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Acne Vulgaris: Causes, Symptoms, and Treatments

Before and after portrait of woman with acne

Acne vulgaris is a common and often frustrating skin condition affecting millions worldwide. It’s frequently associated with adolescence, but the truth is acne doesn’t always disappear with the last page of a teenage diary. It can persist into adulthood, causing various emotional, psychological, and physical impacts. 

In this guide, Dr Justin Boey, Medical Director of Sozo Aesthetic Clinic, explores everything from the underlying causes of acne vulgaris to the spectrum of treatments available to manage it. So, whether you’re a young adult just dealing with the onset of this condition or a member of the population combatting persistent acne, this post will empower you with knowledge on how to better manage and understand this complex skin issue.

What is Acne Vulgaris?

Acne vulgaris is a long-term skin disease that occurs when hair follicles are clogged with dead skin cells and oil from the skin. According to the NHS, acne is characterised by blackheads, whiteheads, pimples, and greasy skin. It may result in scarring and lead to anxiety, reduced self-esteem, and depression. 

The term “vulgaris” is derived from Latin and means prevalent, which describes the general distribution of this skin disorder. Acne has various subtypes, but vulgaris is the most frequent type recognised by the presence of comedones, papules, pustules, and nodules.

The term acne is frequently misused to designate any red spot or zit. However, acne is a complex medical condition. To avoid confusion, this article will use the term “acne” for common acne vulgaris. Other types of acne include rosacea and folliculitis. These conditions are related to acne but may require different treatments.

Causes of Acne Vulgaris

frightened girl touching face frowning

Acne vulgaris develops for a combination of reasons. The exact cause of acne is unknown, but doctors believe it results from several related factors. One important factor is an increase in androgens (male sex hormones). These increase in both boys and girls during puberty and cause the sebaceous glands to enlarge and produce more sebum. 

Hormonal Influences

Hormonal fluctuations play a pivotal role in the development of acne vulgaris. Androgens, a type of hormone that increases in quantity during puberty in both sexes, significantly influence sebum production. These hormones stimulate the sebaceous glands embedded in our skin, triggering them to produce an excess amount of sebum, an oily substance designed to keep our skin hydrated. 

However, when produced in surplus, sebum can clog hair follicles and dead skin cells, creating an ideal environment for acne-causing bacteria to thrive. This bacterial growth can lead to inflammation and the development of acne lesions, including whiteheads, blackheads, and more severe forms such as cysts. 

Hormonal changes related to menstrual cycles, pregnancy, and the use of certain medications can also exacerbate or trigger the production of sebum, thereby increasing the risk of acne flare-ups.

Genetic Factors

The propensity to develop acne vulgaris is also significantly influenced by genetics. Studies suggest that if both parents had acne, there is a higher likelihood that their children will also experience acne at some point in their lives. This genetic predisposition is primarily because certain genes can affect how the skin responds to hormonal fluctuations, sebum production, and the presence of acne-causing bacteria. Individuals with a family history of severe acne are more prone to develop similar conditions, indicating a hereditary link to the severity of acne as well. 

While genetics alone do not guarantee the development of acne, they can play a critical role in the condition’s onset, severity, and persistence, laying the foundation for how individuals may need to tailor their acne management and treatment approaches.

Lifestyle and Environmental Factors

In addition to hormonal changes and genetic predispositions, lifestyle and environmental factors significantly contribute to the incidence of acne vulgaris. 


Whilst the correlation between diet and acne is still a subject of ongoing research, certain foods have been known to exacerbate acne symptoms in some individuals. High-glycaemic foods such as white bread, chips, and sugary drinks can cause blood sugar levels to spike rapidly, potentially leading to increased sebum production and, subsequently, acne flare-ups. Some studies have also implicated dairy products, although the evidence remains inconclusive.


Stress, too, plays a substantial role in how acne develops. When stressed, the body produces more androgens, stimulating sebaceous glands and hair follicles in the skin, which can lead to acne. Chronic stress can aggravate acne symptoms, worsening existing conditions or causing acne to emerge in individuals prone to it.

Environmental Pollutants

Environmental factors like pollution and humidity can also exacerbate acne. Pollutants and dirt can clog skin pores, and high humidity levels can increase sweat and oil production on the skin, creating the perfect breeding ground for acne-causing bacteria. Urban environments, in particular, are known for their high levels of pollutants, which can contribute to the severity of acne symptoms among their populations.

While the direct cause of acne vulgaris can be complex and multifaceted, it’s clear that both lifestyle and environmental factors play significant roles in its development and severity. Understanding these contributors can help formulate more comprehensive treatment and prevention strategies for individuals suffering from acne.

Common Symptoms of Acne Vulgaris

Acne is more than occasional breakouts. For some, it’s a chronic condition that can lead to permanent scarring. Key symptoms include:

  • Comedones (blackheads and whiteheads)

  • Papules (raised, tender bumps)

  • Pustules (papules with pus at their tips)

  • Nodules (painful, solid lumps beneath the skin’s surface)

These acne lesions can appear on the skin surface of the face, neck, chest, back, and shoulders. Not only do they cause physical discomfort but also emotional distress due to the impact on appearance, often leading to anxiety and self-esteem issues.

Severity Levels

Broadly, acne is categorised into three levels of acne severity, namely:

  • Mild Acne: Comprises primarily non-inflammatory lesions such as comedones (blackheads and whiteheads), with few, if any, inflammatory lesions like papules or pustules. This form of acne is often confined to the face but can appear on other areas prone to oiliness, such as the back, chest, and shoulders. Mild acne, while generally less severe in appearance, can still cause significant emotional distress and discomfort to individuals. Typical management strategies include over-the-counter treatments containing salicylic acid (SA) or benzoyl peroxide to reduce oil production and prevent clogged pores. Consistent and gentle skincare routines, alongside regular cleaning of items that come into contact with the affected skin often (such as pillowcases and mobile phones), are also recommended to minimise the risk of exacerbation.

  • Moderate Acne: Characterised by a greater number of inflammatory lesions, including papules and pustules, which are spread more widely across the face and can also affect other body parts like the chest and back. It often presents a mix of comedones and inflamed, red spots that may be tender to the touch. Individuals with moderate acne may begin to see more persistent cystic acne breakouts that are harder to manage with over-the-counter treatments alone. This level of acne can lead to more pronounced skin discolouration and may start to affect the deeper layers of the skin, increasing the risk of scarring. 

  • Severe Acne: The most intensive form of acne vulgaris, characterised by a significant number of deeply inflamed cysts and nodules in addition to the presence of numerous papules, pustules, and comedones. This level of acne tends to be widespread across the face, chest, and back and is more likely to lead to scarring due to the depth and severity of skin lesions. Individuals experiencing severe acne often report considerable pain and discomfort, alongside significant emotional and psychological distress. The risk of permanent scarring and skin discolouration is notably higher in severe cases, necessitating professional medical intervention. 

Understanding the severity of your acne is crucial in determining the most effective course of action for treating it.

How Acne Vulgaris is Diagnosed

Woman looking at mirror at home and checking her face

Diagnosing acne is often straightforward based on the appearance of the skin. In some cases, a clinical evaluation by a trained professional is sufficient to diagnose the condition. No special tests are needed. However, additional assessments are sometimes required to rule out other skin problems. 

A healthcare professional or aesthetic practitioner like Dr. Justin Boey at the Sozo Aesthetic Clinic will assess the skin lesions for the typical signs of acne. They’ll also ask about the patient’s medical history in case areas such as polycystic ovary syndrome may be causing or exacerbating the acne. Once a diagnosis has been made, the practitioner will classify the acne to determine the most effective treatment approach.

Acne Vulgaris Treatment Options

Effective acne treatment involves various strategies, from over-the-counter ointments and lifestyle changes to prescription medications and medical procedures. The primary objectives are to clear lesions, prevent new lesions from forming, prevent acne scars, and minimise the psychological stress and embarrassment caused by the condition.

Over-the-Counter Remedies

Mild acne can often be managed with over-the-counter products that contain ingredients like benzoyl peroxide, alpha hydroxy acids, or SA. These products work by unclogging pores, reducing inflammation, and killing acne-causing bacteria.

Ingredients to Look For:

  • Benzoyl Peroxide (BP): A common over-the-counter ingredient, BP reduces acne-causing bacteria and promotes the shedding of skin cells to unclog pores.

