Acne. What is It, Why Do I Have It And How Can I Get Rid Of It?

If you are suffering from acne, you are not alone. The American Academy of Dermatology suggests that anywhere between 40 to 50 million Americans are suffering from acne at any one time, and the number of adults suffering from acne is growing.

Although acne is widespread, it can still cause many people to experience anxiety and frustration with misleading information and failed treatments. It is important to understand what acne is, what causes it and the treatment options that are available to you before you even head down the aisle of your local drug store.

What Is Acne?

In the most basic of terms, acne is a result of clogged pores.

Normally, dead skin cells rise to the top of the skin through the pores and are then shed by the body. However, when the skin produces excess sebum (an oily substance that lubricates the skin), the dead skin cells can get stuck in the pore and clump together.

When that happens, the bacteria that live on our skin can make their way into the clogged pore and in there find an environment that encourages them to reproduce and multiply. The pore can then become inflamed, appearing red and swollen.

woman with acne

The extent of the inflammation and the depth as to where it reaches contributes to the type of acne.

While acne is most commonly associated with the face and neck, it can occur anywhere on the body. Acne on the back, chest, arms (upper), buttocks, and shoulders is also common.

Besides the known blemishes and redness, acne can also cause other symptoms, like:

  • Once the acne heals and the inflammation and redness disappears, it can leave dark spots on the skin that take months or even years to disappear completely.
  • Severe acne (the presents with cysts and of pustules) often leaves permanent scars on the skin.
  • Many people who have acne can also have low self-esteem that can be so severe that it impedes their social life.
  • some people, the complications of severe or chronic acne paired with low self-esteem can lead to depression.

What Is This? Types Of Acne

The type of acne you have will determine the type of acne treatment or acne treatment combinations that would be most suited. The most common type of acne is Acne Vulgaris, which can present in several different forms ranging from Mild, Mid to High Severity.

Mild Severity – Comedones

When a pore or hair follicle becomes clogged, it is called a comedo. Comedones (plural) present as either white- or blackheads. In both cases, there is no inflammation.


A whitehead is a pore that has become clogged with sebum and dead skin cells, under a thin layer of skin. A whitehead is firm and not the same as a pimple.



A blackhead is essentially the same as a whitehead, except that the pore is not covered by skin. The melanin in the sebum is exposed to air, which causes it to oxidize, resulting in a dark or ‘black” spot (hence the name).


Mid-severity acne, unlike mild severity acne, causes more discomfort. The resulting papules and pustules are inflamed and can be quite painful.


When the sebum, dead skin cells and bacteria in a whitehead causes the skin to become inflamed, it has progressed to what is called a papule. Papules are red and swollen but do not have pus.


Pustules are similar to papules, but they contain pus. Because the distinctive pustules feature is a white-ish discharge, they look like more prominent, inflamed whiteheads.

High Severity

High severity acne is usually harder to treat at home and in most cases require dermatological acne treatment.

acne severity


When swollen, clogged pores become further irritated, they grow larger and deeper into the skin. Nodules are clogged and inflamed pores that have grown so deep into the skin that they become hard to treat with over-the-counter acne treatments.


Cysts are the largest form of acne and are similar to nodules, except that the inflammation occurs deep under the skin; further below the surface. Cysts usually result in severe infection and are the most likely to scar after healing.

What Causes Acne?

While there is no one cause of acne, experts agree that there are specific factors that can encourage acne to appear.


It is widely recognized that genetics play a role in the risk of developing acne. Genes determine, amongst a myriad of other things, the oil production of your skin and the condition of the dead skin cells. Both of these are important factors in the development of acne.


However, it is important to keep in mind that there are no studies that prove that having “acne-genes,” guarantees that you have acne. It merely indicates that you have a higher risk of developing acne.

Cigarette Smoking

Despite a lot of research, the effect of smoking on acne continues to be inconclusive and therefore controversial. While there have not been any studies to prove a direct correlation between smoking and acne, there are certain effects of smoking that could indirectly affect the risks of developing acne.

