Acne is a common inflammatory skin condition that occurs when the follicles connecting pores and oil glands become clogged and oil starts to build up under the skin. As soon as the mixture of bacteria, sebum, hair and dead skin cells starts to break down, a small skin lesion forms underneath or at the surface of the skin, often accompanied by redness and pain.

In the United States, acne is the most common skin condition, affecting around 50 million people every year. Although it is often described as a teenage condition and occurs mostly during puberty, acne can affect people of all ages, especially between the ages 12 to 25. However, it can occur long after that. Despite being relatively harmless, acne is a complex skin condition that is often misunderstood and mistreated. Depending on the persistence of the bacteria causing it, acne can take several forms, each requiring a different treatment approach.


Acne Overview & Facts

One of the most important acne facts that anyone struggling with acne should know is that this skin condition is extremely common. On average, 4 out of 5 people have some form of acne and 85% of people under the age of 30 said they had acne at one point. Acne can affect both men and women, but differently. While female acne usually starts at 14 and peaks and the age of 17, male acne is statistically the worst around the age of 19. In women, acne can also appear during pregnancy and during their 40s.

According to the American Academy of Dermatology, people in the US spend more than a few billion per year on acne treatments, over the counter products in particular, but only a small percentage of them know that acne cannot be “cured”, only kept under control.

In the past years, mental health studies have revealed a new, dangerous face of acne: this harmless condition can cause deep psychological damage, especially during puberty. A worrying 95% of people dealing with acne confessed that it made them feel depressed and caused self confidence issues. Meanwhile, 15% said that acne made them have suicidal thoughts.


Stages of Acne


Types of Acne

Not all acne manifests in the same way. In fact, patients can experience different levels of discomfort, depending on the type of acne they have. Dermatologists recognize two acne types:

1. Non-inflammatory acne, which causes non-inflamed comedones. These can be either whiteheads or blackheads.

  • Whiteheads are small white spots that sit under the skin surface and don’t come to a head. They contain trapped sebum and bacteria and make the skin look bumpy.
  • Blackheads are larger and darker in color. Contrary to common myths, a blackhead is not filled with dirt, but with oxidized melanin. Blackheads do not go away when washed with water and they need a long time to heal.

2. Inflammatory acne occurs when the contents of a non-inflamed comedone are released or when the follicle wall ruptures, usually as a result of skin picking. This causes an inflamed skin lesion, which can take different forms:

  • Papule – an inflamed pore that looks like a red bump
  • Pustule – generally known as a pimple, this is a lesion containing yellow fluid.
  • Nodule – large, swollen pimples under the skin that are swollen to the touch
  • Cyst – very large painful pimples under the skin, filled with fluid or puss. Take the longest to heal and usually cause acne scars.


Open vs. Closed Comedone


Acne Symptoms & Diagnosis

Acne symptoms are quite clear and are generally noticed as soon as the comedone starts to form, sometimes even a few hours before. There are no other symptoms other than the aforementioned skin lesions caused by inflammatory or non-inflammatory acne. Acne can be self-diagnosed, but professional acne diagnosis can be required when there is no progress in home treatment for a long time or to clear out other conditions that give symptoms similar to acne. Some skin conditions that can be confused with acne:

  • Rosacea can be confused with acne because it causes redness, especially at the center of the face, dilated blood vessels and even skin bumps.
  • Some allergic reactions include red patches and skin bumps that look like pimples. However, unlike acne, allergies cause itchy lesions that go away when you are no longer in contact with the allergen.
  • Contact dermatitis occurs when the skin comes in contact with an irritant agent, leading to acne-like lesions and ulcerations.
  • Basal cell carcinoma is a cancerous tumor that resembles a large red acne cyst. However, it never comes to a head and it does not go away. If you’ve had a cyst for months, you should have it checked by a professional.


Stages of Acne


Acne Treatment & Care

Acne treatment depends on the type of acne (inflammatory or non-inflammatory) and its severity. Moreover, acne care is often a matter of trial and error, as some patients do not tolerate all treatments.

Over the counter acne treatments are usually recommended for people with mild acne, patients who do not tolerate stronger treatments or simply as a way of complementing acne medicine. Skincare for acne prone skin includes face washes, moisturizers, gels, spot treatments, face masks with active ingredients such as:

  • Azelaic acid reduces sebum production and fights acne-causing bacteria.
  • Salicylic acid reduces swelling and is recommended for blackheads and whiteheads
  • Benzoyl peroxide fights acne causing bacteria, keeps sebum production in check and speeds up skin recovery.
  • Retin-A – anti-aging ingredient that also unblocks pores and speeds up cell turnover

These are all strong anti-acne ingredients that work for specific types of acne. Side-effects such as redness, flakiness and even skin purging are common, which is why it’s advisable to start with a smaller concentration of the active ingredient and increase it as the skin learns to tolerate it. When trying out an acne skincare routine, patients should be diligent and apply recommended products for at least one month, because they need time to work. If there are no visible signs of improvement after this time, then a dermatologist can suggest a different approach.

Oral antibiotics for acne may be prescribed for patients with moderate or severe acne to discourage the growth of acne-causing bacteria. Dosage will be higher at first and then will decrease as the skin clears out.

