What Do You Know about Acne?


What is Acne?

It is a skin condition that occurs when the skin’s hair follicles become clogged with dead skin cells and oil from the skin. It may also be referred to as acne vulgaris and is normally associated with hormonal fluctuations experienced during a person’s teenage years [1]. Propionibacteriaacnes is the bacterium responsible for inflamed acne breakouts.

Acne is more common in teenagers, although adults may also suffer from the condition.  About 17 million Americans have acne; making it one of the most common skin conditions among children and adults [1]. The American Academy of Dermatology reports that at any one time there may be as many as 50 million people in the United State who have acne [2].

What causes Acne?

Acne may arise from a number of factors. Four main factors cause acne:

  • Excess oil production
  • Hair follicles clogged by oil and dead skin cells
  • Bacteria
  • Excess activity of a type of hormone (androgens)

Other factors that may trigger or aggravate acne include hormones, medications, diet, and stress. Genetic composition is also thought to be the primary cause of acne in many cases.

Acne and Hormones

Excessive hormonal activities may trigger acne. Major hormones in this regard are androgens. Androgens are hormones that increase in boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy and the use of oral contraceptives also can affect sebum production. Low amounts of androgens circulate in the blood of women and can worsen acne [3].

During puberty, in both sexes, acne is often brought about by an increase in hormones such as testosterone. This causes greasy skin because it increases production of sebum, the oily substance secreted at the base of hairs to protect and lubricate the skin. A frequent factor is the excessive growth of the bacterium Propionibacterium acnes, which is normally present on the skin.

Acne and Stress

An increase in normal daily activities can lead to stress and this can worsen acne breakouts on the skin. Dermatologists posit that stress can make acne worse. However, engaging in stressful activities will not cause acne. When you already have acne and you get into a stressful situation,  your acne really flares up.

In other words, emotional stress will not trigger a new case of acne, but it may worsen matters in someone who already has the skin disorder [4].

When a person who has acne engages in stressful activities, their body produces more oil that clogs the hair follicles and allows acnevulgaris to form.

Acne and Diet

Studies indicate that certain dietary factors, including skim milk and carbohydrate-rich foods such as bread, bagels, and chips may worsen acne [5]. However, unlike the popular belief, eating greasy food has little or no effect on acne. Working in a greasy environment, on the other hand, may cause acne. This is because the oil from the environment may stick to your skin and block the hair follicles; causing acne to develop.

Taking medicines that contain corticosteroids, testosterone or lithium may lead to acne or worsen acne conditions. Friction or pressure from electronic devices like your cellular phones plus clothing materials and other materials like helmets can cause acne breakouts on the skin.

What about increased calories?


Increased body calories are often rumored to be major causes of acne. However, although an increase in body calories increases the body’s secretion of androgens; which results in increased secretion of skin oil, research has shown that obesity and an increased body mass index; which are conditions that arise from extra calories, do not exactly correlate with acne.


There are many speculations surrounding acne and its causes. One of such is the belief that acne is caused by a dirty skin. Acne is not caused by a dirty skin. In fact, scrubbing the skin too hard or using hard soaps can cause skin irritation.

In addition, cosmetics do not necessarily worsen acne unless you use oil make up that clog the skin’s pores (noncomedogenics). Also, non-oily cosmetics do not interfere with the effectiveness of acne drugs [6].

Where does acne appear?

Acne usually appears on the face, forehead, chest, upper back and shoulders. Typically, It affects areas of the skin with a relatively high number of oil glands. For teenagers, the most common area is the face. This is because there are a lot of sebaceous glands in the face [7].

What really happens?

The development of an acne breakdown is a gradual process. It is an extended process that begins at the cellular level [8]. All acne begin as a blockage of the skin pore. This blockage occurs within the hair follicles and sebaceous glands. In acne-prone skin, sebum and dead skin cells easily become trapped within the follicle. This accumulation of cellular debris and sebaceous material forms a hard plug that obstructs the pore’s openings. This obstruction is called a comedo and it manifests itself as a non-inflamed bump or blackhead on the skin’s surface [8].

When a comedo blocks the pore opening, it creates an environment that lacks oxygen within the follicle. This anaerobic environment, along with excess sebum within the pore, creates a favorable environment where Propionibacteria acnes bacteria can thrive.

As the follicle becomes filled with sebum, dead cells, and bacteria, it begins to swell. The follicle wall ruptures and spills into the dermis. White blood cells rush in to fight the bacteria. Redness and swelling occur, and pus is created. An acne is now formed [8].

Types of acne

Six types of acne may be identified based on how they appear. These are :

  • Whiteheads
  • Blackheads
  • Papules
  • Pustules
  • Nodules
  • Cyst Acne

 What are whiteheads?

They are caused by closed plugged skin holes. Whiteheads are a mild form of acne that appears as small, round, white bumps on the skin’s surface [10]. This type of acne occurs when a pore becomes clogged with sebum, dead skin cells, and debris. If this clogged pore is covered with a thin layer of skin, it appears white on its surface. Whiteheads may appear on the face, shoulders, neck, chest, and back [10]. Whiteheads can range in size, sometimes being so small they are virtually invisible or growing larger into noticeable acne blemishes.