  • Reduces inflammatory response of the skin- Smoking can cause the immune system to become less active, which forces the skin to heal more slowly.
  • Reduces vitamin E- vitamin E is an important antioxidant. When Vitamin E production is lowered, oxidants (sunlight, pollution, etc.) can cause the sebum to become damaged and oxidize. This can exasperate acne.
  • Increase hormones. Some studies have shown that smoking can cause increased insulin resistance and free testosterone. Both of these hormones can aggravate acne caused by hormones.

Increase In Hormones

Hormones can increase the chances of developing acne by affecting the production of oils or sebum. The most common hormonal increases happen during puberty and pregnancy, where androgen and testosterone levels are elevated. This increase in hormones causes the skin to produce more sebum, which in turn increases the risk of pores becoming clogged.


Over recent years the relationship between diet and acne has become clear. It is now generally accepted, thanks to growing evidence, that diet does affect the inflammation response of the body and therefore acne.

Contrary to popular believe, fatty foods do not seem cause or encourage the development of acne. Instead, the evidence seems to support, that foods that affect hormone levels do.

milk products

Amongst these are dairy products, carbohydrates that score high on the glycemic index (increase blood sugar) and foods high in processed sugars.

What Is The Best Acne Treatment?

Most people with acne will be looking for treatment. Most treatments consist of a regimen that combines different therapies, both medical and non-medical, to combat the onset of severe acne or treat it completely. The type of acne you have will determine which treatment will work best for you.

Before consulting a dermatologist, there are steps you can take to help reduce, prevent or even cure acne in the early mild severity stages of acne. These include lifestyle changes, dietary changes, certain over the counter medications and alternative acne treatments.

In more severe cases of acne, you are best served by combining lifestyle changes and dietary changes with medications or procedures prescribed by your dermatologist.

Lifestyle Changes

The first line of defense for any treatment involves taking care of the skin and taking extra care to keep it clean and free of irritants.

Dermatologists advise to take the following steps and precautions:

  • Wash the affected skin at least twice a day with a mild and non-abrasive cleanser. Avoid products that contain alcohol.
  • Wash your skin after sweating. Sweat, which contains amongst others salt, can make acne worse. So always, wash after any perspiration.
  • Avoid using washcloths, sponges or anything else that can irritate the skin. Similarly, avoid the temptation to scrub. Always gently wash the skin using only the fingers/hand and a gentle cleanser.
  • Do not irritate the skin. Use gentle products, avoid alcohol-containing cleansers, astringents, toners, and exfoliates.
  • Rinse with lukewarm water; avoid irritating the skin with hot or too cold water.
  • Squeezing, popping or picking at acne will only increase the time it will take the skin to heal. The longer a wound takes to heal, the higher the risk of developing scars so let your skin heal on its own.
  • You may not have considered it, but products and oils in your hair can make their way to your neck or face. Take care to keep your hair clean and oil-free by washing it regularly with a gentle shampoo. Be careful of the products that you apply to your hair. Avoid using oils, gels or ointments that can get under your skin. Also, take steps to avoid hair to skin contact, either keep it short or tied back.
  • Take measures to avoid friction. Friction can further irritate sensitive or inflamed skin, so try to protect your skin from phones, hats, straps or backpacks.
  • Avoid touching the affected skin. Touching the skin can transmit dirt and bacteria from the hands to the skin.
  • Avoid the sun and stay out of tanning beds. Not only does UV affect the skin under normal conditions, but many acne medications also make the skin more sensitive to it.

Dietary Changes

As we have discussed above, people who suffer from acne can benefit from avoiding or moderating certain foods. You should examine your current diet and take steps to remove:

  • Dairy
  • Refined Carbohydrates
  • Processed Sugars

It can also be beneficial to look at sources of probiotics, whether as supplements or not. Some studies seem that consuming probiotics can help in the treatment of acne by reducing the production of the inflammatory protein cytokine.


Most acne treatments prescribed by Dermatologist will rely on topical therapies or a combination of topical and non-topical medicines.


