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What is acne?

Acne is a skin condition which causes breakouts of spots to appear on the face, back or chest. It's very common and most people will experience it at some point in their life. 

What are the causes of acne?

Acne occurs when the sebaceous glands near the skin's surface produce too much oil and block the pores, which are the hair follicles present in the skin. The excess sebum combines with dead skin cells which cause spots to appear. In teenagers, increased levels of testosterone are usually the cause of acne. Acne can also affect adults, predominantly women, which is often due to fluctuating hormone levels. This can be due to your period, pregnancy or having polycystic ovaries. Acne can also be a side effect of certain medications or it could occur after aggravating the skin with clothing or accessories which rub against the skin, wearing make-up which clogs the pores or smoking.  

Where can you get acne?

Acne mainly affects the face but it can also appear on the back and chest. 

What are the different types of acne?

There are six different types of acne. The first two are non-inflammatory:  whiteheads and blackheads.  These are small yellow or black lumps which cannot be squeezed or emptied. The colour comes from the hair follicle. Papules are small red bumps, pustules being similar but they also have a pus-filled centre. These are more commonly known as pimples. Nodules and cysts are characteristic of more severe acne. Nodules are hard and build up underneath the surface of the skin and are often painful. Cysts resemble boils in appearance and are large and pus-filled. They carry the biggest risk of permanent scarring. 

What is hormonal acne?

Hormonal acne is caused by hormonal changes or imbalances in the body. This is commonly seen in teenagers where their testosterone levels increase during puberty. 80% of adult acne occurs in women due to hormonal changes during menstruation and pregnancy.


Acne symptoms

The symptoms of acne are visible breakouts of spots on your face, back or chest. Acne spots do not usually itch, but they can be tender, painful or in many cases completely painless. Acne spots can be cblocked pores, pus-filled lumps, or more solid lumps beneath the skin. 

How is acne diagnosed?

A GP can diagnose acne by looking at your skin, examining the type of spots you have and how severe they are. Mild acne usually produces just whiteheads and blackheads with a couple of pimples. Moderate acne consists of numerous pustules and papules amongst whiteheads and blackheads. Painful cysts and nodules are a sign of severe acne.


How is acne treated?

There are a variety of different treatments for acne. Mild acne can be treated successfully with over the counter creams containing benzoyl peroxide. If this proves ineffective, or if you have a significant number of pustules or papules then you will need prescription treatment for your acne. These include topical retinoids and antibiotics, azelaic acid or oral antibiotics. You'll usually be given a combination of a topical gel or cream and oral antibiotics. A medication called Isotretinoin is given for severe acne, or will be the next step if no other treatments have worked. 

Prescription vs over the counter acne treatments

Over the counter treatments work well for mild acne and if you just have a few whiteheads, blackheads or pimples. There are lots of products available including cleansers and toners for spot prone skin or spot creams and gels. Topical ointments are the most effective over the counter product, such as Differin Gel. Acne treatments available on prescription are stronger and provide adequate treatment for moderate to severe acne. These will usually include antibiotics and topical treatments containing retinoids, antibiotics or azelaic acid. The combined pill can also be prescribed for women as a way of treating acne. Isotretinoin is prescribed for severe acne which produces cysts and nodules, or if your acne has not responded to other types of treatment.

How to prevent acne?

Acne isn't always preventable if it is caused by hormones but there are things you can do to help. Cleansing effectively twice a day will help to remove excess oil, keeping your skin clean. Use a moisturiser which is non-comedogenic, hydrating your skin without clogging up the pores. Some over the counter acne treatments can be used to prevent breakouts, in particular cleansers and toners designed to fight acne. The ingredients to look out for are benzoyl peroxide, salicylic acid, or sulfur. Drinking plenty of water, wearing light oil-free makeup, avoiding touching your face or squeezing spots are all useful preventative measures. 

How to reduce acne scarring

Acne can lead to scarring after the spots have cleared up. This is more likely if you have experienced cysts or nodules, as they damage the skin. Squeezing spots also increases the risk of scarring. Surgery or laser treatment is often required to remove or reduce acne scars which is a cosmetic procedure. Retinoic acid may prove effective as a topical treatment as well as product containing glycolic or salicylic acid. Using sunscreen everyday will also help to protect your skin and stop scars or acne from getting worse. 

How to treat back acne

Back acne can be treated in the same way as other forms of acne. There are often Lifestyle aspects which contribute to it however. Always shower after a workout, wear loose clothing which is sweat wicking and wash workout clothes after each use. Try to keep long hair away from your back as excess hair oils can rub off onto the skin and cause spots to form. Exfoliating the skin and using tea tree oil based washes can also help to eradicate dead skin cells and bacteria. 

Can acne be cured?

Acne cannot be cured but it can be treated successfully. In other words, you can achieve acne-free skin and maintain it by continuing to use treatment to prevent it from returning. For most people, their acne will eventually go away. Isotretinoin is the most effective method of treatment for getting rid of acne. This medication isn't suitable for everyone and is usually prescribed for severe acne with nodules and cysts. 

Can acne be avoided?

Acne can't always be avoided as hormones are a major factor in the cause of it. However, keeping up a good skin care routine including preventative treatment for acne-prone skin, wearing oil-free makeup, avoiding abrasive skin products and maintaining any prescribed treatments can help to avoid breakouts. 

Is squeezing spots good for acne?

Squeezing spots is not a good idea if you have acne as this leaves you at risk of developing scarring which can be permanent. 

Are chemical peels good for acne?

Glycolic acid peels can be used to treat acne and reduce the appearance of acne scars. These may not be suitable for all skin types however so you should check with a doctor or pharmacist before using one. 

Side Effects

What are the complications of acne?

Acne can lead to low self esteem and problems with anxiety and depression. This is due to the way it affects your appearance as it can be distressing and have an impact on your confidence. Acne can also leave scars after the spots heal. These may be red or brown marks that disappear after a couple of months or more pronounced like icepick, boxcar and rolling scars. 

Will my acne scars go away?

Acne scars can disappear but it depends on the severity of your scars. Red or brown marks usually vanish after a couple of weeks. Ice pick scars resemble small puncture parks across the surface of your skin; rolling scars form underneath the skin's surface, creating an uneven bumpy appearance and boxcar scars leave large crater like depressions in the skin. These types of scars may need surgery or laser treatment to improve their appearance. 


What makes acne different from normal spots?

Most spots are also forms of acne and the terms are interchangeable. However, you can have spots for other reasons such as an allergic reaction or an insect bite.

How often should you wash if you have acne?

Washing your face more than twice a day can make acne worse as it aggravates the skin. Stick to a normal cleansing routine, showering daily and washing your face once in the morning and again in the evening. 

Is back acne different?

Back acne is caused in the same way as any other spots; by excess sebum (oils) becoming trapped in the hair follicles, mixing with dead skin cells or bacteria. Warm, sweaty conditions are a major factor in back acne as this exacerbates excess oil production and leaves your pores at a greater risk of becoming blocked. Showering immediately after exercise and washing workout clothes after wearing them can help to reduce back acne or prevent these types of breakouts. 

Who is most likely to get acne?

Acne can affect people of all ages. It's most common in teenagers and young adults and adult acne is more likely to affect women than men.

Does age affect acne?

Acne can affect anyone, regardless of their age. Acne is particularly common during hormonal changes which includes puberty, menstruation, pregnancy and menopause. 

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