They may be caused by hormonal changes, puberty or stress.

Luckily, whiteheads are a mild form of acne and are easy to treat.


Blackheads are caused by your skin producing too much oil which turns dark when exposed to air. Contrary to popular belief, they do not consist of trapped dirt or grime. They tend to appear when hormones lead to the increased production of sebum, an oily substance, by the glands under the skin.

Blackheads appear more frequently on the face, back, chest and arms. There are more hair follicles in these areas.

Papules and Pustules

They are moderate types of acne. Papules and pustules are the moderately severe form of acne in which the pimples are painful. In the case of pustules, the pimples are filled with liquid pus [11]. Papules usually appear like red bumps, raised over the surface of the skin. The bacterial growth inside the acne makes them infectious and painful.

Papules and pustules usually occur together. It is actually the papules that gradually turn into pustules. When papules get filled with liquid pus, they take the form of blisters termed as pustules. Pustules can be easily differentiated from the papules by their appearance. Pustules appear to be small raised spots that have a whitish or yellowish appearance.


Acne nodules remain intact, deep under the skin. Nodular acne may also be skin toned. Nodules may persist for weeks or even month as a result of their contents hardening into deep and stubborn cysts.

Cyst Acne

Cystic acne is the most severe forms of acne in which the pimples are accompanied with cyst formation. These pimples are big and deep and often leave marks on the skin [11].

How can you treat acne?

Treatment for acne varies depending on how serious it is.The most common forms of treatment are oral medications, topical medications, and therapies. Whiteheads and blackheads can be treated with simple over the counter creams that contain benzoyl peroxide. Prescription medication that can be used to treat acne include: topical retinoid, topical antibiotics, and azelaic acids. In addition, visiting a dermatologist can help you control your acne, prevent scarring or damage to the skin and make scars less noticeable.

Acne medications work by reducing the production of sebum in the skin, fighting bacteria and reducing inflammations.

Oral medications

Oral medications can be used for moderate to severe acne. You may need oral antibiotics to reduce bacteria and fight inflammation. A common antibiotic used for treating acne is tetracycline. Oral antibiotics should be used for the shortest time possible to prevent antibiotic resistance.

Using antibiotics may result in side effects like dizziness or increased skin sensitivity.

Combined oral contraceptive and anti-androgen agents may also be used for acne treatment. Anti-androgen agents may be used for teenage girls. They work by reducing the effect of the androgen hormones on the sebaceous glands.

Acne treatment

Topical medications

Common topical medications include retinoid and azelaic acids. Retinoid comes as cream and gel and is derived from vitamin A. It works by plugging off the hair of the follicles.

Azelaic acid is a naturally occurring acid that is found in grains and whole wheat. It is an effective option especially for women who are breastfeeding.


Lasers, chemical peels and extraction of whiteheads may be suggested in extreme acne cases. Your doctor may use special tools to remove the whiteheads that have not cleared with topical medications. Steroid injections may also be used to treat nodular and cyst acnes.



Getting treatment for acne is possible and easy. Knowing the type of acne you have is key to getting the best treatment.

It is also important to be patient with your acne treatment — know that while some treatments may work immediately for some friends, they may take some time with you.

With the right treatment and patience, your days of acne and acne breakouts will be over soon.

Acne: Before and After


[1] ‘Hormonal Acne – Causes, types and treatments.’ Available: https://www.medicalnewstoday.com/articles/313084.php

[2] ‘ What causes Acne?’ Available: https://www.bioclarity.com/pages/what-causes-acne

[3] ‘Acne- Symptom and Causes.’ Available: https://www.mayoclinic.org/diseases-conditions/acne/symptoms-causes/syc-20368047

[4] ‘How Stress Affects Acne.’ Available: https://www.webmd.com/skin-problems-and-treatments/acne/features/stress-and-acne

[5] ‘Acne.’ Available: https://www.slideshare.net/mobile/xoxoxoAngelique/acne-28897861

[6] ‘Acne Treatment and Medication for Pimples and Blackheads.’ Available: https://www.webmd.com/skin-problems-and-treatments/acne/understanding-acne-treatment

[7] ‘ Sebaceous Cyst’. Available: https://www.healthline.com/health/sebaceous-cyst

[8] ‘How Do Acne Breakouts Develop?’ Available: https://www.verywell.com/what-causes-a-pimple-15484

[9] ‘ Types of Acne with Pictures – Mild, moderate and severe.’ Available: htttps://www.ehealthstar.com

[10] ‘ What Are Whiteheads?’ Available: https://www.bioclarity.com/pages/what-are-whiteheads

[11] ‘Types of Acne Pimples.’ Available: http://theacneproject.com/types-of-acne-pimples-07/

[12] ‘ Can Acne Scars be treated completely?’ Available: www.quora.com