Acne is a common skin condition that affects most people at some point. It causes spots to develop on the skin, usually on the face, back and chest.
- The spots can range from surface blackheads and whiteheads – which are often mild – to deep, inflamed, pus-filled pustules and cysts, which can be severe and long-lasting and lead to scarring.
- Acne is most commonly linked to the changes in hormone levels during puberty, but can start at any age.
- It affects the grease-producing glands next to the hair follicles in the skin. Certain hormones cause these glands to produce larger amounts of oil (abnormal sebum).
- This abnormal sebum changes the activity of a usually harmless skin bacterium called P. acnes, which becomes more aggressive and causes inflammation and pus.
- The hormones also thicken the inner lining of the hair follicle, causing blockage of the pores (opening of the hair follicles). Cleaning the skin does not help remove this blockage.
- Acne is known to run in families. If both your mother and father had acne, it is likely that you will also have acne.
- Hormonal changes, such as those that occur during the menstrual cycle or pregnancy, can also lead to episodes of acne in women.
- There is no evidence that diet, poor hygiene or sexual activity play a role in acne.
Who is affected?
- Acne is very common in teenagers and younger adults. About 80% of people between the ages of 11 and 30 will be affected by acne.
- Acne is most common between the ages of 14 and 17 in girls, and boys between 16 and 19.
- Most people have acne on and off for several years before their symptoms start to improve as they get older. Acne often disappears when a person is in their mid-twenties.
- In some cases, acne can continue into adult life. About 5% of women and 1% of men have acne over the age of 25.
Causes of acne
- Acne is caused when tiny holes in the skin, known as hair follicles, become blocked.
- Sebaceous glands are tiny glands found near the surface of your skin. The glands are attached to hair follicles, which are small holes in your skin that an individual hair grows out of.
- Sebaceous glands lubricate the hair and the skin to stop it drying out. They do this by producing an oily substance called sebum.
- In acne, the glands begin to produce too much sebum. The excess sebum mixes with dead skin cells and both substances form a plug in the follicle.
- If the plugged follicle is close to the surface of the skin, it will bulge outwards, creating a whitehead. Alternatively, the plugged follicle can be open to the skin, creating a blackhead.
- Normally harmless bacteria that live on the skin can then contaminate and infect the plugged follicles, causing papules, pustules, nodules or cysts.
Acne causes spots and oily skin, and sometimes skin that is hot or painful to touch.
Acne most commonly develops on:
- The face – this affects almost everyone with acne
- The back – this affects more than half of people with acne
- The chest – this affects about 15% of people with acne
There are six main types of spot caused by acne:
- Blackheads – small black or yellowish bumps that develop on the skin; they are not filled with dirt but are black because the inner lining of the hair follicle produces pigmentation (colouring)
- Whiteheads – have a similar appearance to blackheads, but they can be firmer and will not empty when squeezed
- Papules – small red bumps that may feel tender or sore
- Pustules – similar to papules, but have a white tip in the centre that is caused by a build-up of pus
- Nodules – large hard lumps that build up beneath the surface of the skin and can be painful
- Cysts – the most severe type of spot caused by acne; they are large pus-filled lumps that look similar to boils and carry the greatest risk of causing permanent scarring
What can I do if I have acne?
- Keeping your skin clean is important, but will not prevent new spots developing. Wash the affected area twice a day with a mild soap or cleanser, but do not scrub the skin too hard to avoid irritating it.
- If your skin is dry, use a moisturiser (emollient). Most of these are now tested so they don’t cause spots (non-comedogenic).
- Although acne can’t be cured, it can be controlled with treatment. Several creams, lotions and gels for treating spots are available at pharmacies.
- If you develop acne, it’s a good idea to speak to your pharmacist for advice. Products containing a low concentration of benzoyl peroxide may be recommended, but be careful as this can bleach clothing.
- If your acne is severe or appears on your chest and back, it may need to be treated with antibiotics or stronger creams that are only available on prescription, speak to your practitioner to arrange a consultation.
Things you can try
Some self-help techniques may also be useful:
- Do not wash affected areas of skin more than twice a day. Frequent washing can irritate the skin and make symptoms worse.
- Wash the affected area with a mild soap or cleanser and lukewarm water. Very hot or cold water can make acne worse.
- Don’t try to “clean out” blackheads or squeeze spots. This can make them worse and cause permanent scarring.
- Avoid using too much make-up and cosmetics. Use water-based products that are described as non-comedogenic (this means the product is less likely to block the pores in your skin).
- Completely remove make-up before going to bed.
- If dry skin is a problem, use a fragrance-free, water-based emollient.
- Regular exercise cannot improve your acne, but it can boost your mood and improve your self-esteem. Shower as soon as possible once you finish exercising as sweat can irritate your acne.
- Wash your hair regularly and try to avoid letting your hair fall across your face.
Treatments can take up to three months to work, so don’t expect results overnight.
Treatments from your Practitioner
See your practitioner if your acne is more widespread – for example, you have a large number of papules and pustules, or over-the-counter medication hasn’t worked – as you probably need prescription medication.
Prescription medications that can be used to treat acne include:
- Topical retinoids
- Topical antibiotics
- Azelaic acid
- Antibiotic tablets
- In women, the combined oral contraceptive pill (GP only)
- Isotretinoin tablets(GP only)
If you have severe acne, such as a large number of papules and pustules on your chest and back as well as your face, or if you have painful nodules, your GP can refer you to an expert in treating skin conditions (dermatologist)
Your GP or practitioner will be able to diagnose acne by looking at your skin. This will involve examining your face, chest and back for the different types of spot, such as blackheads or sore, red nodules.
How many spots you have and how painful and inflamed they are will help determine how severe your acne is. This is important in planning your treatment.
Four grades can be used to measure the severity of acne:
- Grade 1 (mild) – acne is mostly confined to whiteheads and blackheads, with just a few papules and pustules
- Grade 2 (moderate) – there are multiple papules and pustules, which are mostly confined to the face
- Grade 3 (moderately severe) – there is a large number of papules and pustules, as well as the occasional inflamed nodule, and the back and the chest are also affected by acne
- Grade 4 (severe) – there is a large number of large, painful pustules and nodules
Acne in women
If acne suddenly starts in adult women, it can be a sign of a hormonal imbalance, especially if is accompanied by other symptoms such as excessive body hair (hirsutism) and irregular or light periods.
The most common cause of hormonal imbalances in women is polycystic ovary syndrome.
Despite being one of the most widespread skin conditions, acne is also one of the most poorly understood. There are many myths and misconceptions about it:
- Acne is caused by a poor diet.” So far, research has not found any foods that cause acne. Eating a healthy, balanced diet is recommended because it is good for your heart and your health in general.
- Acne is caused by having dirty skin and poor hygiene.” Most of the biological reactions that trigger acne occur beneath the skin, not on the surface, so the cleanliness of your skin will have no effect on your acne. Washing your face more than twice a day could just aggravate your skin.
- Squeezing blackheads, whiteheads and spots is the best way to get rid of acne.” This could actually make symptoms worse and may leave you with scarring.
- Sexual activity can influence acne.” Having sex or masturbating will not make acne any better or worse.
- Sunbathing, sunbeds and sunlamps help improve the symptoms of acne.” There is no conclusive evidence that prolonged exposure to sunlight or using sunbeds or sunlamps can improve acne. Many medications used to treat acne can make your skin more sensitive to light, so exposure could cause painful damage to your skin, not to mention increase your risk of skin cancer.
- Acne is infectious.” You cannot pass acne on to other people.