Condition

Acne

Acne is a pore condition that causes blackheads, whiteheads and inflamed spots. It is the most common skin condition there is, and almost all of it responds to treatment if you give the treatment long enough.
Dr. Schwarz, MD · Board-certified dermatologistLast reviewed August 23, 2026
Close-up of a cheek with inflamed acne. Raised pink-red bumps, a few with yellow-white heads, sit in a patch of redness, and the skin between them is dry and flaking.

Start here

Acne is one of the few medical conditions people feel comfortable commenting on. “Are you washing your face enough?” It is not a reflection of how clean you are, how well you take care of your skin, or what you eat. For most people, acne comes down to genetics.

— Dr. Schwarz, Board Certified Dermatologist

Accutane - Complete Guide!

8:41 · Dermapedia on YouTube

Key Facts

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How commonThe most common skin condition in the country - roughly 50 million people a year
Who gets itMost teenagers get some. About 15 percent of adult women still have it in their 30s and 40s
Curable or managedManaged - most acne settles with age, but it can come back
Prescription neededNot always. Mild acne often clears with over-the-counter treatment
Time to improveAbout 12 weeks

Symptoms

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Comedonal
Blackheads and whiteheads

Comedonal

Clogged pores without much redness - blackheads where the pore is open, whiteheads where it is sealed. It usually sits across the forehead, nose and chin, and feels bumpy more than sore. This is the kind that responds best to retinoids, and worst to antibiotics.
Inflammatory
Red spots and pus-filled bumps

Inflammatory

Sore red bumps and pustules mixed in with blackheads. The pore has clogged and then inflamed. This is the most common pattern, and it is the one that leaves dark marks, so it is worth treating properly rather than waiting out.
Nodular
Deep lumps and cysts

Nodular

Firm, painful lumps under the skin that last weeks and never come to a head. This is the kind most likely to leave permanent scars, and the kind least likely to respond to anything bought over the counter. Deep acne is a reason to see a dermatologist now rather than in six months.

How It Looks by Skin Tone

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Inflamed acne on light skin. The spots sit in a patch of pink, and the ring of redness around each one is easy to see. A few have a yellow-white head, and the skin between them is dry and flaking.Acne on medium skin. Raised pink-red spots across the cheek and jaw, some with white heads, alongside flat brown marks left behind by spots that have already cleared.Acne on brown skin. Active spots read as brown-purple rather than red, which makes the inflammation easy to underestimate. Flat dark marks from older spots cover as much of the area as the raised spots do.Acne on deep skin. The active bumps look darker and slightly purple rather than red, and the flat dark marks left behind by earlier spots are the most obvious thing in the photo.
LightMediumBrownDeep

On deeper skin tones, the spot is rarely the main problem. What it leaves behind is. Acne heals into flat dark marks - post-inflammatory hyperpigmentation - that take six to twelve months to fade, far longer than the spot took to clear. So treat new inflammation early instead of chasing marks later, and wear sunscreen daily, because sun makes the marks darker and slower to go.

Redness is what gets missed. Inflammation here often looks brown or violet rather than red, so acne on deeper skin tones is judged milder than it is and treated less aggressively. Deep or nodular acne on the jawline, chest and shoulders also carries a higher risk of raised, thickened scars, so treat it early.

Where It Shows Up

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Front view of a head with red marks across the hairline and forehead, between the brows, on the nose and on the chin. The sides of the face are clear.
Forehead, nose and chin
The most common pattern in teenagers, where oil glands are densest. It often improves with age, but not always.
Front view of a head with red marks along both sides of the jaw, on the chin, on both lower cheeks and on the front of the neck. The forehead is clear.
Jawline, lower cheeks and neck
The usual adult pattern, especially in women. Deep, tender spots that flare in the week before a period are what people call hormonal acne, and they respond better to hormonal treatment than to antibiotics.
Front view of a whole body with red marks across the upper chest. The rest of the body is clear.
Chest
Common here, and often more stubborn than acne on the face. It is frequently missed, because people treat what they can see in the mirror.
Back view of a whole body with red marks across both shoulders and down the upper and middle back. The rest of the body is clear.
Back and shoulders
Common in the same people who get it on the chest, and the hardest place to treat because it is hard to reach. Sweat and friction from tight clothing or a backpack make it worse.
Back view of a whole body with red marks on both buttocks. The rest of the body is clear.
Buttocks
Usually not acne but folliculitis, inflamed hair follicles that look similar. Sweat, friction and damp clothing drive it, and it clears with different treatment, so it is worth having looked at.

