Overview
Acne is a common skin condition in which hair follicles and sebaceous glands become clogged, leading to spots on the face, back, chest, and shoulders. About 85% of adolescents experience acne, but it can occur at any age. It is also common in adult women.
Mild cases are easy to manage, but moderate-to-severe cases can leave scars and affect self-esteem. Early and proper treatment is the key to preventing scars.
Symptoms
- Blackheads (comedones): Open clogged pores
- Whiteheads: Closed clogged pores
- Papules: Small, red, tender bumps
- Pustules: Pus-filled pimples
- Nodules: Large, hard, painful lumps beneath the skin
- Cysts: Deep, pus-filled, painful lesions
Most affected areas: face (especially forehead, chin, nose), back, chest, shoulders.
Causes
Acne is caused by a combination of four main factors:
- Excess oil (sebum) production
- Clogging of follicles by dead skin cells
- Bacterial overgrowth (especially Cutibacterium acnes)
- Inflammation
Risk Factors
- Hormonal changes: Puberty, premenstrual phase, pregnancy, polycystic ovary syndrome
- Family history
- Some medications: Corticosteroids, lithium, some birth control pills
- Stress (worsens acne; not a direct cause)
- Oily cosmetics and skincare products
- Friction and pressure: Mask, phone, tight collar, helmet
- Diet: High-glycemic foods, dairy (in some people)
Common Misconceptions
The following do NOT directly cause acne:
- Chocolate and oily foods (association is debatable)
- Dirty skin (excessive washing makes acne worse)
- Sexual activity or lack of it
Complications
- Acne scars: Pitted (atrophic) or raised (keloid) scars
- Hyperpigmentation: Dark spots after lesions heal
- Psychological effects: Low self-esteem, social anxiety, depression
- Acne fulminans: Severe sudden-onset acne (rare)
When to See a Doctor
- If over-the-counter products do not improve acne within 4-6 weeks
- Severe, widespread, or painful acne
- Scarring cases or cases at risk of scarring
- In women, acne with irregular periods and excessive hair growth (possible PCOS)
- If acne is affecting you psychologically
Diagnosis and Treatment
Diagnosis: Made by visual examination. Hormonal evaluation may be needed.
Treatment (by severity):
Mild acne:
- Topical retinoids (adapalene, tretinoin)
- Benzoyl peroxide
- Salicylic acid products
- Topical antibiotics
Moderate acne:
- Oral antibiotics (doxycycline, minocycline)
- Topical-oral combinations
- Hormonal therapy (in women)
Severe acne:
- Isotretinoin (Roaccutane); the most effective treatment, under dermatologist supervision
- Hormonal therapy
- Cortisone injections for large cysts
Supportive treatments:
- Chemical peels
- Laser and light therapies
- Scar treatments (microneedling, fillers)
Prevention
- Wash your skin twice a day with a gentle cleanser
- Avoid excessive scrubbing and aggressive brushes
- Prefer oil-free, non-comedogenic products
- Keep your hair clean; prevent it from touching your face
- Do not squeeze or pick at pimples
- Protect from the sun, remove makeup before sleep
- Manage stress, get enough sleep
- Increase water intake
- Avoid excessive sugary foods