The Independent Pharmacy

A Guide To Acne

Scott McDougall
Scott McDougallMPharmDirector & Registered Manager

Reviewed on 3 Oct 2023

Acne is a common challenge faced by millions worldwide, and it’s completely natural to feel overwhelmed or self-conscious about it. Although acne is often associated with adolescence, it can persist into adulthood, leading to painful and inflammatory bumps and even permanent scarring. Understanding the causes, implications, and treatments for acne is the first step you can take towards self-acceptance and finding the right care.

We will support and guide you through a deeper understanding of this skin condition, ensuring you never feel alone in your journey. Once you know more about acne and ways to treat and prevent it, you can set on the odyssey to reclaim your physical and emotional well-being.

What Is Acne?

Acne is a common skin condition that most people will experience at some point. It happens when pores on the skin become clogged with oil and dead skin cells. This clogs up the pores and leads to pimples or “zits” forming on the skin.

Acne most often appears on the face, back, chest, neck and shoulders. These areas of our body have a lot of oil glands in the skin. Tiny hair follicles are connected to these oil glands under the skin. Our skin has oil glands that produce an oil called sebum. This oil keeps our skin soft and protected.

But with acne, the oil glands make too much sebum. The extra oil and dead skin cells stick together and plug up the hair follicles. Bacteria that live on our skin can then get trapped inside the plugged follicles. This causes swelling, which we see as pimples on the surface of the skin.

The pimples can range from mild to severe depending on how much bacteria and swelling there is.

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Symptoms of Acne

Spotting the first signs and identifying different types of pimples are important in determining the best treatment plans for acne. Whiteheads and blackheads are often the initial lesions that appear:

  • Whiteheads form when oil and dead skin cells get trapped under the skin’s surface, creating small, flesh-coloured bumps.
  • Blackheads occur when this plugged material oxidises from air exposure, turning dark in colour. These tiny dots appear when follicles remain open to the air.

Recognising these early manifestations of acne is key, as treatment options target specific lesion types and severity levels. Paying attention to the symptoms arising on your skin provides insights into selecting the right acne treatments.

Inflammatory acne lesions include papules, which are small, pink or red bumps that feel tender to the touch. Pustules look similar but contain visible pus. More severe inflammatory acne consists of nodules or cysts – large, painful lumps deep within the skin that can cause permanent acne scarring if not properly treated.

It’s a common misconception that only teenagers experience acne. Many adults, too, navigate the challenges of persistent acne flare-ups, and it’s okay to seek help at any age. Symptoms like consistent whiteheads, blackheads, and inflammatory lesions should be addressed with a dermatologist to prevent the acne from worsening over time.

Types of Acne

There are several types of acne, ranging from mild to severe. Understanding the different types is important in identifying the cause and seeking proper treatment.

CategoryType/SubtypeDescriptionRecommended Treatment
Non-InflammatoryWhiteheadsSmall bumps caused by trapped oil and dead skin in our pores. Not inflamed.Over-the-counter products with salicylic acid, benzoyl peroxide, or alpha hydroxy acids.
Non-InflammatoryBlackheadsSmall dark spots formed when trapped oil in pores gets exposed to air.Over-the-counter products with salicylic acid, benzoyl peroxide, or alpha hydroxy acids.
InflammatoryPapulesSmall, sensitive red or pink bumps.Prescription topical or oral antibiotics like clindamycin, erythromycin, doxycycline.
InflammatoryPustulesSimilar to papules but have a yellowish liquid inside.Prescription topical or oral antibiotics like clindamycin, erythromycin, doxycycline.
InflammatoryNodulesPainful lumps formed when oil and cells clog the follicles deeper within the skin.Oral isotretinoin or hormonal therapies like birth control pills.
InflammatoryCystsDeep, pus-filled lumps that can cause scarring.Oral isotretinoin or hormonal therapies like birth control pills.
SubtypesAcne vulgarisMedical term for the usual kind of acne. Includes whiteheads, blackheads, etc.Depends on the specific manifestations. Could range from OTC products to prescriptions.
SubtypesAcne conglobataCauses big skin bumps.Oral isotretinoin combined with corticosteroids or antibiotics.
SubtypesAcne fulminansAppears suddenly with large bumps, fever, and joint pain.Oral isotretinoin combined with corticosteroids or antibiotics.
SubtypesAcne mechanicaBrought on by friction, pressure, or heat on the skin.Gentle cleansing, avoiding friction, and OTC treatments.
SubtypesAcne cosmeticaBreakouts from using certain oils, creams, or makeup that clog the pores.Discontinuation of the offending cosmetic, gentle cleansing, and OTC treatments.

