Acne is a skin condition that occurs when hair follicles become clogged. And according to the American Academy of Dermatology (AAD), it is the most common skin condition in the United States. Acne commonly appears on the face, back, and chest and causes different types of blemishes, including blackheads, whiteheads, and pustules (what many call pimples).
Although it mostly affects teenagers, acne can occur at any age. Newborns can get acne, and a growing number of women are being affected by the condition in their 30s, 40s, 50s, and beyond.
If not treated, acne can cause permanent scarring and lead to depression and low-self esteem. Fortunately, there are many effective treatments available.
Acne signs and symptoms vary depending on its severity. It usually causes any of the following blemishes:
- Blackheads (open comedones): small, dark-colored bumps that appear on your skin. They are black due to oxidation, not dirt.
- Whiteheads (closed comedones): small, white bumps on the skin’s surface, which cannot be pushed out.
- Papules: small, red, tender bumps on the skin.
- Pustules: red, tender bumps with a white tip following pus build-up.
- Nodules: lumps beneath the surface of the skin that may be malignant or benign.
- Cysts: sacs that form in the skin or any part of the body and which contain fluid, air, or semisolid material. They are more likely than other acne spots to cause permanent scars.
Besides the face, back, and chest as aforementioned, acne can also occur on the neck, shoulders, upper arms, and buttocks.
You develop acne when your hair follicles clog. Hair follicles are small openings in your skin from which hair grows. They are attached to sebaceous glands, which produce an oily substance called sebum. Sebum lubricates your hair and skin to prevent them from drying out.
Sebum also carries dead skin cells through the follicles to the skin surface for shedding. However, when your body produces too much sebum, it mixes with dead skin cells forming a plug in the follicle.
If the clogged follicle is close to the surface, it may bulge creating a whitehead. Alternatively, it can open to the surface, which exposes the trapped bacteria and oil to air. As a result, a blackhead is formed from the comedo turning black due to oxidation.
Additionally, harmless bacteria that live on your skin can get in the clogged pore infecting it. Depending on the severity of the infection, you can develop either papules, pustules, nodules, or cysts.
Factors that may worsen acne
These factors have been known to trigger or aggravate acne:
- Hormones: androgens are hormones whose levels increase during puberty, causing the sebaceous glands to grow and produce more sebum. Changes in hormone levels associated with pregnancy, periods, and the use of oral contraceptives can also influence sebum production.
- Certain medications: these include drugs that contain lithium, corticosteroids, or testosterone.
- Oil-based cosmetics: using skincare products that contain oil can cause an acne outbreak.
- Stress: it doesn’t cause acne but can worsen it.
- Genetics: if your parents had acne, you’re also likely to develop it.
- Friction or pressure on your skin: this could be from items you regularly wear or use such as headbands, cellphones, backpacks, and helmets.
- Age: acne mostly affects teenagers or young adults.
Although acne is a widespread skin condition, there are a lot of myths and misconceptions surrounding it, these include:
- ‘A poor diet causes acne.’ No studies have found any foods to cause acne. But eating a healthy, balanced diet promotes your overall health.
- ‘Poor hygiene causes acne.’ Dirt on your skin’s surface does not cause acne. On the contrary, excessive washing and scrubbing of your skin can worsen acne.
- ‘Sexual activity can influence acne.’ Neither having sex nor masturbation betters or worsens your acne.
- ‘Acne is contagious.’ You cannot pass or get acne from another person.
A doctor or dermatologist diagnoses acne by examining your skin for the different types of acne spots, that include blackheads, pustules, and nodules. Dermatologists grade acne in these four categories based on severity:
- Grade 1 (mild): open and closed comedones with a few papules and pustules.
- Grade 2 (moderate): multiple papules and pustules, mostly confined to the face.
- Grade 3 (moderately severe): many papules and pustules and occasional inflamed nodules, affecting the face, chest, and back.
- Grade 4 (severe): many large, painful pustules and nodules or cysts.
If you are found to have acne, you will be treated depending on how severe your acne is.
There are various effective acne treatments available. Where you should go for treatment and the treatment you should get depends on the severity of your acne.
Over-the-counter acne treatment products
If you have mild or moderate acne, which is characterized by comedones and papules and or pustules, a pharmacist can advise you on how to treat them with over-the-counter acne treatment products.
OTC or nonprescription acne products include gels, creams, towelettes, lotions, and soaps. These products work differently depending on the active ingredients they contain. Common active ingredients found in OTC acne treatment products include:
- Benzoyl peroxide: kills acne-causing bacteria, dries excess oil from your skin, and accelerates the replacement of dead skin cells.
- Salicylic acid: breaks down oil and dead skin cells that clog hair follicles.
