Whether it’s one pimple or a cluster of blemishes, acne is a common problem that affects people of all ages.
Acne, or acne vulgaris, occurs when glands in the skin produce and secrete too much sebum, the skin’s natural oil. Sebum, along with dead skin cells, can clog pores, resulting in acne. And sometimes, bacteria called Cutibacterium acnes (C. acnes) gets into pores, causing inflamed acne.
Acne is a broad term encompassing a variety of breakout types that all have different symptoms.
There are six specific types of acne:
- Whiteheads A whitehead forms when a closed pore becomes impacted with oil and dead skin cells. It appears as a white bump on the skin’s surface.
- Blackheads In a blackhead, the pore is only partially clogged and remains open. Blackheads turn black when oil and dead skin cells react to oxygen in the air.
- Papules Papules are tiny, red, hard pimples. They form when bacteria get trapped in a pore.
- Pustules Pustules are similar to papules but contain pus that’s made of dead white cells.
- Nodules These large inflamed lesions occur when a pimple extends into the deeper layers of the skin.
- Cystic Acne This type of severe acne is similar to nodules and forms when the deeper layer of skin becomes inflamed. The difference is that cysts contain pus. These red lumps are soft, painful, and difficult to treat. Usually, they require a visit to a dermatologist.
In the same way that acne can take various forms, the severity of acne also varies depending on the type.
Blackheads and whiteheads are noninflammatory and typically easier to control. Papules and pustules are inflammatory types of acne. However, inflammation doesn’t necessarily indicate severe acne.
“People with mild acne can have some whiteheads and blackheads and a few — but not more than 10 — inflamed, red pimples called papules or pustules,” says San Francisco-based dermatologist Yoram Harth, MD, chief medical officer for MDacne.
Whiteheads and blackheads, while the less severe types, can still become a moderate problem. “People with moderate acne can have many blackheads and whiteheads, as well as 10 to 30 red, inflamed acne pimples,” says Dr. Harth.
Severe acne includes the presence of nodules and cysts or many breakouts on different parts of the body such as the face, back, neck, and chest.
Sometimes, severe acne can qualify as acne fulminans, which is a rare, highly inflammatory, immunologically induced form of acne that occurs mainly in male patients between the ages of 13 and 22 years.
“People with severe acne will usually have more than 30 red, inflamed pimples at any moment in time. They can also have a few deep cysts and nodules, which are more difficult to treat and usually heal with scars,” says Harth.
Acne symptoms vary based on the type of acne a person is experiencing, but generally, watch out for these signs:
- Oily skin due to the skin’s overproduction of sebum
- Redness and swelling around inflamed acne lesions of any type
- Tenderness or pain, common with nodules and cystic acne
- Hyperpigmentation as a result of skin inflammation triggering the overproduction of melanin
- Scarring or dark spots, which can result from severe acne and cysts
A number of factors can exacerbate acne or increase your risk.
- Changes in Hormone Levels Changing hormones, such as during puberty or menstruation, can cause the sebaceous glands to secrete more sebum.
- Cosmetics or Hair-Care Products Oily cosmetics can clog your pores, making you susceptible to breakouts.
- Family History There appears to be a connection between acne and genes, so if your parents struggled with acne, you may as well.
- Some Medications You may have acne if you take other medications like corticosteroids or lithium (Lithobid).
- Skin Friction Breakouts can also occur whenever there’s any type of pressure or friction on your skin, such as a hat, helmet, or face mask, says Kara Shah, MD, a board-certified dermatologist based in Cincinnati, Ohio. With the increased use of face masks to prevent COVID-19 and other viruses, maskne, or “mask acne,” has unsurprisingly become a problem, given what dermatologists know about the effects of friction on skin.
- Stress Stress increases your body’s level of cortisol, a hormone that causes your glands to produce more sebum.
A doctor or dermatologist can usually diagnose acne by looking at your skin. They’ll examine your face, chest, back, and any other areas where acne appears.
Some skin conditions such as
rosacea,
perioral dermatitis, and keratosis pilaris are sometimes mistaken for acne. If you believe you have acne yet your skin doesn’t improve with treatment or worsens, your doctor can make an accurate diagnosis.