Non-Inflammatory Acne

Non-inflammatory acne is generally mild and manifests as whiteheads and blackheads.

Whiteheads, sometimes called closed comedones, are small bumps caused by trapped oil and dead skin in our pores. The small, skin-coloured bumps are not inflamed and don’t cause scarring.

Blackheads, sometimes called open comedones, are small dark spots on the skin. They form when trapped oil in our pores gets exposed to air and turns black. They are mild and easily treated.

Inflammatory Acne

Inflammatory acne is more severe and happens when bacteria infect the clogged hair follicles, leading to swelling and redness.

Papules are small, sensitive red or pink bumps. Pustules are similar but have a yellowish liquid inside. Painful nodules form when oil and cells clog the follicles deeper within the skin, creating a hard lump. Cystic acne consists of deep, pus-filled lumps that can cause scarring.

It’s important to treat red and swollen acne quickly to avoid lasting skin damage. Understanding the differences between non-inflammatory and inflammatory acne can help guide treatment options.

Subtypes of Acne

There are a few less common subtypes or special forms of acne to know about:

  • Acne vulgaris is just a medical term for the usual kind of acne that many people get. It includes the typical whiteheads, blackheads, papules and pustules.
  • There are rare and severe acne types like acne conglobata, causing big skin bumps, and acne fulminans, which appear suddenly with large bumps, fever, and joint pain.
  • Acne mechanica is brought on by friction, pressure or heat on the skin. This is common with athletes wearing helmets and gear that rubs against the skin.
  • Acne cosmetica refers to breakouts from using certain oils, creams or makeup that clog the pores.

Knowing the differences can help identify the specific cause and best treatment option for each acne subtype.

Causes of Acne

While acne can be complex, there are a few main reasons why it happens:

  • Hormonal changes - Changes in hormones during times like puberty, menstruation, menopause or pregnancy can make the skin produce more oil, leading to acne.
  • Genetics - Acne tends to run in families. If parents had acne, children are more likely to develop it.
  • Excess oil production - Sometimes, hormonal changes make our skin produce too much oil, which can block the pores.
  • Bacteria - A specific bacteria linked to acne, called Propionibacterium, can cause redness and swelling when trapped in clogged pores.
  • Medications - Certain medications containing lithium, corticosteroids or testosterone can trigger acne flare-ups.
  • Stress - High stress does not directly cause acne but may worsen existing acne.

It’s important to remember that factors like eating greasy foods once in a while or occasionally skipping a face wash aren’t the direct culprits for acne. Everyone’s skin is unique, and it’s okay to seek clarity on what might be affecting yours. Good skin cleansing habits and a balanced diet can help reduce bacteria and excess oil buildup but do not prevent underlying acne development.

Additionally, acne is not just a teenage concern that people “outgrow.” Due to cyclical hormonal fluctuations, persistent acne can continue into adulthood, especially for women. Seeking treatment is key, as severe acne often requires professional care for satisfactory resolution. Debunking acne myths is the first step to clearer skin.

Risk Factors for Acne

While anyone can develop acne, certain factors place some people at higher risk:

  • Age - Acne typically begins at puberty and is most common in adolescents and young adults.
  • Family history - Having a parent or sibling with acne increases risk. Genetics play a role.
  • Oily skin type - Overactive sebaceous glands producing excess oil raise susceptibility to acne.
  • Hormonal changes - Fluctuating or high hormone levels during puberty, menstrual cycles, pregnancy and menopause can trigger acne flares.
  • Stress - High stress does not directly cause acne but may worsen existing acne.
  • Hot and humid climates - Increased sweat and oil production can promote acne in these environments.
  • Tight collars, helmets, backpacks - Things like tight collars or helmets rubbing against the skin can cause a type of acne called acne mechanica.
  • Use of certain medications - Drugs containing corticosteroids, testosterone or lithium are associated with acne.

Knowing the risk factors allows people prone to acne to be proactive about prevention and early treatment.