Topical treatments are those medications that are applied to the skin. Topical treatments can have different purposes like killing bacteria, reducing oil production or encourage the shedding of dead skin cells. Some topical treatments do two more or more of these.

topical medication

Most topical acne treatments will contain:

  • Retinoid or retinoid-like drugs – Retinoids are derived from Vitamin A and can come as creams, lotions or gels. Retinoids help treat acne y preventing hair follicles or pores from becoming clogged.
  • Salicylic acid – also known as BHA, salicylic acid helps treat acne thanks to its exfoliating properties; it removes dead skin cells from the surface of the skin. It is a prevalent ingredient in over the counter and cosmetic cleansers.
  • Benzoyl peroxide – Benzoyl peroxide is a common acne treatment that works much the same as salicylic acid. Benzoyl peroxide also unclogs and removes dead skin cells, but it has the added benefit of even being antibacterial. It is usually only prescribed by Dermatologists since the strength can also irritate the skin.


When acne is more severe or does not respond to topical medication, a Dermatologist can prescribe an acne treatment that includes both topical and non-topical medicines. In those cases, the non-topical medications usually consist of:

  • Antibiotics – most antibiotics used in combined acne treatments are tetracycline or antibiotic in the tetracycline family. These antibiotics help kill bacteria by impeding their ability to produce proteins. One of the side effects of these antibiotics is an increased sensitivity to sunlight, which makes it even more important to avoid direct sunlight.

get rid of acne

The American Academy of Dermatology advices that antibiotics always be used in combination with a topical treatment.

  • Birth control pills – some woman have found that certain birth control pills help treat acne, usually in combination with a topical treatment. Birth control pills affect the hormonal balance and as such can help reduce acne caused by hormonal imbalances.

A Dermatologist can help determine if and which birth control pill will help treat acne. Keep in mind that birth control pills cannot always help treat all forms of acne, they only help when the pill consists of the right hormone in the correct dose.

  • Isotretinoin – Isotretinoin is a powerful retinoid or form of Vitamin A. Isotretinoin is one of the most potent acne medications. It works by decreasing oil production, reducing bacteria, calming inflammation and slowing down the cell turnover of the skin (less dead skin cells). It fights all the four major causes of acne.

However, despite its powerful acne-fighting properties, it is only prescribed in the most severe cases and usually after antibiotic treatment has failed.

Isotretinoin can cause severe side effects that include muscle and joint pain, elevated cholesterol, and even liver toxicity. The most serious side effect is that it can cause serious congenital disabilities and in some cases even fetus mortality.

Woman taking Isotretinoin must be extra vigilant and are advised to use two forms of birth control.

Medical Procedures

A dermatologist may advise a treatment that includes a combination of topical, non-topical or procedural treatments. These procedures are usually performed by a dermatologist during a scheduled office visit and may include:

Lasers And Other Light Therapies

While it had not yet been determined by study what the ideal method, dosage, and source is for different types of acne, these types of treatments have been very useful for some acne patients. The photodynamic treatments work by reducing the presence of bacteria and the activity of sebum producing glands. These types of treatments also cause a heightened sensitivity to sunlight, so beware.

Chemical Peels

The chemical peels that dermatologist can prescribe uses a chemical solution of prescription strength acids. These acids usually include salicylic, retinoic or glycolic acid to remove the upper layer of skin (including the accumulated dead skin cells).

chemical peel

These types of treatments are most effective for blackheads and papules and do not have a long-lasting effect.

Since the body will naturally keep producing new skin cells, chemical peel treatments are prescribed to be repeated as needed.

Acne Removal

A dermatologist may prescribe and perform manual removal or extraction of acne in these cases:

  • Cysts – when a cyst does not respond to medication the dermatologist can suggest draining and extracting the cyst. It helps to decrease the pain and discomfort caused by the cyst, while also help reduce the risk of scar formation.
  • Whiteheads and Blackheads – If topical treatments have not resolved blackhead or whiteheads (or combinations of these), a dermatologist can use special extraction tools to remove them. You should be aware that this procedure can cause scarring and is therefore only applied when standard topical medication did not do its job.