What Happens in the Skin

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This is what is going wrong under the skin, in the order it happens. Click a step to see it.

How Acne happens
Skin basics
BARRIEREPIDERMISDERMISPOREOILGLAND0NORMAL SKIN1OIL PRODUCTION2DEAD SKIN CELLS CLOGGING THE PORE3BACTERIAL GROWTH4INFLAMMATION

A pore is a narrow tube with an oil gland at the base of it. The gland makes just enough oil to keep the surface soft, and it travels up and out with nothing in its way. The cells lining the tube shed one at a time, so the opening stays clear.

The gland makes more oil than the pore can drain.

Cells lining the pore shed too slowly and pack into a plug.

Oil trapped behind the plug is what the bacteria feed on.

The pore wall gives way and the skin around it goes red and sore.

The outer film of dead cells and oil. It holds water in and keeps irritants out, and it is thinner than a sheet of paper. Almost every dry, itchy, stinging skin problem starts here.

The outer layer, and the only one anything in a jar reaches. It renews itself constantly: a cell made at the bottom takes about a month to reach the surface and flake off. Most of what a skincare product does, it does here.

The living layer underneath, holding the blood vessels, the nerves and the collagen. It is where lasting change happens and it is hard to reach: most of what is sold for the skin never gets this far.

Four things happen inside a pore, in order. The oil gland makes too much oil. The cells lining the pore stop shedding cleanly and clump together, plugging the opening so the oil cannot escape. A normal skin bacterium, Cutibacterium acnes, multiplies in the trapped oil. The immune system reacts, and the pore turns red, swollen and sore.

Risk Factors

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Some people are simply more prone to acne
Genetics, hormones and age make clogged pores and inflammation more likely, and none of it is something you caused.
Hormones
Puberty
The big one. Rising androgens enlarge the oil glands and make the pore lining shed faster.
Hormones
Hormone conditions
Polycystic ovary syndrome drives adult acne, usually alongside irregular periods or unwanted hair growth.
Hormones
Menstrual cycle
Many people break out in the week before a period, when hormone levels shift.
Hormones
Pregnancy
Hormone changes can set acne off or settle it down, and there is no predicting which.
Inherited
Genetics
If both parents had bad acne, yours is more likely to be bad too.
Inherited
Naturally oily skin
A real risk factor. Being unwashed is not.
Other health conditions
Some medicines
Oral steroids, testosterone, lithium and certain progestins can all cause it. Never stop a prescribed medicine on your own - ask your doctor.
Other health conditions
Cancer treatments
EGFR inhibitors cause an acne-like rash that is inflammation, not oil.

What Makes It Better & Worse

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Acne is four problems at once — oil, dead cells clogging the pore, bacteria, and inflammation. Match your routine to the step causing the problem.

What is driving yours?

POREEPIDERMISMELANOCYTESDERMISOILGLANDBACTERIACOLLAGEN

The gland makes more oil than the pore can drain.

Cells lining the pore shed too slowly and pack into a plug.

Oil trapped behind the plug is what the bacteria feed on.

The pore wall gives way and the skin around it goes red and sore.

What helps

  • A retinoid at night Cuts oil, stops plugs, calms inflammation.
  • Cut back on sugar and refined carbs Helps a little, mostly in oily, hormonal acne.
  • Give it 12 weeks before deciding Real change shows between weeks six and twelve.

