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.
Key facts
Acne at a glance.
Typical signs
Clogged pores and inflamed spots
Common locations
Face, chest, back
Expected course
Can persist or recur
Treatment options
Acne topicals; pills for selected cases
What is it?
Top things to know about Acne
- It starts in the follicle. Acne affects the hair follicle and its oil gland.
- Spots take several forms. Plugs form blackheads or whiteheads; inflammation forms pimples and deeper lumps.
- It is not about dirt. Bacteria are only one part of the process.
- Tests are rarely needed. An unusual pattern or hormonal symptoms may call for assessment.
- Overview Oil and dead skin cells block hair follicles. This can cause blackheads, whiteheads, pimples, or deeper painful lumps.
What it looks like
What Acne looks like
Acne forms when pores clog with oil and dead skin cells. It shows up mainly on the face, chest, upper back and shoulders, where oil glands are most active. Breakouts can include blackheads and whiteheads, red tender bumps, pus-filled pimples, and deeper painful lumps. Many people have a mix. Once spots heal, they can leave behind red or dark marks, and deeper acne can leave scars.
Acne is usually described by the main type of spot. Most people have more than one type at the same time.
Comedonal acne
Mostly blackheads and whiteheads.
Inflammatory acne
Red papules and pustules.
Nodulocystic acne
Deep painful lumps that can scar.
Hormonal acne
Breakouts along the jaw and chin.
Body acne
On the chest, back and shoulders.
Where it shows up
Acne commonly affects the face and may also involve the chest and upper back.
Face
Facial locations.
Chest
Locations on the front of the upper trunk.
Upper back
Locations on the upper back.
On different skin tones
Acne on different skin tones
On lighter skin, inflamed acne looks pink or red, and healed spots often leave red marks. On brown and Black skin, pimples may look brown or purple, and healed spots often leave dark marks, called post-inflammatory hyperpigmentation, that can last longer than the acne itself. Treating acne early and gently helps prevent these marks.
What happens in Acne?
Oil and shed skin cells can block a hair follicle, changing the environment inside the pore. Bacterial activity and the immune response contribute to inflammation, swelling and tender spots.
- Oil and cells build up: Extra oil and sticky skin cells can block a pore.
- The pore environment changes: C. acnes bacteria contribute to inflammation.
- Inflammation creates a pimple: Immune activity causes swelling and tenderness.
Causes and triggers
What causes Acne
Causes
Why it happens
Acne forms when oil and dead skin cells clog pores, acne bacteria grow inside them, and inflammation follows. Hormones that increase oil play a central role.
Acne often runs in families. A parent with severe acne raises the chance of severe acne.
Risk factors
Raise the odds
- Teen years
- Family history
- Polycystic ovary syndrome
- Oily skin
Triggers
Bring it on or make it worse
- Hormone changes around periods (Well established)
- Heavy, pore-clogging products (Strong link)
- Some medicines like steroids (Strong link)
- Friction from masks, helmets or phones (Strong link)
- High-sugar and dairy-heavy diets (Possible)
- Stress (Possible)
When it usually starts
When it usually starts
Often begins in the teen years; acne can continue or first appear in adulthood.
Daily care
Daily care for Acne
Strip the routine back
Use a gentle cleanser, moisturizer and sunscreen without unnecessary product layers.
Cut back on sugar and refined carbs
Helps a little, mostly in oily, hormonal acne.
Wear sunscreen daily
Stops dark marks from deepening.
Avoid: Picking and squeezing
The biggest cause of avoidable scars.
Avoid: Scrubbing and over-washing
Strips the barrier and pushes you off treatment.
Avoid: Adding more products
Avoid adding several irritating products at the same time.
Avoid: Heavy oil-based hair products
Cause stubborn small bumps along the hairline.
Avoid: Friction and trapped sweat
Straps and collars press oil into pores.
Avoid: Heat and humidity
Swell the pore lining and trap what is behind it.
Avoid: High-glycemic diet
Sugar and refined carbs raise the hormones driving oil.
Avoid: Skim milk and whey protein
Linked to acne more than other dairy, though weakly.
Avoid: Stress
Raises the hormones that worsen acne you already have.
Avoid: Stopping treatment once it works
Acne usually returns within two to three months.
Treatments
Treatments for Acne
Adapalene
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.
Benzoyl Peroxide
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.
Azelaic Acid
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.
Salicylic Acid
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.
Niacinamide
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.
Sulfur
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.
Tea Tree Oil
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.
Tretinoin
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.
Aklief
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.
Clindamycin
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.
Tazarotene
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.
Winlevi
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.
Aczone
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.
Doxycycline
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.
Accutane
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.
Spironolactone
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.
Birth Control Pills
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.
Minocycline
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.
Seysara
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.
Cortisone Injection
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.
Comedone Extraction
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.
Chemical Peel
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.
1726 nm Laser
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.
Photodynamic Therapy
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.
Blue Light Therapy
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.
Outlook
What to expect with Acne
Controlled rather than cured.
- 1
By the mid-twenties
For most people it settles by the mid-twenties.
- 2
Into the 30s and 40s
About one in six women still has it into her 30s and 40s.
- 3
With hormone shifts
It can return after pregnancy, after stopping the pill, or with any hormone shift.
Complications
Complications to know about
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.
When to get help
When to get help
Make an appointment
Seek help for painful deep spots, scarring, persistent breakouts, or an uncertain diagnosis. Earlier treatment can reduce the chance of more scars.
Eye symptoms
Do not assume eye symptoms are part of acne. They need their own assessment.
Lookalikes
What else could it be?
Rosacea
Acne can cause blackheads. Rosacea does not; it more often brings flushing and lasting redness across the cheeks and nose.
Fungal Acne
Fungal acne usually causes itchy bumps that are all about the same size. Acne can include blackheads and a mix of small and larger spots.
Perioral Dermatitis
Perioral dermatitis usually clusters around the mouth, nose or eyes, leaving a clear strip beside the lips. Acne can spread more widely and include blackheads.
Keratosis Pilaris
Keratosis pilaris feels like dry, rough goosebumps, often on the arms or thighs. Acne is more likely to include blackheads or inflamed spots.
Hidradenitis Suppurativa
Hidradenitis causes deep, painful lumps that return in skin folds and may form tunnels. This pattern differs from typical acne and needs specialist care.
Questions
Questions you might be asking.
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.
Sources