An Overview of Acne

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Acne is a common skin problem that develops when your pores get clogged by oil and dead skin debris. This results in pimples, blackheads, and whiteheads, especially on the face, neck, chest, back, upper arms, and shoulders. Acne is the most frequent skin problem in the United States, especially in teenagers and young adults.

Symptoms

Acne varies in development from very mild to extremely severe. You may have only a few blemishes here and there, or a more extensive breakout.

Non-inflamed acne breakouts consist of micro-comedones (blemishes too small to see with the naked eye), blackheads, and milia (white bumps). These types of blemishes aren't red or painful. They may not look like your stereotypical acne blemishes, rather just bumps across the skin's surface or an uneven skin texture.

People with inflammatory acne have papules, pustules, and possibly larger, deeper blemishes like nodules and cysts. Acne can cause redness, swelling, and irritation of the skin, along with possible crusting, oozing, or scabbing breakouts.

Causes

Acne is caused by three main factors:

  • People with acne tend to have overactive sebaceous glands—the glands that make your skin's oil.
  • Acne-prone skin doesn't shed dead skin cells as effectively, so the pores can become clogged.
  • Acne-prone skin also has a higher amount of Propionibacteria acnes (bacteria linked to inflamed acne blemishes) within the pores.

All breakouts begin as a blocked pore. As the breakout progresses and bacteria invade, the wall of the hair follicle can rupture within the dermis, creating inflammation and redness.

Androgen hormones, specifically testosterone, significantly influence acne development, especially at puberty. Other factors can contribute to acne as well, including genetics, the use of certain skincare products, certain medications, and more.

Diagnosis

To diagnose acne, a physician will do a simple visual inspection of the skin, rule out other causes, and assign a grade of I to IV based on the characteristics of the acne they are evaluating. The grade of acne helps guide the treatment used.

In addition to the different grades of acne, your doctor may label a severe case as nodular acne (if there are hard, painful nodules) or cystic acne (if there are large, inflamed, soft, fluid-filled cysts). These forms often require treatment with oral medications.

Many people self-diagnose their breakouts as acne and may only see a doctor if their condition is more severe or if it doesn't respond to over-the-counter products. There are many other skin conditions besides acne that also cause pimples or red, bumpy skin.

If you're not absolutely sure what you're dealing with is common acne, a trip to the dermatologist or your primary care physician is a good idea.

Treatment

No matter what type of acne you have, its severity, or at what age you're breaking out, there is an acne treatment out there for you.

Over-the-counter topical medications may be used for mild to moderate outbreaks. Although you may think you can clear acne on your own with drugstore products, the reality is most cases need to be seen by a dermatologist and treated with topical prescription medications. Severe types of acne may require prescription oral medications.

Procedural treatments such as facials, comedo extractions, and microdermabrasion can be done by estheticians at a spa, while more deep chemical peels, phototherapy, or acne surgery can be done at a dermatology office. 

Coping

Living with acne can be a challenge as outbreaks can affect you emotionally, from your self-esteem to your sense of self-control. Treatment can take time to become effective, leading to frustration. There are risks of social isolation and even depression.

Your feelings are valid, and parents should give teens with acne needed support and advocate for effective treatment. Taking care of your skin with medications, moisturizing, and avoiding picking at or popping blemishes will become a daily part of coping with acne. If you think you might need help navigating how you feel, especially if your acne is chronic, consider seeking the help of a therapist.

A Word From Verywell

Acne is a complex problem, but one we are learning more about every day. While there is no cure, nearly every case of acne can be cleared successfully. Your first step should be a trip to the dermatologist. This specialist can not only prescribe medication that's the right fit for you, but give you plenty of tips and tricks to help clear your skin. It does take time, which can be hard when you feel like your skin is out of control. But stick with it. With the right medication, a bit of patience, and consistent treatment, your acne can be cleared.

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Article Sources

  1. Zeichner JA, Baldwin HE, Cook-bolden FE, Eichenfield LF, Fallon-friedlander S, Rodriguez DA. Emerging Issues in Adult Female Acne. J Clin Aesthet Dermatol. 2017;10(1):37-46. PMID:28210380

  2. Gollnick HP, Zouboulis CC. Not all acne is acne vulgaris. Dtsch Arztebl Int. 2014;111(17):301-12. https://doi.org/10.3238/arztebl.2014.0301

  3. Tanghetti EA. The role of inflammation in the pathology of acne. J Clin Aesthet Dermatol. 2013;6(9):27-35. PMID:24062871

  4. Elsaie ML. Hormonal treatment of acne vulgaris: an update. Clin Cosmet Investig Dermatol. 2016;9:241-8. https://doi.org/10.2147/CCID.S114830

Additional Reading

  • Questions and Answers About Acne. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Jan 2016. National Institutes of Health.

  • Zaenglein AL, Pathy AL, Schlosser BJ, Alikhan A, Baldwin HE, et. al. Guidelines of Care for the Management of Acne Vulgaris. Journal of the American Academy of Dermatology 74.5 (2016): 945-73. doi:10.1016/j.jaad.2015.12.037