The duration of acne varies from person to person. When acne develops in the teen years, it often becomes less of an issue by the time a person is in their mid-twenties.
Unfortunately, some people struggle with acne even through their twenties. In fact, about 3 percent of adults over age 35 continue to deal with bouts of acne.
There’s no cure for acne, but
treatments can get rid of breakouts and help prevent new ones.
The acne treatment that’s best for you depends on the type and severity of your acne.
A good skin care regimen is often the first line of defense for mild acne or the occasional pimple. But sometimes, treatment is needed to keep skin healthy.
Over-the-Counter Products
These solutions include medicated cleansers, lotions, creams, gels, and face pads. They typically contain acne-fighting ingredients, such as:
- Benzoyl peroxide
- Glycolic acid
- Salicylic acid
- Azelaic acid
- Niacinamide
- Topical retinoids
These ingredients work by preventing the plugging of hair follicles, fighting bacteria on the skin, reducing oil production, or exfoliating the top layer of skin.
Harth explains that to heal body acne, such as
back acne, you will need an anti-acne treatment like benzoyl peroxide, which is the most effective for body acne.
Prescription-Strength Products
Options for ointments, creams, and lotions that you can receive with a prescription from your dermatologist include:
- Injections of a corticosteroid
- Isotretinoin (Accutane), a pill that is selectively prescribed to manage very severe acne and is under close supervision by a healthcare professional
- Oral antibiotics, such as minocycline (Minocin) and doxycycline (Vibramycin)
- Oral antihormonal medications for women, such as spironolactone (Aldactone)
- Oral contraceptives for women (Yaz)
- Retinoids, chemical compounds that are natural derivatives of vitamin A, such as adapalene topical (Differin) and tazarotene topical (Tazorac)
- Topical antibiotics (Acanya, BenzaClin, BenzaClin Pump, Duac, Neuac, and Onexton)
- Topical antihormonal medications for women, such as clascoterone (Winlevi)
- Topical azelaic acid (Azelex and Finacea), which has antibacterial, anti-inflammatory, and exfoliating properties
Some acne medications can make your skin more sensitive to the sun, so be mindful of spending long hours outdoors and always wear
sunscreen for protection.
Dermatology Procedures
For stubborn acne, your dermatologist may recommend an in-office treatment, such as
laser resurfacing therapy or a chemical peel. Other in-office treatments include light therapy, steroid injections, or drainage and extraction of cysts and pimples.
The Importance of Consistency in Treating Acne
You’ll probably need to treat acne for an extended period of time rather than during breakouts exclusively. Also, don’t stop an acne treatment until your doctor says it’s okay. Otherwise, you run the risk of having another breakout just when your skin starts to clear.
Without treatment, you may have persistent breakouts and scarring of the skin.
Anxiety and low self-esteem are also associated with persistent acne.
Alternative and Complementary Therapies
Although traditional acne therapies are proven effective, you may want to experiment with home remedies to complement your plan. While these options won’t be as effective as medications or procedures, they may come with fewer side effects. Some acne medicines can cause dizziness, upset stomach, and sun sensitivity.
Ingredients that may help fight acne include:
You can take steps to stop pimples before they pop up:
- Wash your face twice a day. Use warm water and a mild cleanser, and don’t scrub too hard, or else you could damage the protective layer of your skin and make acne worse, says Harth.
- Keep hair off your face. Greasy, oily hair can make your skin oily, which can clog your pores and cause acne. Wash your hair regularly, and keep hair off your face.
- Use oil-free skin care products. Look for “noncomedogenic” skin care products, which don’t clog pores. Noncomedogenic products are less likely to result in acne breakouts.
- Don’t sleep in your makeup. Removing all traces of makeup before bedtime keeps your pores open and prevents acne. Sometimes, warm water isn’t enough to remove makeup. “You will usually need to use oil-free makeup remover wipes in addition to your cleanser,” says Harth. Some dermatologists also recommend micellar water as part of a double-cleanse routine to help remove makeup without leaving an oily residue behind.
