What is acne?
Acne is a common skin condition that occurs when hair follicles become clogged with sebum (oil) and dead skin cells. It affects about 85% of teenagers in the US but can occur at any age. Most outgrow it by their 30s, though some adults continue to experience breakouts into their 40s and 50s. Acne usually appears on areas with the most oil glands: the face, forehead, chest, shoulders, and upper back.
Types of lesions
- Papules (small red bumps)
- Pustules (bumps with white or yellow pus)
- Whiteheads (closed plugged follicles)
- Blackheads (open plugged follicles discolored by air exposure)
- Cysts and nodules (deep, painful lumps)
- Redness around lesions
- Scarring (depressed or raised)
Complications if untreated
- Persistent redness or dark spots
- Permanent scarring
- Emotional impact: low self-esteem, anxiety, depression
Causes of acne
A combination of factors contributes to acne:
- Hormonal changes (androgens during puberty or menstrual cycles)
- Certain medications (testosterone, corticosteroids, lithium, some birth control pills)
- Genetics (family history of acne)
- Diet (high-glycemic foods, dairy, chocolate may play a role)
- Underlying conditions (e.g., PCOS, congenital adrenal hyperplasia)
- Risk factors: aggressive scrubbing, smoking, oil-based products, poor sleep
- Possible links: stress, refined sugars, carbohydrates
Acne symptoms
Acne lesions vary in appearance and severity:
- Whiteheads: small plugged follicles beneath the skin
- Blackheads: plugged follicles that open to the surface and oxidize
- Papules: tender red or purple bumps
- Pustules: red bumps containing pus
- Nodules: large, solid, painful lumps
- Cystic acne: deep, pus-filled lesions that can scar
Scarring types:
- Depressed scars: ice pick, rolling, boxcar
- Raised scars: hypertrophic, keloid, papular
- Post-inflammatory hyperpigmentation or hypopigmentation
Acne diagnosis
- Medical and family history
- Menstrual history in females
- Medication review
- Skin examination to identify lesion types
- Laboratory tests if an underlying condition is suspected
Acne medications
For mild acne, over-the-counter options include:
- Topical retinoids (e.g., adapalene)
- Benzoyl peroxide
- Salicylic acid
Moderate to severe acne often requires prescription treatments, such as:
- Topical: azelaic acid, tretinoin, tazarotene, trifarotene
- Oral antibiotics: doxycycline, minocycline, erythromycin
- Hormonal agents: oral contraceptives, spironolactone
- Isotretinoin (Accutane)
Many regimens combine two or more of these and require 2–3 months to assess effectiveness.
Procedural treatments
- Comedone extraction
- Chemical peels
- Dermabrasion
- Steroid injections into cysts
- Laser and light therapies for scars
Skincare routine tips
- Wash twice daily with a gentle, non-soap cleanser
- Avoid scrubbing or picking at lesions
- Use non-comedogenic, oil-free products
- Shampoo regularly if hair is oily
- Apply sunscreen to prevent medication-induced sun sensitivity