Oral contraceptives for acne are a long-term solution, prescribed when acne is caused by overactive glands. A visit to the gynecologist should be scheduled first, because these contraceptives may be dangerous for women who smoke, have migraines or blood clots.

Corticosteroid injections can be administered to take down a severely inflamed and swollen pimple.

Topical retinoids such as tretinoin tazarotene are vitamin A derivates that unclog pores and prevent whiteheads and blackheads.

Isotretinoin is an oral retinoid, a strong form of medication recommended only for patients with severe acne who have seen no improvement with other acne treatments. Isotretinoin is prescribed with great care, often together with vitamin supplements, and side effects can range from dry skin to mood swings and nosebleeds. Isotretinoin is never administered during pregnancy.

Apart from these solutions, long term acne care is also required to prevent inflammation. Because acne is such a common condition, there is a huge market for acne treatments, but not all of them work. Patients should be informed, read about the type of acne they have, understand the triggers that make it worse and stick to an acne skincare regimen that works for them. They should also know about the acne list of ingredients to avoid:

  • Physical scrubs or exfoliators with microbeads. They cause microlesions and dry out the skin. The feeling of freshness is only temporary, because the skin will compensate for the dryness and will secrete more sebum, clogging pores even more.
  • Alcohol is an irritant that aggravates acne, especially in patients with dry, sensitive skin.
  • Fragranced skincare products aggravate redness and inflammation
  • Comedogenic ingredients that clog pores, such as coconut oil and silicone. See the full list of comedogenic ingredients here.
  • Sodium lauryl sulfate is a harsh surfactant used in foaming skincare products, but it can strip the skin of its natural oils and encourage excess sebum production.

In addition to these, patients should refrain from picking at their skin and popping pimples, because this only spreads the bacteria and causes inflammation.


Acne Causes

The exact cause of acne is unknown and dermatologists have yet to understand why clogging occurs in one glad. However, current research points in the direction of several acne causes that can also be acne risk factors:

  • Hereditary factors
  • Overreactive sebaceous glands
  • Hormonal imbalance
  • Stress and trauma
  • Vitamin D deficiency
  • Certain medications
  • Menstruation

Apart from these, acne is also believed to be caused by certain foods, but no clear connection has been made yet. Foods that cause acne may include sweets, white bread, spices, caffeine and fast food, but each patient is different and cutting out these foods does not always stop acne.


Post-Acne Scars

Even after acne lesions have passed, patients can still struggle with post-acne scars, which need a long time to heal. Scarring occurs in different forms. If a larger area was affected, the skin can look bumpy and boxy. In other cases, scars manifest as hyperpigmentation or discoloration. post-acne scars can be prevented if the patient refrains from popping pimples and picking at their skin, but there are also cases when the skin heals slower.  Effective acne scar remedies include:

  • Chemical exfoliants such glycolic acid, which remove dead skin cells gently and speed up skin recovery
  • Vitamin supplements
  • Microdermabrasion
  • Chemical peels

All these treatments should be accompanied by everyday use of broad spectrum SPF creams (SPF 30 in the cold season and SPF 50+ in summer), because UVA and UVB rays aggravate acne scars.

Depending on the severity of the acne and the type of skin, the time needed to get rid of acne scars may vary, which is why it is very important to be patient and not resort to untested treatments.


Types of Acne


Body Acne

Although acne is usually encountered on the face, body acne can also occur on the back, chest and neck. Body acne causes are the same as in the case of face acne, because the human body has follicles almost everywhere and produces oil. Statistically, body acne usually occurs among men and it is often accompanied by face acne, which is why the treatment for body acne includes the same active ingredients. In addition to those, dermatologists advise patients to have a good body hygiene, but avoiding overshowering. In addition, they should avoid wearing synthetic clothes and switch to organic materials such as cotton.


Acne Myths

Acne is a common skin condition, but the fact that its causes are misunderstood has triggered many acne myths that prevent patients from finding the appropriate treatment. Some myths about acne that have long been debunked include:

  • Acne is caused by dirt. FALSE. Acne is not caused by dirt, so washing your face vigorously will not make pimples go away.
  • Only teenagers have acne. FALSE. Acne can occur at any age and adult acne (even after the age of 40) is quite common.
  • Pimples should not be popped. FALSE. Popping your own myths can slow down healing and cause more inflammation, but when done by a professional, popping a pimple actually helps.
  • You can’t eat chocolate if you have acne. FALSE. The cocoa in chocolate is not the problem, sugar is. If regular chocolate breaks you out, you can still have low-sugar dark chocolate in small servings.
  • Make-up causes acne. FALSE. Some irritant ingredients in makeup can aggravate acne and make lesions worse, but the cause of acne is not at the surface of the skin, it is inside. As long as patients avoid irritant, comedogenic makeup products, they should not experience problems.
  • Toothpaste is a good acne treatment. FALSE. Toothpaste contains alcohol, peppermint and essential oils that dry out the skin, but irritate it, doing more harm than good.
  • SPF causes acne. FALSE. Patients who do not respond well to chemical sunscreens and get clogged pores from them can switch to physical sunscreens which contain titanium dioxide and zinc oxide. These do not clog pores and may actually help fights bacteria.

Last updated on September 30th, 2020

Chris Riley

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