What makes it worse

  • High-glycemic diet Sugar and refined carbs raise the hormones driving oil.
  • Skim milk and whey protein Linked to acne more than other dairy, though weakly.
  • Stress Raises the hormones that worsen acne you already have.
  • Stopping treatment once it works Acne usually returns within two to three months.

What helps

  • Azelaic acid Unclogs, cuts bacteria, calms redness. The gentlest option.
  • Salicylic acid Dissolves the plug inside the pore.

What makes it worse

  • Heavy oil-based hair products Cause stubborn small bumps along the hairline.
  • Friction and trapped sweat Straps and collars press oil into pores.
  • Heat and humidity Swell the pore lining and trap what is behind it.

What helps

  • Benzoyl peroxide Fastest of these on red, sore spots.

What helps

  • Strip the routine back Cleanser, moisturizer, one active, sunscreen.
  • Start strong actives slowly Two or three nights a week, moisturizer on top.
  • Wear sunscreen daily Stops dark marks from deepening.

What makes it worse

  • Picking and squeezing The biggest cause of avoidable scars.
  • Scrubbing and over-washing Strips the barrier and pushes you off treatment.
  • Adding more products One active used consistently beats four used erratically.

Your Routine

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Good skincare advice is hard to find. This routine is built on treatments with real evidence behind them, not on whatever happens to be trending.

Acne
Acne
AM
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PM
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How These Treatments Work

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Acne treatments do not all do the same thing. Each one works on a different part of the pore.

Pick a treatment
Skin basics
POREEPIDERMISMELANOCYTESDERMISOILGLANDBACTERIACOLLAGENKILLS BACTERIAUNCLOGS THE PORESPEEDS UP CELL TURNOVERSTOPS PIGMENT MOVING UPUNCLOGS THE POREBUILDS COLLAGENFADES DARK SPOTSUNCLOGS THE POREKILLS BACTERIALOWERS OILFADES DARK SPOTSKILLS BACTERIALOWERS OIL PRODUCTIONSHRINKS THE OIL GLANDUNCLOGS THE POREEPIDERMISMELANOCYTESTHE POREOIL GLANDBACTERIACOLLAGENTHE DERMIS

Not all acne treatments work in the same place. Tap one to see where.

Benzoyl peroxide releases oxygen inside the pore, and the bacteria involved in inflamed acne cannot live in it. It is the fastest of these on red, sore spots, and the one thing that stops acne bacteria becoming resistant to antibiotics.

Salicylic acid dissolves in oil, so it gets down inside the pore rather than sitting on the surface, and loosens the plug of dead skin and sebum blocking the way out. That suits blackheads and whiteheads more than deep, sore spots.

Retinoids change how the pore lining sheds, so plugs stop forming in the first place — which is why they prevent spots rather than treat the ones already there. Given months they also slow pigment reaching the surface and push fibroblasts to build collagen.

Azelaic acid does three things at once: loosens the plug in the pore, reduces the bacteria in it, and calms the pigment cells that leave a dark mark behind. That combination makes it useful on deeper skin tones, where the mark often outlasts the spot.

Niacinamide turns oil production down a little and interrupts pigment being handed to the cells above. The evidence for clearing spots is thin; it earns its place for the marks left behind, and for making stronger actives easier to tolerate.

Clindamycin is an antibiotic that quiets the bacteria in an inflamed pore. Used on its own it stops working within months as they adapt, so it is always paired with benzoyl peroxide or a retinoid.

Spironolactone blocks the hormone signal telling oil glands how much to make. It works on the pattern rather than the individual spot, over three to six months, which is why it suits deep jawline acne that flares with the cycle.

Isotretinoin shrinks the oil glands themselves, and much less oil means less of everything downstream: fewer plugs, fewer bacteria, less inflammation. It is the only acne treatment that often keeps working after the course ends.

