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Virginia Chachati

Reviewed by Virginia Chachati MPharm
(2013, University College London)
GPhC Registration number: 2087654

Information last reviewed 24/06/2021

About

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?

You get acne when sebaceous glands in the skin produce too much sebum (oil) and block your pores. Sometimes, these can include blocked hair follicles. The extra sebum sticks to dead skin cells which cause spots to appear. In teenagers, high levels of testosterone are usually the cause of acne. Acne can also affect adults, which is often due to fluctuating hormone levels. As a woman, this can be due to your period, pregnancy or having polycystic ovaries. Acne can also be a side effect of some medicines. You can get acne from clothing or accessories which rub against the skin. Wearing makeup, which clogs your pores, or smoking can also cause acne.

Where can you get acne?

You can get acne on your face, but it can also appear on your back or 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 purged. Papules are another type of acne that come up as small red bumps. Pustules are similar but they also have a pus-filled centre. These are commonly known as pimples. Nodules and cysts are found in more severe acne. Nodules are hard, build up underneath the surface of the skin and are often painful. Cysts look like boils, are large and pus-filled. Cysts 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 go up during puberty. Women can experience acne due to hormonal changes during their period or pregnancy.

Symptoms

Acne symptoms

The symptoms of acne include breakouts of spots on your face, back or chest.  Acne spots can be blocked pores, pus-filled lumps or solid lumps underneath the skin. They do not usually itch, but they can be tender or painful.

How is acne diagnosed?

A doctor can diagnose acne by looking at your skin and asking you questions about the type of spots you have. Mild acne usually produces whiteheads, blackheads and a few pimples. Moderate acne can be seen as pustules, papules, whiteheads and blackheads. Painful cysts and nodules are a sign of severe acne.

Treatment

How is acne treated?

You can treat mild acne with over the counter creams containing benzoyl peroxide. If this is not effective, or if you have a lot of pustules or papules, you may need prescription treatment for your acne. These include azelaic acid, retinoid or antibiotic skin applications such as gels, creams or lotions. There are also capsules or tablets you can swallow which are antibiotics or contain retinoids. Your doctor may suggest isotretinoin for severe acne, or if no other treatments work. For your acne solution, start a free consultation with Dr Felix today.

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?

Cleansing your skin twice a day will help to remove excess oil and reduce breakouts of spots. After cleansing, use a non-comedogenic moisturiser which will hydrate your skin without clogging pores. You can use over the counter acne treatments that contain benzoyl peroxide or salicylic acid to prevent breakouts. Try drinking plenty of water, wearing light oil-free makeup and avoiding touching your face or squeezing spots to prevent acne.

How to reduce acne scarring?

Avoid squeezing spots to reduce the chances of scarring, especially cysts or nodules. Apply gels that contain retinoic acid, glycolic acid or salicylic acid to help even out your skin and prevent scarring. Use a high SPF sunscreen daily to protect your skin and stop scars or acne from getting worse. As a last resort, cosmetic surgery or laser treatment can remove or reduce the appearance of acne scars.

How to treat back acne?

Always shower after a workout, wear loose clothing that helps sweat evaporate quickly and wash your workout clothes straight away. Try to keep long hair away from your back, as oil from your hair can rub onto your skin and cause spots to form. Exfoliate your skin once or twice a week maximum. Use a body wash with tea tree oil to get rid of 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?

You can avoid acne most of the time by keeping up a good skin care routine. This includes using treatments that prevent acne from coming up, wearing oil-free makeup, avoiding skin products with harsh exfoliants and keeping up with any prescribed treatments to help avoid breakouts. If your acne is coming up because of hormonal changes, speak to Dr Felix for a solution.

Is squeezing spots good for acne?

Squeezing spots is not a good idea if you have acne. You can end up with 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, so check with your doctor or pharmacist before using one. You should only use a chemical peel once every so often to allow enough time for your skin to recover.

Side Effects

What are the complications of acne?

Acne can lead to low self-esteem and problems with anxiety or depression. This is due to the way it affects your appearance. It can be uncomfortable and have an impact on your confidence. Acne can also leave scars after the spots heal. These may be red or brown marks on the surface of your skin, or deep scars like icepick, boxcar and rolling scars.

Will my acne scars go away?

Acne scars can go away on their own, but it depends on how deep they are. Red or brown marks on the surface of your skin usually disappear after a couple of weeks. Ice pick scars look like small deep dips in your skin. Rolling scars are small round scars which are not as deep as ice pick scars, but they make your skin look bumpy and uneven. Boxcar scars are the deepest scars and are round or oval in shape. These three types of scars may need regular acid peels, laser treatment or surgery to improve how they look.

Q&A

What makes acne different from normal spots?

Most spots are different types of acne. However, you can have spots for other reasons. For example, you can get spots from an allergic reaction, an infection 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 can irritate your skin. Stick to a normal cleansing routine, shower daily and wash 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. This is when sebum (oils) become trapped in the hair follicles and mix with dead skin cells or bacteria. Warm, sweaty conditions can make back acne worse because your skin will produce more oils that can block your pores. Showering straight after exercise and washing your workout clothes can help reduce back acne or prevent these types of breakouts.

Who is most likely to get acne?

Acne can affect people of all ages and gender. Puberty, hormonal changes, pregnancy and lifestyle are all factors that can contribute to developing acne.

Does age affect acne?

Acne can affect anyone, regardless of their age or gender. Acne is particularly common when your body goes through hormonal changes such as puberty, periods and pregnancy. 

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