Steroid Injection

When the acne is severe, presenting with nodules and cyst, a dermatologist can decide to inject a steroid drug directly into them. This procedure seems to result in fast improvement and reduce the pain associated with this type of acne. However, one side effect is that the skin in the treated area becomes thin.

Alternative Treatments

While medical acne treatments are the most common and have been studied for effectiveness, several alternatives or natural acne treatments can be very beneficial and efficient. Here are a few:

Rhassoul Clay

Rhassoul Clay is a reddish brown clay found in Morocco. It has been used for many cosmetic reasons, due to its cleansing properties. Regarding acne treatment, it is especially exciting for its feature to remove surface oils and oils that have accumulated around or in pores.

Willow Bark Extract

Willow bark contains a natural source of anti-inflammatory salicin.

Tea Tree Oil

Tea tree oil has long been used as a topic antimicrobial. However, tea tree oil is also known to be very irritating to the skin so caution is advised in its use, which should be administered in a diluted solution.

Green Tea

While the antioxidant properties of green tea are now commonly accepted, there are also studies that show that the topical application of green tea can help reduce the presence of acne-causing bacteria and reduce pustules and comedones.


Studies into the effects of antioxidants in the treatment of acne have not been widely enough accepted be prescribed by dermatologists. However, according to the Dermatological Times, there is evidence to suggest that the negative effects of oxidants can cause acne. Which is why they advise people with acne to look into including topical antioxidants in their acne treatments, particularly:

  • Vitamin C is a powerful and well-known antioxidant.
  • Vitamin B works as an anti-inflammatory for the skin.

Acne During Puberty

While acne can occur during adulthood, it remains mostly a problem for adolescents. During this time, the hormonal imbalances and increased stress of social adaptations cause many teens to experience bouts of acne. Teenage acne usually tends to last for about five years, generally disappearing in the early 20s. Although boys tend to have more severe cases of acne, acne affects both sexes.

Acne during adolescence tends to have a more serious effect on physiological health and thus perhaps more severely compromise a normal day-to-day life.


Appearance becomes especially important during adolescence. Dealing with visible skin problems, like acne, can be especially upsetting to some teenagers, causing low self-esteem. While most teenage acne can clear after a couple of years, having to deal with low self-esteem for that period can be devastating.

Seeking treatment with a dermatologist, even at earlier stages of acne, can help to be diligent about the treatment. Keeping regular appointments seem to make patients more likely to follow a prescribed treatment than self-medication.


Related to the issues of low self-esteem that acne can cause, depression is a real possible effect of acne. Especially in cases where acne is severe and persist for a long time frame. It is therefore advisable, not only to seek treatment by a dermatologist as soon as possible but also to keep an eye out for signs of depression.


Most teenagers experience a lot of pressure, due to either social relationships, performance anxiety or other issues. Stress causes the body to react by releasing hormones, which in turn can make acne more severe.

Acne During Pregnancy

Acne is quite common during pregnancy. It seems that as many as 50% of pregnant women develop acne, some even severe acne. The primary cause of acne during pregnancy is the increased androgen (hormone) levels during the first trimester. In most cases, pregnancy acne is of low severity and tends to subside once hormone levels return to normal.

During pregnancy, it is safest to stay away from medical acne treatments and choose drug-free home remedies instead. You could, for example, research changes to your diet and stick to the dermatologist lifestyle changes and tips.

If you are planning to get pregnant, you should inform your dermatologist before starting treatment. The dermatologist can then prescribe a combination of treatments that are safe to use in the case that you do get pregnant. Be especially careful when taking Isotretinoin.

If you are already following an acne treatment and you become pregnant, you should stop immediately with taking any medication and consult with your dermatologist before continuing any therapy.


Acne is a common condition that affects people in all walks of life. The severity of the acne can range from mild and cosmetic to severe and require medical acne treatments.

Now that you know more about the causes that can increase the risk of developing acne, how to determine the type of acne that you have and the possible treatments available you are better prepared to start living a life free or cured of acne.


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