Acne is a prevalent skin condition caused by clogged pores, leading to blackheads, whiteheads, and pimples. The medical term for acne is acne vulgaris, and it can range from mild to severe, affecting self-esteem and sometimes causing permanent scarring.

Types of Acne

Broadly speaking there are two main types of acne, namely, non-inflamatory and inflamatory.

Non-Inflammatory

Blackheads

Blackheads, or open comedones, form when pores are clogged with oil and dead skin but remain open at the surface. The black colour is not dirt but a result of the oil oxidising when exposed to air. These are common on the nose, chin, and forehead and often respond well to exfoliation and proper skincare.

Whiteheads

Whiteheads, or closed comedones, occur when a pore is clogged but remains closed, trapping oil and dead skin inside. These appear as small white or flesh-coloured bumps on the skin. They can be challenging to treat as they are less responsive to topical remedies than blackheads.

Inflammatory

Papules

Papules are small, red, and tender bumps that occur when inflammation develops in a clogged pore. These do not contain pus and often feel sore to the touch. Papules signal the beginning stages of an inflammatory acne breakout.

Pustules

Pustules are what most people associate with pimples. They are red, inflamed bumps filled with pus, often having a white or yellow center. Pustules can appear anywhere on the body but are most common on the face, chest, and back.

Nodules

Nodular acne is a severe form that presents as large, hard, and painful lumps beneath the skin’s surface. Nodules occur when bacteria, oil, and dead skin cells cause significant inflammation deep within the skin. These do not form a head and often require medical intervention, such as prescription medications or corticosteroid injections, to resolve.

Cysts

Cystic acne is the most severe type and results in large, soft, and painful lumps filled with pus. Cysts form deep beneath the skin and are prone to scarring. This type of acne requires aggressive treatment, often involving oral medications like isotretinoin or hormonal therapies.

Other Types of Acne

Fungal

Fungal acne, or pityrosporum folliculitis, is caused by an overgrowth of yeast in the hair follicles. It often appears as uniform, itchy, red bumps and is commonly found on the chest, back, and shoulders. Although it looks similar to regular acne, it requires antifungal treatments rather than traditional acne medications.

Hormonal

Hormonal acne primarily affects adults and is closely tied to fluctuations in hormone levels. It is most common among women and appears along the jawline, chin, and lower face. Hormonal acne often involves deep, painful cysts and requires specialised treatments like oral contraceptives, anti-androgen medications, or retinoids.

Acne Mechanica

Acne mechanica is caused by friction, heat, and prolonged pressure on the skin, often from helmets, masks, or tight clothing. This type of acne is commonly seen in athletes or individuals who wear gear that irritates the skin. Prevention involves minimising friction and using breathable fabrics.

Who Is Affected by Acne?

Acne impacts nearly everyone at some point, particularly teenagers and young adults undergoing hormonal changes. It is more common in women and individuals assigned female at birth (AFAB). Family history is also a significant risk factor.

Prevalence of Acne

Approximately 80% of people aged 11 to 30 experience at least a mild form of acne, making it the most common skin condition.

Common Acne Locations

Acne frequently appears on the face, forehead, chest, shoulders, and upper back. These areas have a higher concentration of oil glands, contributing to pore blockages.

Symptoms

Acne symptoms include pimples (pus-filled bumps), papules (small discoloured bumps), blackheads, whiteheads, nodules (painful lumps under the skin), and cysts (fluid-filled lumps). The severity can range from occasional mild pimples to severe nodules and cysts.

What Causes Acne?

It’s caused from clogged pores caused by excess sebum, bacteria, or dead skin cells. This triggers inflammation, leading to pain, swelling, and skin discolouration around the affected area.

Environmental Triggers

Acne can worsen due to tight clothing, air pollution, humidity, greasy personal care products, stress, medication side effects, and habits like picking at pimples.

Dietary Links

Certain foods, such as skim milk, whey protein, and high-sugar diets, may contribute to acne. A balanced diet rich in fruits and vegetables, particularly those high in vitamin C and beta-carotene, can help reduce inflammation.

Hormones and Acne

Androgen hormones, such as testosterone, play a significant role in acne development. Hormonal fluctuations during puberty, menstrual cycles, or stress can trigger outbreaks.

Diagnosis and Treatment

How is Acne Diagnosed?

Healthcare providers diagnose it through a physical skin exam and may inquire about factors like stress, family history, and menstrual cycles. Tests for underlying conditions may be recommended for sudden, severe outbreaks.

Severity Levels

Dermatologists categorise acne into four grades: mild (Grade 1), moderate (Grade 2), moderately severe (Grade 3), and severe nodulocystic (Grade 4).

Treatment Options

Topical Medications

• Benzoyl Peroxide: Targets surface bacteria and is available over the counter.
• Salicylic Acid: Helps remove damaged skin layers and unclog pores.
• Retinoids: Prevent clogged pores and treat existing blemishes.
• Antibiotics: Combat bacteria that aggravate acne.
• Azelaic Acid and Dapsone: Reduce swelling and fight bacteria.

Oral Medications

• Antibiotics: Treat moderate to severe cases caused by bacteria.
• Isotretinoin: Shrinks oil glands and treats severe cases.
• Contraceptives and Hormone Therapy: Help regulate hormonal acne.

Additional Therapies

Severe acne or scarring may require treatments like steroid injections, laser therapy, or chemical peels.

Prevention and Self-Care

At-Home Remedies

Maintain a skincare routine by washing your face daily with warm water and a gentle cleanser. Avoid harsh products with alcohol or exfoliants, and use oil-free moisturisers. Refrain from picking or squeezing pimples to prevent scarring.

Lifestyle Adjustments

Choose non-comedogenic makeup and remove it before bed. Keep your hands away from your face and minimise stress to reduce hormone-driven breakouts.

Living with Acne

Long-Term Outlook

While acne often resolves in early adulthood, some individuals may experience it throughout their lives. Effective treatments can manage symptoms, though finding the right solution may take time.

Scarring and Mental Health

Acne can cause permanent scars, particularly if left untreated. It may also impact mental health, leading to anxiety or low self-esteem. Consulting a healthcare provider or mental health professional can help address these challenges.

When to Seek Medical Attention

If it persists, worsens, or causes distress, visit a healthcare provider or dermatologist. Early treatment can prevent scarring and improve your quality of life.

Questions for Your Doctor

Ask your healthcare provider about the type and severity of your acne, recommended over-the-counter treatments, and whether a dermatologist referral is necessary.