The outer layer, and the only one anything in a jar reaches. It renews itself constantly: a cell made at the bottom takes about a month to reach the surface and flake off. Most of what a skincare product does, it does here.

The cells that make pigment. They sit along the base of the epidermis and hand melanin to the cells around them, which is what gives skin its colour. Dark marks, melasma and the patch left behind by a spot are all these cells making more than usual.

A narrow tube running from the surface down into the skin, with an oil gland at the bottom of it. Oil travels up and out. When the tube blocks, what is behind it has nowhere to go — which is where blackheads and spots start.

Makes sebum, the oil that keeps the surface soft and stops water escaping. How much it makes is set by hormones, not by how often you wash — which is why scrubbing does not fix oily skin.

Cutibacterium acnes lives in the pores of everyone with skin. It is not an infection and it is not a hygiene problem. It only causes trouble when a pore blocks and it multiplies in the oil trapped behind it.

The scaffolding in the dermis that keeps skin firm and springy. It is built by fibroblasts and broken down by age, sun and smoking. Lines and looseness are collagen lost faster than it is replaced.

The living layer underneath, holding the blood vessels, the nerves and the collagen. It is where lasting change happens and it is hard to reach: most of what is sold for the skin never gets this far.

Over-the-Counter Products

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Everything here you can buy without seeing anyone. Filter to one kind, or leave it to see them all.

Showing everything below, including options with limited or weak evidence.
Cross-section diagram of a pore and oil gland labeled Adapalene, with three effects markedLabeled cutaway diagram of a single skin pore, headed Adapalene. The epidermis is a brick-textured band across the top and the dermis is pink below it, with a yellow oil gland at the base of the pore and a small cluster of bacteria inside it. Three callout lines point in: decreases dead cells in pore and decreases oil production are drawn in dark navy as main effects, and decreases inflammation is drawn in gray as a lesser one.
Strong evidence
The strongest thing you can buy without a prescription, and the best first move for most acne. It unclogs pores before they inflame, which is why it prevents spots rather than treating them.
Cross-section pore diagram titled Benzoyl Peroxide with KILLS BACTERIA printed inside the poreLabeled cutaway diagram of a single skin pore. The epidermis is drawn as a brick-textured layer across the top and the dermis in pink below it, with a yellow oil gland at the base of the pore. Three callout lines point into the pore: decreases dead cells in pore near the opening, kills bacteria at the cluster of bacteria deep in the shaft, and decreases inflammation in the surrounding dermis.
Strong evidence
Kills the bacteria involved in inflamed spots, and is the one thing that stops acne bacteria becoming resistant to antibiotics. Lower strengths work about as well as higher ones and sting less. It bleaches towels and pillowcases.
Cross-section pore diagram titled Azelaic Acid, labeled decreases dead cells, kills bacteria, decreases inflammationDiagram: how Azelaic Acid 15% (Finacea) works in the skin
Moderate evidence
Works on the spot and the mark it leaves at the same time, which makes it useful on deeper skin tones. It is also one of the few acne treatments considered safe in pregnancy.
Cross-section pore diagram titled Salicylic Acid, labeled decreases dead cells in poreLabeled cutaway diagram of a single skin pore, headed Salicylic Acid. The epidermis is a brick-textured band across the top and the dermis is pink below it, with a yellow oil gland at the base of the pore and a small cluster of bacteria inside it. A single dark navy callout line points into the top of the pore: decreases dead cells in pore. There are no other callouts, so the drawing shows one effect where the other ingredient diagrams show two or three.
Moderate evidence
Gets inside the pore and loosens the plug, so it suits blackheads and whiteheads more than deep spots. Gentler than a retinoid, and weaker than one.
Cross-section pore diagram titled Niacinamide, labeled lower oil production and decreases inflammationLabeled cutaway diagram of a single skin pore, headed Niacinamide. The epidermis is a brick-textured band across the top and the dermis is pink below it, with a yellow oil gland at the base of the pore and a small cluster of bacteria inside it. Two callout lines point in: decreases inflammation is drawn in dark navy as the main effect, and decreases oil production is drawn in gray as a lesser one. Nothing points at the dead cells blocking the pore.
Limited evidence
Sold heavily for acne, and the evidence for clearing spots is thin. It is genuinely useful for the marks left behind and for tolerating stronger actives - just not as the treatment itself.
Four sulfur acne products: Kate Somerville EradiKate, De La Cruz 10% sulfur ointment, The Ordinary and Thayers16:9 hero for Sulfur. Never cropped: the tone strip and the corner logo depend on the full frame.
Limited evidence
An old treatment, usually a mask or a spot dab, that dries the surface of a spot and mildly loosens plugs. It is gentle enough for skin that cannot tolerate benzoyl peroxide or a retinoid. It smells, and it is weaker than everything above it on this list.
Five dark glass tea tree essential oil bottles with glass droppers and one green box on white16:9 hero for Tea Tree Oil. Never cropped: the tone strip and the corner logo depend on the full frame.
Limited evidence
A 5 percent gel reduces inflamed spots in small studies, more slowly than benzoyl peroxide does. Neat oil straight from the bottle is a common cause of an itchy rash, so buy it already diluted. It is a reasonable extra rather than something to build a routine on.