Getting a Diagnosis

If you’ve tried over-the-counter treatments and haven’t seen the results you hoped for, it’s completely okay. Then, a visit to a dermatologist can provide more personalised guidance. While self-diagnosis has limits, a dermatologist can properly evaluate and categorise the types of acne lesions present, like papules, pustules, nodules or cysts.

At the first appointment, the doctor will ask about when the acne started, what seems to worsen it, and how it affects your life. The dermatologist will examine the areas of concern, noting the characteristics and distribution of the acne.

The doctor can help determine whether an underlying hormonal, genetic or medical condition contributes to persistent acne. Doctors might do blood tests, skin tests, or take small skin samples to understand the acne better.

Early professional diagnosis of the specific acne type and cause is essential for effective treatment to prevent further skin damage and permanent acne scarring.

Acne Treatments: What Works and What Doesn’t

Navigating acne treatments can be daunting, but a wide range of options are available. Whether it’s over-the-counter products or prescription medications, there’s a path to clearer skin for everyone. The right treatment depends on the severity and type of acne.

Mild Acne Treatments

Over-the-counter products containing ingredients like salicylic acid, benzoyl peroxide, or alpha hydroxy acids can be effective for mild acne. These exfoliate dead skin cells, reduce oil, and fight acne bacteria. One step you could take to get over mild acne is to boost your skincare routine with a cleanser like the ones from CeraVe or Purifide. When it comes to moisturisers, you can give a try to products from brands like Cetaphil. Lotions could be another good way to make your skin happy - so why don't you have a look at the one from Dalacin-T? If you want to bring your skincare routine to another level, you could also reach out to CeraVe's Resurfacing Retinol Serum, Skinoren's cream, or Acnecide's 5% Benzoyl Peroxide Gel.

Moderate Acne Treatments

Moderate inflammatory acne usually requires prescription topical or oral antibiotics to reduce bacteria and inflammation. Common topical antibiotics include clindamycin and erythromycin. Doctors might prescribe certain oral antibiotics like doxycycline or minocycline to be taken for a few months. Some of the other options you might encounter along the way are Oxytetracycline or Tetralysal.

Severe Acne Treatments

Severe nodular cystic acne often needs oral isotretinoin. This powerful drug is highly effective but can have significant side effects. Hormonal therapies like birth control pills may also be an option for some women.

Natural treatments like tea tree oil might help, but they aren’t proven to work as well as medical treatments, especially for more severe acne. A dermatologist can recommend therapies proven to work based on acne type and severity.

Acne Home Remedies

If you’re facing more persistent acne, it’s beneficial to consult a dermatologist. However, some gentle home remedies might offer relief for those milder and occasional breakouts:

  • Tea tree oil - This has antimicrobial properties that fight acne bacteria. Dab onto pimples.
  • Aloe vera gel - The cooling gel reduces the redness and swelling of pimples.
  • Exfoliating face masks - Gentle masks with lemon juice, oatmeal or sugar gently remove dead skin cells and excess oil.
  • Stress relief - Activities like exercise, meditation and yoga may help prevent stress-related acne flares.
  • Healthy diet - Eating a diet rich in antioxidants found in fruits, vegetables, and healthy fats may promote clear skin.

Be cautious with DIY remedies, as some ingredients like lemon or baking soda can damage sensitive skin if used too aggressively. Remember that the effectiveness of home remedies could differ from person to person. It’s best to ask a dermatologist about safe supplemental home remedies to use.

Side Effects of Acne Treatments

While acne treatments aim to improve the skin’s condition, some potential side effects may occur that need to be monitored.

  • Topical acne products containing benzoyl peroxide, salicylic acid or sulfur can cause redness, stinging and peeling, especially at first as the skin adjusts. Using a gentle product formulation and reducing application to every other day can minimise irritation.
  • Oral antibiotics like tetracyclines may cause upset stomach, dizziness or sun sensitivity. Taking the medication with food and using sun protection helps reduce such effects.
  • Isotretinoin, a medicine for very severe acne, can have strong side effects like dry skin, muscle pain, headaches, and vision or mood changes. Strict medical supervision is required with this drug.

While most acne treatments are well-tolerated, patients need to be aware of potential adverse reactions. Following the dermatologist’s instructions can help manage temporary side effects and achieve optimal treatment results.

