What is Acne?
Acne is a common skin condition involving the oil glands and pores of the skin. When these become blocked and inflamed, spots can appear in different forms – from whiteheads and blackheads to red pimples, painful deep lumps, and sometimes red marks or permanent scarring.
Who gets acne?
Acne is often thought of as a teenage condition that clears by adulthood. While this is true for many, it can also start in childhood, appear for the first time in adults, or persist into middle age.
What causes acne?
Acne is not caused by poor hygiene. Genetics play a major role, and hormones are the main trigger – during puberty and with hormonal changes such as the menstrual cycle. In people prone to acne, oil glands respond abnormally, becoming enlarged and blocked.
This blockage occurs because too much keratin – the substance that forms the skin’s surface layer – builds up inside the pore. Why this happens is not fully understood, but it occurs too deep in the skin for simple “unblocking” to work.
Other factors may also contribute:
- Diet: Sugary foods and drinks can worsen acne in some people.
- Stress: A common trigger for flare-ups
- Products: Heavy or oily moisturisers, makeup, or sunscreens can block pores.
- Sunlight: May temporarily calm inflammation but too much causes skin damage.
What are the clinical features of acne?
The type of acne helps guide treatment. Whiteheads and blackheads (comedones) rarely cause scarring but can be resistant to simple therapies. Red pimples, pustules, and deeper nodules are more important to treat, as they are more likely to scar.
Acne most often affects the face, where topical treatments are easiest to use. When larger areas are involved, such as the back, applying creams regularly is less practical, and oral treatments may be required.
It’s also important to distinguish marks from scars.
- Temporary marks: Red (post-inflammatory erythema, PIE) or brown (post-inflammatory pigmentation, PIH) spots fade over months.
- True scars: Permanent changes such as small indentations on the cheeks and temples, or firm raised scars on the jawline, chest, or back. Preventing these makes early treatment essential.
How is acne treated?
General skincare
- Washing with plain water is fine; cleansers don’t change how much oil the glands produce.
- Keratolytic products (e.g. salicylic acid) may help mild acne but are not always strong enough.
- Choose non-comedogenic products to avoid clogging pores; mineral makeup is usually a good option.
- Picking pimples rarely causes scars, but preventing new breakouts is more important.
Topical treatments
- Over-the-counter: Benzoyl peroxide, azelaic acid.
- Prescription creams/gels:
- Antibiotics (e.g. clindamycin) reduce inflammation in red pimples and pustules.
- Retinoids (e.g. tretinoin, adapalene, trifarotene) reduce keratin buildup, unblock pores, and prevent new breakouts. Used long-term.
- Clascoterone reduces oil gland activity and inflammation.
Topicals are often combined with oral treatments under medical supervision.
Oral treatments
- Antibiotics (doxycycline, minocycline): Used for 3–6 months to calm inflamed acne. Not recommended long-term.
- Hormonal therapy (for women): Certain oral contraceptives can be used, and also spironolactone and cyproterone acetate, especially if hair thinning or excess hair is also present.
- Isotretinoin: The most effective oral treatment. Clears both comedones and inflammatory spots and reduces the risk of future acne. Because of potential side effects and high risk of birth defects, it must be prescribed by a dermatologist.
Physical therapies
- Comedone extraction or gentle diathermy
- Chemical peels and microdermabrasion for mild acne
- Light therapies (blue/red LED; photodynamic therapy for a stronger effect)
- Steroid injections into inflamed nodules to prevent scarring
Scar treatment
- PIE/PIH: Usually fade on their own; vascular lasers can speed fading of red marks.
- Indented scars: Treatments include microneedling, fractional radiofrequency, laser resurfacing, needle subcision, punch excision, and TCA cross.
- Raised scars (hypertrophic/keloid): Treated with steroid injections.
What is the outcome of acne?
Acne is treatable, and with proper care and treatment most people can avoid permanent scarring. Over time, oil glands naturally shrink, so acne usually improves with age.