Prescriptions

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Pick the tile above that looks most like yours and this list narrows to what suits it. The basics stay put - a gentle cleanser, a moisturizer and a daily sunscreen are right whichever kind you have.

These need a prescription. Filter to one kind, or leave it to see them all.

Showing everything below, including options with limited or weak evidence.
A white tube labeled Tretinoin with a dark blue swoosh, lying on a plain white backgroundDiagram: how Tretinoin works in the skin
Strong evidence
The most studied topical in acne. Stronger than adapalene and more irritating with it, so it is usually the step up rather than the starting point. Not used in pregnancy.
A white pump bottle labeled Trifarotene in teal lettering, lying on a plain backgroundDiagram: how Aklief works in the skin
Strong evidence
A newer retinoid, and the one specifically tested on chest and back acne rather than just the face. Useful when the trunk is the main problem. Expensive without coverage.
16:9 hero for Tazarotene. Never cropped: the tone strip and the corner logo depend on the full frame.Diagram: how Tazarotene works in the skin
Strong evidence
The strongest of the prescription retinoids, and the step to take when tretinoin has stopped making a difference. It is particularly good on stubborn blackheads and whiteheads. It is also the most irritating of them, so it is usually started two or three nights a week. Not used in pregnancy.
A white metal tube labeled Clindamycin with a teal swoosh, lying on a plain backgroundDiagram: how Clindamycin works in the skin
Moderate evidence
Calms inflamed spots, but should never be used on its own. Guidelines are explicit about this - alone it stops working within months as bacteria adapt, so it is always paired with benzoyl peroxide or a retinoid.
A white tube labeled Clascoterone in blue with a blue swoosh, lying on a plain white backgroundDiagram: how Winlevi works in the skin
Moderate evidence
Blocks the hormone signal that drives oil production, but only where you put it. It is the first hormonal option that works topically, and the only one that can be used by men as well as women.
A white metal tube labeled Dapsone with a purple swoosh, lying on a plain backgroundDiagram: how Aczone works in the skin
Moderate evidence
Mild on the skin and tends to suit adult women with inflamed spots who cannot tolerate a retinoid. Applied at the same time as benzoyl peroxide it can temporarily stain skin orange, so space them apart.
An amber pill bottle labeled Doxycycline on its side with round white tablets spilling outDiagram: how Doxycycline works in the skin
Strong evidence
Brings widespread inflamed acne down quickly, and is meant to be used for three to four months, not indefinitely. Always alongside a topical, which is what carries on once the tablets stop.
An amber pill bottle labeled Spironolactone on its side with round white tablets spilling outDiagram: how Spironolactone works in the skin
Strong evidence
For the pattern rather than the individual spot - deep jawline acne in adult women that flares with the cycle. It works slowly, over three to six months, and can be continued long term. Not used in pregnancy.
An unlabeled blister pack holding twenty-one white tablets and seven peach ones in four rowsDiagram: how Birth Control Pills works in the skin
Strong evidence
Lowers the hormone signal driving oil production across the whole body, so it suits acne on the chest and back as well as the face. Takes about three months to show, and carries a small clot risk that needs weighing up.
A white blister pack of eight oval capsules printed ACCUTANE in blue letteringDiagram: how Accutane works in the skin
Strong evidence
The only acne treatment that often produces lasting clearance after the course ends. What it costs you is months of dry lips and skin, blood tests, and strict pregnancy prevention. For acne that scars, that trade is usually worth making early rather than late.
16:9 hero for Minocycline. Never cropped: the tone strip and the corner logo depend on the full frame.Diagram: how Minocycline works in the skin
Strong evidence
Another tetracycline antibiotic for widespread inflamed acne, used the same way as doxycycline: three to four months, always alongside a topical. It is usually kept as the second choice, because it carries rarer but more serious side effects, including a blue-gray skin discoloration with long use.
An amber pill bottle labeled Seysara tipped over with white tablets spilling out16:9 hero for Sarecycline (Seysara). Never cropped: the tone strip and the corner logo depend on the full frame.
Moderate evidence
A narrow-spectrum antibiotic designed specifically for acne, so it disturbs gut bacteria less than doxycycline. One tablet a day, still meant for three to four months and still alongside a topical. It works about as well rather than better, and it is considerably more expensive.

