Acne: causes, types of spots, treatment and self-care, a review

Acne is a skin condition. It is not dangerous, but it can be painful, can leave marks and can affect how people feel about themselves. This article explains what acne is, what can set it off and how it is managed, using information from the NHS and MedlinePlus.

1. Introduction

Acne is a skin condition that causes spots, most often on the face, neck, chest, back and shoulders. The NHS describes it as ranging from a few spots to deep, painful lumps ^[1]. MedlinePlus, the health information service of the US National Library of Medicine, notes that anyone can get acne, but it is especially common in teenagers and young adults ^[2]. It is not usually serious, although it can cause scars ^[2].

2. What causes acne

Each pore in the skin opens into a hair follicle, which holds a hair and a small oil gland. When oil and dead skin cells mix and block the follicle, a plug forms. Bacteria that live on the skin can multiply inside the plug, and the body reacts with redness, swelling and pus ^{[1, 3]}.

Several things can make acne more likely or worse ^{[1, 3]}:

• Hormone changes, such as those in puberty, around periods, in pregnancy and at the menopause
• Some medicines, including certain steroids and hormone treatments
• Greasy or oily make-up, skin products or hair products
• Heavy sweating, humid weather, and frequent touching or rubbing of the skin
• A family history, because acne tends to run in families ^[3]
• Related conditions such as rosacea (a skin condition causing facial redness), or hormone conditions such as polycystic ovary syndrome ^[1]

MedlinePlus says stress does not cause acne but may make it worse ^[2].

Myths about acne

Many people think acne comes from dirty skin or from eating chocolate or greasy food. MedlinePlus states that dirty skin does not cause blackheads or pimples and that there is little evidence that food has much effect on acne for most people ^[2]. The encyclopedia entry adds that a link with refined sugar or dairy foods is still debated ^[3]. Scrubbing hard does not help and can irritate the skin ^[1].

3. Types of spots and symptoms

The NHS lists the following kinds of spots ^[1]:

• Blackheads: black or brown spots, usually flat but sometimes raised.
• Whiteheads: small bumps the same colour as the skin.
• Papules: small raised red or pink bumps, which may look brown or purple on darker skin.
• Pustules: raised bumps that contain pus.
• Nodules and cysts: larger, deeper lumps that can be painful and may join together.

Acne can also make skin feel hot or sore and can leave marks or scars after spots heal ^[1]. In some people, severe acne is linked with low mood, anxiety or low self-esteem ^{[1, 3]}.

4. Diagnosis

Doctors usually recognise acne by looking at the skin, and tests are normally not needed. MedlinePlus says a swab to grow bacteria may be taken in certain patterns or if large pus-filled bumps keep coming back ^[3].

5. Self-care

Gentle habits are the foundation of acne care. The NHS suggests ^[1]:

1. Wash the affected skin twice a day with a gentle cleanser.
2. Remove make-up before going to bed.
3. Choose skin and make-up products labelled non-comedogenic, which means they are less likely to block pores.
4. Wear loose, breathable clothing if you have acne on the body, especially when sweating.
5. Avoid picking or squeezing spots, because this can cause scarring.

MedlinePlus also advises avoiding tight hats and frequent touching of the face, and washing after exercise ^[3]. The encyclopedia notes that short sun exposure may slightly improve acne, but tanning is not recommended because of the risk of skin ageing and skin cancer ^[3].

6. Treatment options

A pharmacist can advise on products sold without a prescription. The NHS and MedlinePlus mention ingredients such as benzoyl peroxide and salicylic acid, which can cause dryness or peeling ^{[1, 3]}. If these do not help, a doctor may prescribe treatment from one or more of these groups ^{[1, 3]}:

• Skin treatments containing vitamin A related substances (retinoids)
• Antibiotic creams or tablets, which reduce the bacteria and inflammation
• Hormone-based treatments for some women whose acne is linked to hormones
• A stronger vitamin A related tablet for severe or scarring acne, which needs close monitoring and regular blood tests

MedlinePlus warns that one of these tablets causes serious birth defects and must not be used in pregnancy, so anyone who is or could become pregnant needs careful medical guidance ^[3]. Procedures such as chemical peels or draining a large cyst may be offered in some cases ^[3].

Treatment often takes six to eight weeks to show a benefit, and flare-ups can happen ^[3]. Acne often settles after the teenage years but can continue into middle age ^[3].

7. Special groups

Acne can affect babies too. MedlinePlus advises seeing a provider if a baby's acne has not cleared within three months ^[3]. Acne can be linked to hormone changes such as periods and pregnancy, and the NHS names polycystic ovary syndrome as a related condition ^{[1, 3]}.

8. When to see a doctor

The NHS advises seeing a GP, which means a family doctor, if ^[1]:

• self-care is not improving your acne
• you have many spots, or spots are deep, painful or leaving scars
• the skin looks hot, swollen or red, which may mean infection (redness can be harder to see on brown and black skin)
• acne is affecting your mental health

MedlinePlus suggests seeking advice if home care and non-prescription products have not helped after several months ^[3]. Your doctor may start treatment or refer you to a dermatologist, a doctor who specialises in skin.

In an emergency, call your local emergency number (112 in India, 911 in the United States).

9. Conclusion

Acne is caused by blocked hair follicles, not by dirty skin, and many everyday myths about food and washing are not supported by evidence. Gentle skin care, avoiding picking and early medical advice can help limit scarring and distress. Because treatments differ in safety, especially in pregnancy, your doctor decides what is right for you, and you should tell your doctor about every product and medicine you use.