- Resorcinol: works by breaking down rough, scaly, or hardened skin.
- Sulfur: removes dead skin cells that clog pores and helps remove excess oil.
- Azelaic acid: gets rid of dead skin and kills bacteria.
- Glycolic acid and lactic acid: remove dead skin cells and reduce inflammation.
Caution: The Food and Drug Administration (FDA) warns that some popular OTC acne products can cause a severe reaction, including throat tightness and swelling of the face, lips, or tongue.
However, a reaction like this is rare and should not be confused with the redness, itchiness, or irritation that could occur from using these products.
If you are uncertain about which product to buy, begin with benzoyl peroxide as it’s effective and well-tolerated by most people. It is also advisable to start with lower strength products to minimize redness, irritation, and other skin problems.
Prescription acne medications
If your acne doesn’t improve after several weeks of treatment using OTC acne products, consider seeing your doctor or dermatologist for a prescription of stronger medication. Prescription medicines that can be used to treat acne include:
The most common topical prescription medications for acne are:
- Retinoids: they work by removing dead skin cells from the surface of the skin (exfoliating), preventing the hair follicles from clogging. Examples include tretinoin and adapalene, which are available as gels or creams. Topical retinoids are usually applied once a day before you go to bed.
- Antibiotics: they help kill excess skin bacteria and reduce redness. Topical antibiotics are combined with benzoyl peroxide to reduce the risk of the bacteria becoming resistant to the antibiotics. They come in gels and lotions, and examples include clindamycin with benzoyl peroxide and erythromycin with benzoyl peroxide.
- Azelaic acid: works by killing bacteria and getting rid of dead skin cells. For azelaic acid to improve your acne, you’ll need to apply it twice a day for at least four weeks. It is even more effective when used together with erythromycin.
- Antibiotics: for more severe acne, you may need antibiotic tablets to reduce bacteria and fight inflammation. Tetracyclines such as minocycline and doxycycline are usually the most prescribed. It takes about six weeks before you notice an improvement in your acne. Antibiotic tablets can make your skin sensitive to sunlight and cause dizziness.
- Combined oral contraceptive pill: can be recommended even if you’re not sexually active. Helps improve acne in women, but you may not see the benefit of this treatment for up to a year. Examples include Ortho Tri-Cyclen and Yaz.
- Isotretinoin: only recommended for severe cases of acne that haven’t responded to other treatments. Doctors need to closely monitor anyone they treat with isotretinoin because it carries the risk of severe side effects. These potential side effects include inflammation and irritation of your eyes (conjunctivitis), birth defects, kidney disease, and suicidal thoughts.
Several acne treatments do not involve medication. These include:
- Lasers and photodynamic therapy: light energy is passed through the skin to improve acne symptoms.
- Chemical peels: a chemical solution is applied to the skin, causing it to exfoliate and eventually peel off revealing new skin.
- Comedone/blackhead extractor: a small metal tool with a loop at one end and a lancet on the other used to remove blackheads and whiteheads. It may cause scarring.
Prevention and management tips
Here are a few tips on how to look after skin that has acne or is prone to it.
- Wash your face with warm water and mild soap twice a day.
- Wash your hair regularly as it collects sebum and skin residue. Avoid using greasy hair products such as those containing cocoa butter.
- Wash your hands frequently, especially before applying makeup or lotions.
- Shower after strenuous activities to avoid acne breakouts caused by oil and sweat buildup.
- Use an electric shaver or sharp safety razors when shaving and soften your skin and beard with warm soapy water before applying shaving cream.
- Avoid touching your face or picking at the problem areas as it may lead to infection and scarring.
- Use cosmetics and skincare products that are labeled non comedogenic, which means they are less likely to cause acne.
- Avoid facial scrubs, astringents, and masks as they tend to irritate the skin, which can worsen acne.
- Avoid friction or placing pressure on your skin as you would when talking on your cell phone.
- Avoid tight garments, such as headbands, caps, and scarves, or wash them regularly if used.
Avoid excessive sun exposure, as it can worsen acne in some people. And some acne medications make you more susceptible to sunburn.
- Acne by mayo clinic staff (2018) https://www.mayoclinic.org/diseases-conditions/acne/symptoms-causes/syc-20368047
- Acne Overview (2019) https://www.nhs.uk/conditions/acne/
- Why treat acne (n.d) https://www.aad.org/public/diseases/acne-and-rosacea/acne
- What you need to know about acne (2017) https://www.medicalnewstoday.com/articles/107146.php
- Skin treatments (n.d) https://www.asds.net/skin-experts/skin-treatments
- Management of Acne (2011) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3080563/