Procedures

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These are done in the office, usually over several visits. Filter to one kind, or leave it to see them all.

Showing everything below, including options with limited or weak evidence.
A clear glass vial with a metal cap beside a small syringe and needle on whiteA small clear glass vial with a metal crimped cap lying on a white background, with a clear plastic syringe and a fine sheathed needle resting against it.
Moderate evidence
Deals with one stubborn painful lump, not the condition. It settles in a day or two and is the safe alternative to squeezing it. It does nothing to prevent the next one.
A small glass bowl of amber liquid beside a white fan brush on a white backgroundDiagram: how Chemical Peel works in the skin
Moderate evidence
Modest benefit for clogged pores and a better one for the dark marks left behind. Needs repeat sessions, and the benefit fades if the daily treatment stops.
A slim white and silver handheld laser wand with a pale blue tip and a gray cableA white and brushed-steel laser handpiece lying horizontally on a white background, with a pale blue lens at the left-hand tip and a braided gray fiber cable running off to the right.
Moderate evidence
Heats the oil glands themselves, which is a genuinely different approach from everything else on this page. Trial results out to about six months are good, it works across skin tones, and it is expensive and rarely covered. Long-term data is still limited.
A slim steel comedone extractor with a wire loop at each end, on whiteDiagram: how Comedone Extraction works in the skin
Limited evidence
Clears blackheads that are already there, quickly and visibly. It does not stop new ones forming, so it is an add-on to a retinoid rather than a substitute for one.
A flat rectangular light panel in a white frame filled with glowing blue LEDsDiagram: how Photodynamic Therapy works in the skin
Limited evidence
Can help stubborn inflamed acne, but the protocols vary widely between clinics, the downtime is real, and the evidence is not strong enough to put it ahead of the options above.
16:9 hero for Blue Light Therapy. Never cropped: the tone strip and the corner logo depend on the full frame.Diagram: how Blue Light Therapy works in the skin
Limited evidence
Blue light kills acne bacteria at the surface, so a course can quiet mild inflamed spots for a while. The effect fades within weeks of stopping, and it does nothing for blackheads or deep lumps. In-clinic courses cost far more than a topical that would do more.

