Acne is driven by sebaceous gland secretions, most common in teenagers, can also occur in adults and in the first few weeks of life (transplacental hormone influences) and occasionally starts at age 8 or 9. The face, chest and upper back are most commonly affected sites although acne may be present on the shoulders, arms, underarms, groin and scalp. Acne may induce lifelong scarring and thereby affect a person's self-esteem. Acne is as a general rule quite curable, excluding those regions which in which scarring has been so severe as to cause cyst formation in sinus tracts which may network the acne scarred face. Even such advanced cases may benefit tremendously from dermatologic management, from the simple topical home remedies to the most elaborate scar revisions which may include scar subcision, soft-tissue augmentation, skin resurfacing, the latter involving peels, lasers and abrasive techniques). In some cases, entire face lifting as well as botox may be necessary to control the damage to the patient's sense of esthetic self-esteem.

Acne is generally earlier in onset and most severe in young men, where as women suffer from a long, slow acne development process. The biologic speaking, acne is driven by androgenic sex hormones, testosterone and androstenedione. Androgen sensitive hair follicles contain the sebaceous glands which thicken of childhood facial skin of the face, scalp, ears, neck, upper back, chest shoulders and arms. Ensuing sebaceous secretions overwhelm clogged hair follicle outlets (pores). Acne is not typically caused by infection, but it sets the stage for secondary infections. Sebacous glands reflect nature's attempts to provide protection from the elements that primitive man encountered. At ages 12-14, boys and girls were expected to make their own way and catch their own food so nature provided them with the hormone of aggression, testosterone. In general, estrogens decrease sebaceous gland activity and androgens increase it. In women, androgens are produced by the ovaries (markedly so in polycystic ovary disease), the placenta and adrenals, and in men by the testes and adrenals. While males experience a peak in testosterone at age 18, female testosterone peaks at 31. Birth control pills by their estrogenic effects have a mild effect on acne. It is occasionally noticed that some of the more androgenic preparations may aggravate acne and even produce mild hirsutism. A certain amount of trial and error for each individual is therefore necessary to pick out the best contraceptive.

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