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Acne: Causes, Types, and Treatments

What is Acne?

Acne is a skin condition that occurs when your hair follicle become plugged with oil and dead skin cells. It causes whiteheads, blackheads or pimples. Acne is most common among teenagers, though it affects people of all ages.

The type of acne that many teens get is called acne vulgaris (“vulgaris” means “of the common type”). It usually shows up on the face, neck, shoulders, upper back, and chest.

What are the causes?

Main factors that cause acne vulgaris:

  • Excess oil (sebum) production
  • Hair follicles clogged by oil and dead skin cells
  • Bacteria
  • Inflammation

Human skin has pores that connect to oil glands under the skin. Follicles connect the glands to the pores. Follicles are small sacs that produce and secrete liquid.

The glands produce an oily liquid called sebum. Sebum carries dead skin cells through the follicles to the surface of the skin. A small hair grows through the follicle out of the skin.

Pimples grow when these follicles get blocked, and oil builds up under the skin.

Skin cells, sebum, and hair can clump together into a plug. This plug gets infected with bacteria, and swelling results. A pimple starts to develop when the plug begins to break down.


The following risk factors for developing acne:

  • Hormones. An increase in androgens, which are male sex hormones, may lead to acne. These increase in both boys and girls normally during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy can also cause acne.
  • Family history. Researchers believe that you may be more likely to get acne if your parents had acne.
  • Medications. Certain acne medication, such as medications that contain hormones, corticosteroids, and lithium, can cause acne.
  • Age. People of all ages can get acne, but it is more common in teens.

Does chocolate cause acne vulgaris?

Some studies have linked particular foods and diets to acne. Skim milk, whey protein and diets high in sugar may contribute to acne flares. Chocolate has not been directly linked to make acne worse.

Types of Acne

  • Whiteheads : Plugged hair follicles that stay beneath the skin and produce a white bump.
  • Blackheads : Plugged follicles that reach the surface of the skin and open up. They look black on the skin surface because the air discolors the sebum, not because they are dirty.
  • Papules : Inflamed lesions that usually appear as small, pink bumps on the skin and can be tender to the touch.
  • Pustules or pimples : Papules topped by white or yellow pus-filled lesions that may be red at the base.
  • Nodules : Large, painful solid lesions that are lodged deep within the skin.
  • Severe nodular acne (sometimes called cystic acne) : Deep, painful, pus-filled acne lesions.

What are the symptoms?

Acne commonly appears on the face and shoulders. It may also occur on the trunk, arms, legs, and buttocks. Skin changes include:

  • Crusting of skin bumps
  • Cysts
  • Papules (small red bumps)
  • Pustules (small red bumps containing white or yellow pus)
  • Redness around the skin eruptions
  • Scarring of the skin
  • Whiteheads
  • Blackheads

How to prevent acne?

Preventing acne is difficult if not impossible during normal hormonal changes. But some things can help to prevent acne worse:

  • Wash your face daily with warm water and a mild soap in the morning, before you go to sleep, and after strenuous exercise.
  • Routinely use moisturizer.
  • You do not have to stop using makeup, but try to use non-comedogenic products, prevent oily substance, and remove makeup at the end of each day.
  • Keep your hands away from your face.
  • Avoid being over-exposed to the sun, as it can affect skin health and appearance.
  • Shampoo the hair regularly. People with oily skin may want to do so daily.
  • Eat a balanced diet and stay hydrated.

Where does acne most commonly occur?

The most common spots where you might have acne are your face, forehead, chest, shoulders and upper back. Oil gland are all over your body, but those are the places where there are the most.

The best way treating acne depends on how the acne severity. It can be mild acne (a few occasional pimples) moderate acne (inflammatory papules) or moderately severe acne (nodules and cysts).

How severe can acne get?

Grade I: Mild acne

Mostly whiteheads and blackheads, with a few papules and pustules.

Grade II: Moderate

Multiple papules and pustules, mostly on your face.

Grade III: Moderate to Severe

Numerous papules and pustules, along with occasionally inflamed nodules. Your back and chest may also be affected.

Grade IV: Severe

Numerous large, painful and inflamed pustules and nodules.


