skin (retinoids are a class of chemical compounds that are related chemically to vitamin A).

Azelaic Acid

HOOC(CH2)7CCOH - strengthens cells that line the follicles, stops oil eruptions, reduces bacteria growth. It is a saturated dicarboxylic acid found naturally in wheat, rye, and barley.

Azelaic acid also mops up free radicals, which reduces inflammation. It is useful for patients with darker skin who have dark patches on their face (melasma), or whose acne spots leave persistent brown marks.Most of these active ingredients may be found in medications in the form of gels, pads, creams, lotions and soaps. OTC medications will have different concentrations of these active ingredients; it is advisable to start with the lowest strengths. At first you may experience skin irritation, redness, or burning - eventually, after continued use, these side effects go away.

People with sensitive skin go for creams or lotions.

Gels tend to be better for people with oily skins. Gels are usually alcohol based and dry the skin.

Prescription medication

If OTC medications are not enough, consider seeing a dermatologists (skin-specialist doctor) or your primary care physician for a stronger prescription medication.

With drainage and extraction, the dermatologist removes a large cyst. The

procedure may be recommended if the cyst has not responded to medication.

Topical treatment

"Topical" means it is applied directly onto the skin. Most acne treatments involve topical medications. Examples include tazarotene, adapalene, and tretinoin. They are all prescription medications derived form vitamin A.

Some topical antibiotics may help get rid of excess bacteria on the skin.

As with many conditions, initially it may take some trial-and-error before you come across your ideal medication or combination. Some people find that a benzoyl peroxide combined with an antibiotic helps. Benzoyl peroxide should be used sparingly as too much can harm the skin. Do not let benzoyl peroxide get on your clothes because the peroxide part is a strong bleaching agent.Dapsone gel has been found to be very effective for patients with inflammatory acne.

Side effects linked to topical prescription medications include burning, peeling, redness, and stinging. It is important that the doctor and patient communicate regularly so that side effects can be kept to a minimum.

Antibiotics

Oral antibiotics (tablets) are typically used together with a topical treatment if the patient has severe acne. Most doctors prescribe tetracyclines, a class of antibiotics (not for pregnant or breastfeeding mothers, who should take an erythromycin).

Most patients on oral antibiotics should notice improvements after about six weeks. A course of oral antibiotics may last from four to six months.

Women on the birth control pill who are prescribed tetracyclines will need to use an alternative method of birth control during the first few weeks. Patients on tetracyclines

should avoid too much direct sunlight exposure.Antibiotic resistance is a growing problem among patients with pimples. Doctors will advise tapering off antibiotics as soon as symptoms start to improve, or as soon as it becomes obvious they are losing their efficacy. When topical benzoyl peroxide is prescribed together with an oral antibiotic the risk of antibiotic resistance is lower.

Isotretinoin

For very severe symptoms, such as deep cysts, the patient may require something stronger that antibiotics. Isotretinoin may be prescribed, but the doctor must monitor the patient closely, because there is a risk of serious side effects. Isotretinoin must not be prescribed to pregnant women.Some studies have linked isotretinoin usage with an increased risk of depression, and even

suicide. The American Academy of Dermatology Association (AADA) emphasized that studies suggested a correlation between isotretinoin usage and depression or anxiety, but not a causal relationship. William D. James, MD, FAAD, president of the AADA and its sister organization, the American Academy of Dermatology said "Isotretinoin offers our patients with severe acne significant, life-changing benefits. Providing this medicine safely is our top priority."Swedish scientists wrote in the BMJ (British Medical Journal) (November 2010 issue) that severe acne is the cause of depression or attempting suicide risk, and not isotretinoin usage.According to the American Academy of Dermatology, "isotretinoin is the only treatment that works on all that causes acne."

Birth control

Women with pimples may benefit if they take a combination of norgestimate and ethinyl estradiol. It is important that the doctor explains the slightly higher risk of hypertension, blood clots and heart diseaseassociated with birth control.

Laser and light therapy

Laser and light therapy targets p. acnes, the bacteria that cause acne inflammation. This therapy reaches deep into the skin without affecting the surface. Experts say that laser and light therapy causes the sebaceous glands to produce less oil by damaging them. Laser therapy for treating acne is a controversial subject; studies have come back with mixed results.

Chemical peels and microdermabrasion

Microdermabrasion is commonly used for skin rejuvenation and improving the appearance of atrophic acne scars. Dermatologists say these cosmetic procedures tend to be more effective when used alongside other acne treatments. According to the American Academy of Dermatology, skin specialist doctors use chemical peels to treat blackheads and papules.

Drainage and extraction

With drainage and extraction, the dermatologist removes a large cyst. The procedure may be recommended if the cyst has not responded to medication. Drainage and extraction also helps reduce the pain as well as the risk that the cyst will leave a scar. If the cyst has to be dealt with rapidly, the doctor may inject it with medication.

What makes pimples worse?

The menstrual cycle - females with pimples often find signs and symptoms worsen one or two weeks before their period (menstrual cycle) arrives. Experts say this is most likely due to hormonal changes that occur. Some females blame chocolates - they say they consume more chocolates during the week or two prior to their period. However, there is no evidence that links chocolate consumption to pimples.

Stress and anxiety - hormonal levels may be affected by anxiety or stress, especially levels of adrenaline and cortisol. Both these hormones are thought to make acne worse.

Some climates - especially ones that make the individual sweat more can cause acne to worsen. An individual who is prone to pimples may find it more difficult to cope in hot and humid climates.

Some makeups - any makeup that contains oil can make pimples worse in some susceptible individuals.

Greasy hair - hair may become greasy, as a result, of using some hair products, such as those with cocoa or coconut butter.

Bursting the pimple - the infection may be pushed down deeper. There is also a risk of scarring.

Further reading

What are pimples (zits, spots)? What causes pimples?Recent developments on pimples from MNT newsHuman zit-causing bacterium now infecting vineyardsIn a striking case of pathogen transfer involving the bacterium responsible for human acne, P. acnes, authors Campisano, et. al., report in the journal Molecular Biology and Evolution on a new type of P. acnes which

exploits grapevines, dubbing it P. acnes type Zappae.Some acne products can cause serious allergic reactions, FDA warnsThe Food and Drug Administration are warning consumers who use certain over-the-counter skin products for acne to stop using them and seek emergency medical help immediately if they experience extreme allergic reactions such as feeling faint, breathing difficulties, throat tightness or swelling of the eyes, lips, face or tongue.