Acne: diagnosis, causes and treatment

Everything you need to know


Acne is a prevalent skin condition characterised by the appearance of spots and pimples on and around the face. It is common in adolescents, but around a fifth of acne cases occur in adults.

The most common, and most visible, outbreaks of acne happen on the face, but it's also perfectly normal for the spots to appear on the neck, chest, shoulders, upper arms and the back. Acne in itself poses no risk to general health, but severe cases can result in scarring if not dealt with carefully and sensitively.

What Causes Acne?

Acne is primarily caused by changes in hormone levels, which is why it is most common during the teenage years where we have fluctuating hormone levels, but can also be triggered by any hormonal fluctuations at any time of life. A common effect of high hormone levels is an increase in the oiliness of the skin, and this excess oil can clog up the pores and hair follicles leading to a growth in natural bacteria which causes acne spots to emerge.

This process can be worsened by makeup or skin irritants, which, although they don't trigger acne directly, can make it harder for the skin to cope.

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Common Acne Myths and Misconceptions

Many people think that acne spots are a sign of poor personal hygiene or dirty skin, but this isn't the case. While it's true that badly washed skin is more prone to spots of all kinds, acne is generally down to hormonal and hereditary factors. Obsessive washing of your face with ordinary soap will have little effect if you have a predisposition to this condition – in fact, scrubbing an affected area can actually make things worse by irritating your skin.

A well-balanced diet rich in fresh fruits and vegetables will generally improve your overall skin health, which may lessen the impact of acne. Still, diet is not proven to be a factor in the development of this condition. Similarly, excess consumption of chocolate or other sweet foods will not in itself cause acne. However, some people do have a mild allergic reaction to chocolate which can result in different kinds of spots appearing, but this is not directly related to acne.

Stress or anxiety is often mentioned as a cause of acne, and this does have some basis of truth. Although stress doesn't directly result in skin problems, it can have a secondary effect through the changes in hormone levels it can cause. Still, again this only makes existing acne worse rather than specifically causing it. 

The Different Types of Acne Pimples

Acne pimples can take many forms. We'll cover most types of spots we're familiar with, from those which are a nuisance but not a real cause for concern, to more severe skin lesions which can lead to scarring. These are the five main types of skin problems acne sufferers can experience, in order of severity:


These are simply clogged and blocked skin pores that have not become infected or too inflamed. The blockage is under the surface of the skin and hasn't broken through the skin barrier, meaning that whiteheads remain more or less invisible but can be felt as small bumps in skin texture.


Blackheads are basically a similar type of pimple as whiteheads. The main difference is the blockage has broken through the pore's surface, exposing the top to air oxidising it – and this leads to a dark appearance of the spot.


Papules are blackheads or whiteheads which have become inflamed, and have swollen up into red bumps that are tender to the touch, or even painful. Despite the discomfort and visible appearance, these papules are not yet infected, and with proper cleaning will eventually heal on their own. A big no no is to squeeze them, as this will only make things worse by risking infection.


These are the final stage of some papules which have filled with pus, and are the classic image of a pimple that most people have in mind: small, hard, red bumps in the skin, painful to the touch, and with a yellow or white tip. Again, no matter how tempting it is, do not squeeze or pop these spots. Try and let nature take its course, leaving them to either fade away or burst on their own. Popping them further raises the risk of greater infection and thus permanent scarring.

Nodules and Cysts

These are the most severe types of acne pimples; large red lumps under the skin which can throb painfully and take a long time to disappear. More than ever, these types of pimples should never be squeezed – nodules and cysts are caused by bacteria growing under the skin. Trying to pop them will usually only push the bacteria deeper down, making the inflammation even worse. Learn more about Cystic Acne here.

How Common Is Acne?

Most people will suffer from acne at some point in their lives, especially during their teenage years or at other times when hormone levels are in flux. It's estimated that around 80% of people between the ages of 11 and 30 will experience at least one acne outbreak. However, it's far from unheard of for people to have an episode in their forties or even fifties. Acne can happen in people of all backgrounds, with no particular correlation to factors such as race or ethnicity.

What Can Make Acne Worse?

Although the root causes of acne are due to hormone levels on the natural oils in the skin, several factors can make an outbreak more severe and longer-lasting. These include:

  • Wearing makeup, other cosmetics, or barrier creams that don't let your skin 'breathe'
  • Air pollution, pollen, or other airborne skin irritants
  • High levels of humidity
  • Skin coverings such as scarves, hats and tight collars over the affected areas
  • Picking, scratching and squeezing of the spots
  • Over-zealous scrubbing when trying to clean your face, as this can both irritate your skin and push the pimple-causing bacteria deeper

Many people say they find that their acne worsens if they overeat chocolate or junk food. Still, in the majority of cases, this is either a separate allergic reaction unrelated to acne or an effect caused by increased skin oiliness as a result of poor diet – this can be tackled by general acne skincare tips given at the end of this article.

Acne Treatment Options

For mild whiteheads and blackheads, gels or creams containing benzoyl peroxide are treatments available over-the-counter. You do not need a prescription to buy these treatments - your pharmacist will be able to help you choose the right treatment. Benzoyl peroxide works as an antiseptic to reduce the number of whiteheads and blackheads on the skin by fighting bacteria and acting as an anti-inflammatory. It should be applied sparingly to the affected area once or twice a day. For most people, a 6-week course will clear or significantly reduce their acne, but you may choose to continue applying the treatment less regularly to prevent your acne from returning.