  • Salicylic Acid: This beta hydroxy acid (BHA) exfoliates the skin and clears pores.

  • Alpha Hydroxy Acids (AHAs): These work mainly to exfoliate the skin’s surface and are often derived from foods, including fruits, milk, and sugar.

Prescription Medications

A medical professional may suggest prescription medications, such as oral antibiotics, hormonal treatments for women, or isotretinoin for more severe cases. These treatments are more potent and potentially have more significant side effects, requiring careful monitoring.

  • Oral Antibiotics: Antibiotics work by eliminating excess bacteria and reducing inflammation. Tetracycline and erythromycin are common choices.

  • Hormonal Treatments: For women, hormonal therapy can be effective against acne. Options include birth control pills, which can help regulate hormonal imbalances that lead to acne.

Isotretinoin: This is a powerful medication used to treat severe nodular acne that has not responded to other treatments. It’s reserved for the most serious cases of acne and comes with a range of potential side effects that need to be carefully managed.

Natural and Alternative Treatments

Some people seek alternatives to conventional treatments, such as home remedies or dietary changes. While these may offer some benefits, they should be approached cautiously and used with professional advice, especially for moderate to severe acne.

  • Home Remedies: Common home remedies include tea tree oil, aloe vera, and green tea. While some of these may have antibacterial or anti-inflammatory properties, the evidence for their effectiveness in treating acne is limited.

  • Dietary Adjustments: Some evidence suggests that dietary factors like dairy and high-glycemic foods may worsen acne. Consider reducing your intake of these foods and adding more fruits, vegetables, and omega-3 fatty acids to your diet.

Prevention Tips for Acne Vulgaris

girl displeased of her problem acne face skin

Preventing acne is often more manageable than treating it. While some risk factors, like genetics, are beyond your control, several preventative measures can help reduce your acne risk:

  • Keep Your Face Clean: Gently wash your face twice a day. Use a mild facial cleanser, and look for one with salicylic acid.

  • Moisturise Regularly: Dry skin can stimulate the production of sebum, which can lead to breakouts. Use a light, non-comedogenic moisturiser after washing your face.

  • Avoid Touching Your Face: Your hands collect bacteria. Touching your face, especially with unwashed hands, can lead to breakouts.

  • Manage Stress: Stress can trigger hormonal changes, increasing sebum production and acne flare-ups. Find ways to manage your stress levels.

  • Consider Birth Control Pills: For women, birth control pills can regulate hormones associated with acne.

  • Consult a Professional: An aesthetic practitioner can recommend a personalised skincare routine that works for your skin type and severity of acne.

When To Consult a Professional?

If over-the-counter treatments are not effective in treating acne, it’s time to consult a healthcare professional or aesthetic practitioner. They can help identify the best course of treatment for your acne. Dr Justin Boey, the Medical Director of the Sozo Aesthetic Clinic, suggests a holistic approach to acne treatment, focusing on both the skin and your general health:

He adds, “At Sozo, we take pride in providing effective treatment tailored to your needs. Our team works closely with patients to identify the root causes of their skin condition and develop a comprehensive treatment plan that includes evidence-based skincare solutions, medical-grade therapies, and if needed, advanced medical procedures.”

Remember, effective treatment of active vulgaris can improve your skin’s appearance and prevent it from affecting your quality of life. Understanding the causes, symptoms, and treatments is the first step to clearer skin, whether you’re dealing with occasional pimples or chronic acne.


Understanding acne vulgaris is the first step in managing this common skin condition. From knowing the various causes to recognising the symptoms and exploring the available treatment options, arming yourself with the right information is essential.

Remember, every individual’s experience with acne is unique, and what works for one person may not work for another. The key to managing acne effectively lies in patience and persistence in finding the right regimen for your skin.

If you’re struggling with acne vulgaris, contact our professional aesthetic practitioners at Sozo Aesthetic Clinic. They can help you understand and manage this condition. With the right support and knowledge, you can take control of your skin and your confidence.


Medical Director

After graduating from the National University of Singapore, Dr Boey’s journey in aesthetics brought him to esteemed institutions such as Harvard Medical School, American Academy of Aesthetic Medicine and Queen Mary University of London in diverse cities like Seoul, London, Boston and New York.