When to See a Dermatologist

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Get on a dermatologist's schedule earlier than feels necessary - scarring cannot be undone, the treatments that prevent it are prescription-only, and waits run months. Book if you have deep, painful lumps, if spots leave marks or dents that stay, if 12 weeks of over-the-counter treatment has done nothing, if acne is affecting your mood, or if adult acne starts suddenly with irregular periods or new hair growth. There is no test - we go on the pattern and what you have already tried, and prescription treatment can start at that visit.

— Dr. Schwarz, Board Certified Dermatologist

Complications

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Dark marks

Flat brown or violet patches left where a spot was. They are not scars and they do fade, but it commonly takes 6 - 12 months, and sun exposure makes them last longer. These WILL FADE with time.

Redness

Flat pink or red marks left where a spot was, most often on lighter skin. Also not scars. They usually settle on their own, though it can take several months. These WILL FADE with time.

Scars

Permanent dents, pits or raised bumps left where inflammation broke down the skin's structure. Once formed, they can only be improved by procedures. These WILL NOT FADE with time.

Depression and anxiety

Acne can affect self-esteem, confidence and mental health. The link is consistent, and it does not track with how severe the acne looks to anyone else - which is itself a reason to treat it.

Family conflict

This is very common. Acne visits involving a teenager and a parent can sometimes be challenging, particularly when there is ongoing conflict about acne care.

Social impact

People may avoid photos, dating, social situations or activities because of their skin.

Lookalikes

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Rosacea

Flushing and persistent redness across the cheeks and nose, with small bumps but no blackheads. Blackheads are the giveaway - rosacea does not cause them. Treating rosacea as acne with strong actives usually inflames it further.

Fungal Acne (Malassezia Folliculitis)

Uniform, itchy, same-sized small bumps, usually on the forehead, chest and upper back, that flare with sweat and do not respond to acne treatment. Also called malassezia folliculitis. It needs antifungal treatment. Antibiotics tend to make it worse.

Perioral Dermatitis

A ring of small red bumps around the mouth, nose or eyes, sparing a thin border right at the lip line. Often follows steroid cream use. It clears with a different treatment entirely.

Keratosis Pilaris

Rough, dry, goosebump-like plugs on the upper arms, thighs and cheeks. It is not inflamed and it is not infected - it is a texture problem, treated with gentle exfoliation and moisture.

Hidradenitis Suppurativa

Painful, recurring deep lumps and tunnels in the armpits, groin and under the breasts. It is often dismissed as bad acne for years. It is a separate condition, and it needs specialist treatment early.

Questions Patients Ask

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Does acne ever go away?

For most people it settles by the mid-twenties. About one in six women still has it into her 30s and 40s, and it can return after pregnancy, after stopping the pill, or with any hormone shift. Controlled rather than cured.

Does what I eat cause acne?

Less than the internet suggests. The evidence points at high-glycemic diets - sugar and refined carbohydrate - and, less consistently, at skim milk. Chocolate and greasy food never held up, and no diet replaces treating the skin.

Why does my skin get worse when I start a new treatment?

That is purging. Retinoids speed up clogs already forming under the surface, so weeks of spots arrive at once. It peaks around weeks two to six and settles by week eight. Still worsening past 10 to 12 weeks is irritation, not purging.

Is it ever okay to pop a spot?

No. Squeezing pushes the contents sideways into surrounding skin, turning a spot that would have gone in days into a mark that lasts months, or a scar that lasts forever. A large, painful lump can be injected in clinic instead, and settles in a day or two.

Do I need antibiotics?

Sometimes, but never alone and never for long. They go alongside benzoyl peroxide or a retinoid, usually for three to four months, then stop while the topical carries on. Alone or indefinitely, they stop working and drive resistance.

Is my acne hormonal?

Almost all acne is hormonal - hormones drive oil production. The label only matters if it changes treatment: deep spots along the jawline and lower face in an adult woman, flaring before periods, usually respond better to hormonal treatment than to antibiotics.

References

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