Your healthcare provider may suggest some non-prescription medications for your condition. Depending on the skin conditions severity, your age, the type of acne you have and how effective the over-the-counter treatments have been, you may need stronger prescription medications.

Various medications and therapies have proven to be effective. They target the underlying factors that contribute to acne. You might require at least one or other treatments, depending on the severe form of your acne.

Medications applied topically (topical therapy):

  • Benzoyl peroxide is available as an over-the-counter medications (such as Clearasil®, Stridex®, PanOxyl®) as a leave-on gel or wash. It targets surface bacteria, which often aggravates acne. Lower concentrations and wash formulations are less irritating to your skin. Irritation (dryness) is a common side effect.
  • Salicylic acid is available over-the-counter for acne, as a cleanser or lotion. It helps remove the top layer of damaged skin. Salicylic acid dissolves dead skin cells to prevent your hair follicles from clogging.
  • Azelaic acid is a natural acid found in various grains such as barley, wheat and rye. It kills microorganisms on the skin, reduces swelling and reduce inflammation.

  • Topical retinoids (vitamin A derivatives) such as Retin-A®, Tazorac®, and Differin® (which is now available without a prescription) break up blackheads and whiteheads and help to prevent clog pores, the first signs of acne.

    Most patients are candidates for topical retinoid therapy. These medications are not spot treatments and must be used on the entire area of skin affected by existing acne to prevent the formation of new pimples. The most common side effect of affected skin is irritation, which usually improves with moisturization and time on the medication.

  • Antibiotics (topical types include clindamycin and erythromycin) control surface bacteria that aggravate and often encourage the swelling of acne. Antibiotics are more effective when combined with benzoyl peroxide.

  • Dapzone (Aczone®) is a topical gel, which also has antibacterial properties, can be used for inflamed acne. It is applied to the skin twice a day.

    • Oral antibiotics, especially tetracycline antibiotics such as minocycline and doxycycline, are commonly used to treat moderate to severe acne.
    • Oral contraceptives can help with breakouts associated with menstrual cycles. Three classes of medications have been approved by the FDA for acne patients. Some brand names include Estrostep®, Beyaz®, Ortho Tri-Cyclen® and Yaz ®.
    • Oral isotretinoin (Amnesteem®, Claravis®, Sotret®), an oral retinoid, is an especially effective drug used only for the most severe forms of acne. Isotretinoin shrinks the size of oil glands, which contributes to develop acne.

      The most common side effect is dryness, but can also cause birth defects. Some evidence suggests a possible increased risk of ulcerative colitis and depression. Because of these risks, anyone using the drug must take part in a Food and Drug Administration-approved risk management program known as iPledge.

    • Other therapies:

      Depending on your condition, your healthcare provider might suggest one of these specialized systemic therapies, possibly combined with medication to improve acne.

    • Steroids. Rarely, steroids can be used to treat more severe acne or injected into large nodules to reduce acne breakouts inflammation.

    • Lasers. Currently, lasers are primarily used to treat acne scars. A laser delivers heat to the scarred collagen under the skin, this relies on the body’s wound healing response to create new, healthy collagen. This encourages the growth of new skin to replace it.

      There are different types of laser resurfacing—ablative and non-ablative. Your dermatologist will determine which type is best for your skin type and nature of acne scars.

    • Chemical Peels. This acne treatment uses special chemicals to remove the top layer of old skin. Typically whenever the top layer is removed, the new skin that grows in is smoother and can lessen acne scars.

When to see a dermatologist?

You should see a board certified dermatologist if:

  • Self-care steps and over-the-counter medicine do not help after several months.

  • Your acne is very bad (for example, you have a lot of redness around the pimples, or you have cysts).

  • Worsen acne.

  • You develop scars as your acne clears up.

  • Acne is causing emotional stress.


It is important to be patient with your acne treatments. While some treatments may work immediately, you may not see widespread improvement for several months. You should also use caution in using too many acne products at once as this can cause dry skin. In response, your pores can create more sebum, then make acne worse.

Seeing a dermatologist is the only way you can receive a full and accurate diagnosis. In some cases, expert treatment may be the only way to fully clear and control your acne.


Clinic Admin