- Don’t touch your face. The more you touch your face, the greater the risk of transferring oil and dirt from your hands to your face. Acne tends to occur on the face and forehead because this part of the body has more sebaceous glands.
Diet Tips for Acne
You may have heard that soda,
chocolate, and junk food can cause acne.
Some people claim that these and other foods trigger their breakouts. Yet registered dietitians and researchers alike are split on whether food is a culprit.
According to Harth, multiple studies have found that acne tends to be worse in people who eat sugary foods, refined
carbohydrates, and dairy. Milk and other dairy products appear to raise levels of insulin-like growth factor 1 (IGF-1), which may trigger greater sebum production and contribute to breakouts.
Meanwhile, blood sugar spikes sparked by eating sugary foods and refined carbohydrates can also lead to skin inflammation and cause the skin to produce more oil.
While the jury’s still out on whether diet choices definitely contribute to acne, Harth recommends erring on the side of caution. “The best diet for people with acne should include anti-inflammatory foods with a low glycemic load,” he says.
The
glycemic index (GI) ranks carbohydrates by how fast they increase blood sugar. Since low-GI foods eliminate blood sugar spikes, they might also support acne reduction.
“Good examples are cold-water fish like mackerel, salmon, and sardines; leafy greens;
nuts; certain seeds; and complex carbohydrates like wild rice and
quinoa,” says Harth.
An unfortunate side effect of acne is scarring, which may take weeks or months to disappear.
Scarring, which is more likely with moderate or severe acne, includes black marks or spots where acne once appeared. The best way to reduce the risk of scarring is to leave acne alone, avoiding touching, squeezing, or picking at bumps.
If you can’t keep your hands off your face, cover acne with a
pimple patch. As a bonus, these patches contain salicylic acid to help treat breakouts.
If scars don’t fade on their own, work with your dermatologist to reduce their appearance.
Your doctor might recommend an acne medication that gets rid of blemishes and stimulates collagen production, as collagen can help minimize the appearance of existing scars.
Procedures to reduce or eliminate acne scars include:
- Dermabrasion
- Microdermabrasion
- Chemical peels
- Microneedling
- Laser treatments
- Fillers
- Punch excisions
A dermatologist can safely remove pimples, but popping a pimple yourself increases the risk of scarring and spreads bacteria from your hands to your face.
An estimated 9.4 percent of people worldwide have acne, totaling some 650 million adolescents and adults.
As many as 50 million people in the United States have acne, most of whom are in their teen or young adult years. About 85 percent of teenagers eventually get acne.
Meanwhile, over 25 percent of women and 12 percent of men in their forties report having acne.
Approximately 20 percent of people affected by acne develop severe acne that results in scarring.
Acne and its effects occur in varying degrees in Black, Indigenous, and People of Color (BIPOC) groups and in white people. Although acne affects all racial groups and ethnicities, it’s more prevalent among Black Americans and Asian Americans compared with white Americans.
Black Americans and Acne
Acne is one of the most common dermatological problems among Black people. It can appear on any part of the body, but often appears near the hairline in Black women. Acne in this area is likely the result of hair-care products clogging pores near the hairline. It’s also very common for Black people to develop post-inflammatory
hyperpigmentation (dark patches due to the overproduction of melanin) and scarring.
Despite the prevalence of acne among this group, Black individuals are less likely than their white counterparts to see a dermatologist for treatment. More research is needed to understand the cause of this disparity.
Hispanic Americans and Acne
Acne is a common dermatological diagnosis among Hispanic Americans as well. For instance, nearly 32 percent of Hispanic women between the ages of 10 and 70 are treated for acne compared to 24 percent of white women. What’s more, hyperpigmentation, dyspigmentation, and atrophic scarring are more common among Hispanic individuals than white people.
Asian Americans and Acne
Acne is a common dermatological complaint among Asian Americans as well, with a slightly higher prevalence than among white people.
Dyspigmentation and scarring aren’t as common among Asian Americans, but hyperpigmentation does affect a greater percentage of this group.
Even though acne develops when pores become clogged with dead skin cells or dirt, it can also occur alongside other conditions or as the result of hormonal changes.
Conditions related to acne include:
