Managing Acne: Causes, Types, and Treatment

Acne is a common skin condition that typically occurs in adolescence, beginning around puberty, but can last into early adulthood. Acne is inflammation of the skin pores and follicles that causes sores. It is an ongoing problem that can last for years.

What causes acne?

Acne develops when the pores or hair follicles in the skin come clogged. Glands in the skin create a special oil called sebum to keep the skin from drying out. Sebum and dead skin cells get trapped in the follicles allowing bacteria to grow. The bacteria creates an infection leading to swelling, redness, pain, and pus or sores known as pimples. This can happen as a single pimple or in an outbreak affecting multiple pores.

While excess oil, dead skin cells, and bacteria are the source of acne, there are other causes at work. The following factors increase the risk of acne:

  • Hormones increase during puberty, which causes the sebaceous glands to become larger and produce more oil, leading to an increased risk of acne.
  • A family history of acne means you are more likely to develop it as well.
  • Certain medications containing hormones, steroids, or lithium may cause acne.
  • Use of oil-based or greasy products like lotions or creams; or regular contact with grease or oil like restaurant cooking oils.

These factors do not cause acne but can worsen symptoms:

  • Diet or foods do not cause acne, though certain foods like carbohydrates may make it worse.
  • Foods like sugar, chocolate, and greasy foods do not affect acne.
  • Stress
  • Scrubbing your skin too hard.
  • Acne is not caused by dirty skin.
  • Cosmetics do not increase acne, though be sure to use oil-free and remove it regularly.
  • Picking at acne sores.
  • Friction or pressure on the skin from hats, helmets, and backpacks can irritate the skin.

Who gets acne?

Acne is most common in teenagers and adults in their early twenties. Less commonly, it can last into the thirties. Some people still struggle with it into their forties or fifties on rare occasions. Acne is more common in males at earlier ages but more common in females at later ages. It affects people of all races.

Symptoms

Acne appears as pink or red raised areas on the skin. These areas may be open, meaning fluid is draining from the inside or covered with a scab, or closed, meaning the skin is still intact. The sores are often painful, especially when swelling increases. Acne most commonly develops on the face, back, chest, neck, and shoulders.

Types

Acne presents with several types of sores or pimples:

  • Whiteheads: Closed pimples that have a white pus-filled top.
  • Blackheads: Open pimples with a black top resulting from the chemical process of the oil in the pore exposure to air.
  • Papules: Small, tender pink bumps.
  • Pustules: Pimples with pus on top and red, inflamed bottoms that present with inflammatory acne.
  • Nodules: Large, hard, painful pimples that come from deep in the skin.
  • Cysts: Deep, painful, pus-filled pimples that result in scars.

Diagnosing Acne

Your healthcare provider can diagnose acne with a physical examination of your skin. They may ask questions about your current symptoms, including when they started, details about puberty symptoms, menstrual cycle questions for females, and medications. They will also ask about family history and how you currently take care of your skin.

Testing is not required for diagnoses. However, if another medical condition is the suspected cause, your healthcare provider may order tests. Your healthcare provider may also refer you to a specialist known as a dermatologist for treatment.

Managing acne

Treating acne can take two to three months before signs of improvement. Acne occurs on several levels, the surface level, which is easily seen, and the levels below the skin's surface. Treatments take longer to clear what is below the surface, and acne may continue to develop for the first several weeks of treatment.

The most important treatment is skincare. This includes:

  • Skin hygiene is an essential part of treatment but must be done well. Wash your face twice a day (not more unless necessary) with a gentle skin cleanser and warm water. Avoid hot water, washcloths, and abrasive scrubbers on your face. Aggressive washing can make acne worse or damage skin.
  • Do not squeeze pimples. It causes swelling and scarring and can lead to infection.
  • Use a moisturizer to avoid dry skin or peeling, especially if using acne treatments, as this may be a side effect. Be sure to use oil-free moisturizers to reduce blocking pores and adding to the problem.
  • Use a broad-spectrum sunscreen with SPF 30 or higher before sun exposure. Acne treatments can increase skin sensitivity, increasing the risk of burns.

Treatments are available over the counter for mild acne or prescription for more severe types. Treatments come in various forms, including topical and oral medications, and vary based on the severity of the acne.

  • Benzoyl peroxide, applied twice daily, breaks down bacteria and oil. It can irritate the skin resulting in redness, dryness, or flaking.
  • Antibiotics, available in topical or oral options if needed, reduce bacteria leading to decreased inflammation.
  • Retinoids, also available in topical and oral forms, reduce inflammation, prevent scarring, and diminish new acne.
  • Hormone therapy use in females may regulate hormones and lessen oil production.
  • Steroids decrease inflammation in severe acne.

Other treatments are available for severe acne, such as laser therapy, light therapy, and chemical peels.

Is acne preventable?

Preventing acne is very difficult because it is impossible to regulate its causes. Hormones frequently fluctuate, causing the skin and oils to change. You may minimize symptoms by taking care of your skin as mentioned in the treatments above.

Complications

Scarring or changes in skin color can occur as a result of acne. These complications tend to occur in people with darker skin or those with more severe acne. Seek care from your healthcare provider and follow your skincare regimen to avoid these complications.

References:

Cleveland Clinic. Acne

Johns Hopkins Medicine. Acne

Mayo Clinic. Acne

National Institutes of Arthritis and Musculoskeletal and Skin Diseases. Acne

UpToDate: Patient education: Acne (Beyond the Basics)

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