Acne Scars: Addressing the Aftermath

At The Independent Pharmacy, we understand that the possibility of lasting scars from acne can be a significant concern. It’s natural to feel anxious about this, especially with severe acne, but there are ways to address and heal these scars. Knowing how to minimise and address acne scars is essential.

There are several types of acne scars:

  • Ice pick scars - Narrow, deep pits in the skin from cystic acne.
  • Boxcar scars - Shallow, angular scars with steep edges, similar to chickenpox scars.
  • Rolling scars - Wide depressions from tissue damage under the skin, giving the skin a wavy appearance.
  • Hyperpigmentation - Post-inflammatory dark spots that fade slowly over time.

Preventing the most severe acne lesions through early treatment intervention is the best way to avoid permanent scarring. However, treatments are available to improve the appearance of acne scars if they do occur, including laser resurfacing, dermabrasion, microneedling, and filler injections.

Addressing the psychological impact of acne scarring is as important as physical treatment. Supportive counselling helps many patients cope with changes in appearance and self-esteem.

How to Prevent Acne

While acne cannot always be prevented entirely due to genetic factors, several proactive measures can help reduce frequency and severity.

  • Practice a consistent skincare routine - Gently cleanse the skin twice a day and apply oil-free moisturisers to maintain healthy skin barrier function.
  • Avoid excessive touching/picking - Frequent manipulation spreads acne bacteria and makes inflammation worse.
  • Wear oil-free cosmetics - Non-comedogenic makeup labelled oil-free or non-acnegenic.
  • Shampoo regularly - Shampoo hair frequently to prevent oil and product residue from contacting the face.
  • Watch diet - While no food directly causes acne, a diet high in processed carbs and sugar may worsen it.
  • Manage stress - High stress levels don’t cause acne but can aggravate existing acne.
  • Protect skin from the sun - Some acne meds increase sun sensitivity. Always wear sunscreen.

While not completely preventable, being proactive reduces the risk of frequent acne flares and helps control outbreaks.

People Also Ask

What’s the main cause of acne?

Hormonal changes during puberty and menstruation are the primary cause, which leads to increased oil production that clogs pores. Genetics also play a role in acne susceptibility.

How do you clear up acne?

Use gentle daily face cleansing over-the-counter products for mild cases, see a dermatologist for a prescription medication if those aren’t working, and avoid picking pimples, which can worsen acne. A combination of lifestyle and medical therapies works best.

What are the types of acne based on severity?

Mild acne is grade 1 with just whiteheads and blackheads. Moderate acne is grade 2 with some red pimples and pus bumps. Grade 3 is more extensive with bigger, sore red bumps. Grade 4 is severe cystic acne with large, painful under-the-skin lumps.

How can I tell what kind of acne I have?

Look at the types of bumps and locations. Just blackheads and whiteheads mean mild, non-inflammatory acne. Red, sore pimples indicate inflammatory acne. Large, painful lumps under the skin are severe nodular cystic acne. See a dermatologist if you’re unsure of the specific type.

Conclusion

Acne is extremely common but is also very manageable with the right information and treatment plan. Don’t hesitate to see a dermatologist if you struggle with moderate to severe acne, as specialised care can prevent lasting physical and emotional scars.

Remember, you’re not alone, and understanding the factors and treatments is a positive step forward. With the knowledge of proven medical therapies, lifestyle changes, and home remedies, you can effectively control acne symptoms and boost your self-confidence. To make sure that you heal correctly, avoid picking and popping pimples. Instead, follow a consistent skincare routine and visit a dermatologist for the first signs of inflammatory lesions.

You deserve to feel confident and at peace with your skin. Don’t lose hope - solutions are available if you take that important first step and seek help.

Sources:

Acne - NHS (www.nhs.uk)

Acne: Signs and symptoms (aad.org)

The Role of Inflammation in the Pathology of Acne - PMC (nih.gov)

Differences of Microbiomes Found in Non-Inflammatory and Inflammatory Lesions of Acne Vulgaris - PMC (nih.gov)

Acne Scarring—Pathogenesis, Evaluation, and Treatment Options - PMC (nih.gov)

Topical treatment of acne vulgaris: efficiency, side effects, and adherence rate - PMC (nih.gov)

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