Topical Solutions for Acne

Topical solutions are creams or gels which are applied directly to the parts of the skin affected by acne, and can work in various ways. Two of the most popular topical medications are Duac Gel and Differin Cream/Gel.

Duac Gel is a once-a-day, prescription-only treatment for mild to moderate acne. It contains two active ingredients that work on different aspects of acne, and is a 12-week course. The first ingredient, clindamycin, is an antibiotic that works against the bacteria in the skin which contributes to the spots forming. The second ingredient is benzoyl peroxide, which helps to remove the dead cells from the surface of the skin, and clears out pore blockages. Duac gel should be applied thinly to the affected areas.

Differin is another topical treatment for acne, available in either cream or gel form, both of which require a prescription. It contains the active ingredient adapalene, which is a form of vitamin A, and works against acne by reducing skin inflammation and helping to shed dead skin cells which can block pores, leading to spots. Like Duac, Differin is applied to the affected areas once a day after washing.

Oral Antibiotics for Acne

An alternative treatment for acne is taking antibiotics in either pill or capsule form rather than as a cream. This is a preferred treatment type in more severe cases of acne where permanent scarring is a real risk, and where topical lotions and creams may not be fully effective. It's normal for oral antibiotics to have larger doses than topical applications, with a correspondingly more powerful effect.

The two common types of antibiotics for acne treatment are Lymecycline and Oxytetracycline. Both of these medications work by tackling the bacteria in the skin, which can cause inflammation and trigger off acne attacks. Oral antibiotics for acne tend to have a slower effect than topical creams. Still, they are suitable for moderate to severe acne, which keeps recurring and has not been contained by other treatments.

How Long Does Treatment Take To Work?

Prescription acne treatments will usually show little immediate effect, especially when taken as oral antibiotics. Creams and gels can have a fast moisturising effect and a noticeable reduction in inflammation within a few days, but this is only a superficial result. The underlying problem usually takes several weeks or even months to be correctly dealt with. It is also possible that your acne could get worse before it gets better. While this is common and not a cause for concern, if you think this is happening to you, then speak to your doctor to ensure that you have no allergic reaction to the medication.

In general, you should see some positive results within a month or two, with severe cases of acne taking up to six months to be fully clear up. An important point with all prescribed medications that contain antibiotics is to complete the full course of tablets or creams that your doctor has prescribed, even if your skin seems to have cleared up before you've used up all the medication.

If you stop the course early, you may still have remnants of the bacteria in your skin, causing the acne to flare up again – and in these situations, the outbreak is often even worse than before.

Will The Acne Return After Treatment?

Unfortunately, acne is a problem that can come back time after time, even after successful treatment. This is because the underlying causes, namely hormones and skin bacteria, are naturally present throughout your life. Of course, the variation in hormone levels is worse during and around teenage years. Because of this, it's relatively common for people with severe cases of acne to continue taking a maintenance dose of medication even when there is no visible acne, to stop it getting a new foothold. This low dose treatment is usually maintained throughout the teenage years and even throughout your twenties if your acne experience has been particularly bad.

Your doctor will advise you whether or not this is necessary, but if so a standard treatment is a mild antiseptic wipe containing benzoyl peroxide, or a similar topical cream, used every day or two to keep the spots at bay. It is very unusual to continue using antibiotic-based treatments for the long term, as this can lead to the bacteria in your skin becoming resistant, making future outbreaks even more difficult to deal with.

Your Acne Skin Care Guide

As previously mentioned, acne is generally caused by hormones, and there is little that can be done to prevent an outbreak from happening. Nonetheless, taking good care of your skin can make the symptoms both less visible and less painful, and also reduce the chances of permanent scarring occurring. Things to pay attention to include:

Keep your skin as clean as possible, using gentle soaps and cleansers, without scrubbing too hard as this can irritate the skin, making the visible signs of acne more apparent as well as spreading bacteria around beneath the surface.

Try your best to avoid rubbing or scratching affected areas, and definitely refrain from squeezing and popping your pimples – this is a fast route to scarring.

If you shave, take care when doing so, and do it as little as possible. Use a sharp razor blade or a good quality electric shaver, and use gentle soaps, foams, or lubricants to keep skin irritation to a minimum.

Keep makeup use as low as possible, and if you do wear cosmetics, ensure that you use oil-free formulations that won't clog up your pores too much. Also ensure that you remove your makeup thoroughly as soon as you can, using a gentle remover.

Avoid too much sun, as both acne, and some acne medications can make it easier to get a sunburn, as well as drying out your skin and risking pimples turning into pockmarks.

Shampoo your hair regularly, especially if you have naturally oily or greasy hair – these oils can spread across your skin, prompting more severe acne outbreaks.

Acne is an unfortunate occurrence in teenage and adolescent life for most people, but for some, it becomes more than an annoyance and can last far longer than usual. However, with adequately supervised medical acne treatment and an excellent preventative skincare regime, the undoubted difficulties that acne causes can be kept in check, allowing you to get on with your life without the stress of dealing with acne.

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